P6.040 Health System Related Factors Associated with Adherence to Antiretroviral Therapy Amongst Adults Living with HIV/AIDS in Developing Countries: A Systematic Review

Abstract

Background: Although ART is one of the most celebrated treatment advances in the recent medical history, a large proportion of eligible people were not receiving ART and one fifth of patients who started ART were no longer in care/treatment after one year due to various reasons in low and middle-income countries. The objective of this study is to systematically review to identify the health system related factors associated to ART treatment adherence among adults living with HIV/AIDS in developing countries. Methods: Reviewer systematically searched MEDLINE and EMBASE databases (1996 to August 2011) and web-based information. The reference lists of included papers were also checked, with citation searching on key papers. The studies examining health system factors associated with ART treatment adherence were considered for inclusion. Quality assessment and data extraction were performed. Results: A total of 622 articles were identified, and 14 studies met the inclusion criteria, representing in 9 qualitative, 3 quantitative and 2 mixed methods and 11 countries out of 152 developing countries. Twenty-four health system themes were found associated to ART non adherence and 18 themes were found as facilitator for adherence. Author's conclusion: The identified health system factors, service providers including clinical team can use this information to engage in open discussion with patients and PLWHAs to promote ART treatment adherence and identify issues within their own health centres. Indeed, HIV patients from developing are found very sensitive in utilisation of health services not only on the amount/numbers of services they received, but also on time, cost, place, information and quality. Thus the responsibility of adherence shifts to the health service provider leaving patients with different choices and options.