"The findings from this systematic review and meta-analysis suggest that ART adherence among sub-Saharan African patients in early treatment programs are favorable, although it should be noted that the complexity of treatment regimens is potentially greater in North America, which should be considered when interpreting the data," the authors write.

The researchers add that the barriers to adherence among impoverished individuals in North America appear to be due to poor patient-clinician relationships, untreated depression, substance abuse, and other factors that are common among poor individuals in the North America setting rather than poverty itself.

"We have shown that there are patients in both settings that have suboptimal adherence and that factors beyond poverty play an important role. Clinicians should therefore proactively inquire with patients about current barriers or facilitators of adherence to HIV medications," they write.

"The findings of this analysis have important policy implications. First, the expectation of poor adherence in Africa is not an evidence-based rationale for delaying the expansion of ART programs in resource-poor settings. Second, given the average relatively high levels of adherence in resource-poor settings documented in this analysis, the focus (or priority) must now be to maintain these ART adherence rates by increasing access to affordable ART and establishing reliable drug supply and distribution networks from the pharmacy to the individual patient. Third, understanding culturally specific barriers to adherence will be important in developing evidence-based interventions targeted at the individuals with poor ART ad
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Contact: Susan Emigh
905-525-9140
JAMA and Archives Journals
8-Aug-2006