Comparisons of Adherence to Antiretroviral Therapy in a High-Risk Population in China: A Systematic Review and Meta-Analysis.

Abstract

BACKGROUND:Reports on antiretroviral therapy (ART) adherence are scare in China; we performed this meta-analysis to estimate ART adherence rates in different populations at high risk for HIV transmission in China. METHODS:We searched PubMed, Chinese Biomedical Literature Database (Chinese), China National Knowledge Infrastructure (Chinese), and Wanfang (Chinese) to identify studies published from January 1985 to May 2015. We used random-effects meta-analysis to calculate weighted mean estimates across studies and 95% CIs. Data were pooled with proportions transformed prior to pooling using the Freeman-Tukey double arcsine transformation and then back transformed to the original scale. We calculated the I2 (and its 95% confidence intervals) and tau2 to assess between-study heterogeneity. RESULTS:We identified 36 eligible articles, including 6885 HIV-positive individuals, reporting ART adherence. Pooled analysis produced an estimate of 77.61% (95% CI = 71.63-83.08) of patients with HIV with adequate adherence; however, high heterogeneity was observed between studies (I2 = 96.60%, 95%CI = 96.00%-97.20%; tau2 = 0.16). Three studies, which included 149 old HIV-infected patients, reported the highest ART adequate adherence rate (89.39%, 95% CI = 72.01-99.26) with high heterogeneity between the studies (I2 = 86.20%, 95%CI = 60.00-95.20%; tau2 = 0.13). While, only two studies, which included 143 heterosexual transmission group (HTG) patients, reported the lowest ART adequate adherence rate (51.55%, 95% CI = 41.33-61.71) with low heterogeneity between the studies (I2 = 31.3%, tau2 = 0.007). In the multivariable meta-regression model, high-risk populations was the main factor explaining heterogeneity (variance explained 28.14%). CONCLUSIONS:ART adherence in some high-risk populations (e.g., heterosexual transmission group) is below the recommended levels for maintaining virologic suppression. It is crucial to develop comprehensive intervention strategies to promote ART adherence in high-risk populations and effectively prevent the spread of HIV/AIDS in China.