Adherence to antiretroviral therapy among HIV-1 patients from sub-Saharan Africa: a systematic review
Pedro R.S. Almeida 1, Carlos A.C. Rafael 2, Victor Pimentel 3, Ana B. Abecasis 3, Cruz S. Sebastião 4, Joana de Morais 5
1 Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola; 2 Maternidade Lucrécia Paim, Ministério da Saúde (MINSA), Luanda, Angola; 3 Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal; 4 Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal; Centro Nacional de Investigação Científica (CNIC), Luanda, Angola; Instituto Nacional de Investigação em Saúde, Luanda, Angola; Centro de Investigação em Saúde de Angola, Caxito, Angola; 5 Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola; Instituto Nacional de Investigação em Saúde, Luanda, Angola
*Correspondence: Ana B. Abecasis, Email not available
Abstract
More than two decades after introducing antiretroviral therapy (ART), several challenges still prevail in keeping well people living with HIV, even with “Test and Treat” and/or “Rapid Start of ART” initiatives, as well as the scale-up of ART worldwide to promote access and adherence to treatment. This review examined articles on ART adherence in Africa between 2016 and 2023, published in English and indexed in PubMed. A total of 16 articles out of 2415 were eligible and included for analyses. Overall, good ART adherence rates in sub-Saharan African (SSA) regions ranged from 43% to 84%. Rates in the center of the SSA region ranged from 58% to 80%, in the north from 50% to 83%, in the south from 77% to 84%, in the west from 43% to 60%, and in the east from 69% to 73%. Most African countries use self-reporting to assess treatment adherence, which is frequently unreliable. The main factors with negative influence on ART adherence were comorbidities, lack of motivation, socioeconomic difficulties, or side effects. Conclusion: Adherence to ART is a good indicator for controlling the spread of HIV in a given region. It is important to overcome the barriers that make it difficult to comply with ART and reinforce the factors that facilitate access to medication.
