Investigators sought to identify positive and negative factors that influenced antiretroviral therapy (ART) uptake in integrated treatment programs for patients with human immunodeficiency virus (HIV) and tuberculosis (TB) co-infections in sub-Saharan Africa (SSA). Their analysis, published in AIDS Research and Therapy, found that staff capacity, medical supplies, stigma, income, and psychological support were frequently reported factors that indicated ART uptake success.
In short, “the recurrence of some specific system-level and patient-level determinants reveals key intervention points to improve ART uptake through integrated treatment programs in SSA,” said Benjamin Momo Kadia, MD, MSC, the lead author on the report.
A systematic review was performed on 27 studies, of which 23 estimated ART uptake and 10 assessed uptake barriers and enablers. Pooled estimates of ART uptake were calculated and a thematic approach was used to evaluate data on barriers and enablers.
Within the included studies, pooled ART uptake was 53% (95% CI 42–63%). Amongst socioeconomic and individual level ART uptake barriers, disease stigma, low income, and younger age group were most common. Limited staff capacity, medical supply shortage, lack of infrastructure, and poor adherence to or lack of treatment guidelines were the most frequent barriers observed at the health system level. Additionally, clinical barriers included anti-TB drug intolerance, fear of drug toxicity, and contraindications to ART.
Conversely, factors that facilitated ART uptake included efficient procurement and distribution, convenience and accessibility of treatment, strong staff capacity, and the availability of psychosocial support.
This study excluded grey literature and studies in non-English languages, which the report acknowledged may have limited the variety of barriers and enablers that were captured. Also, while the reviewers sought to improve uptake of integrated TB and HIV treatments, the analysis was limited to patients concurrently or later diagnosed with HIV and does not represent TB outcomes as a result.
Nonetheless, this study addressed a significant lack of data for ART uptake in integrated treatment for HIV and TB in SSA. Despite prior observations that integrated treatment programs in the region did not achieve high uptake in general, the authors noted that more recent studies displayed upwards trends and concluded that “this may indicate an overall improvement in ART uptake in recent times.”
Source: AIDS Research and Therapy