Summaries for consumers

Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS

People living with HIV/AIDS are required to achieve high levels of adherence to benefit from many antiretroviral regimens. This review identified 19 studies involving a total of 2,159 participants that evaluated an intervention intended to improve adherence. Ten of these studies demonstrated a beneficial effect of the intervention. We found that interventions targeting practical medication management skills, those administered to individuals vs groups, and those interventions delivered over 12 weeks or more were associated with improved adherence to antiretroviral therapy. We also found that interventions targeting marginalized populations such as women, Latinos, or patients with a past history of alcoholism were not successful at improving adherence. We did not find studies that evaluated the quality of the patient‐provider relationship or the clinical setting. Most studies had several methodological shortcomings.

Setting and organization of care for persons living with HIV/AIDS

Policy makers and health workers need evidence about how and where to provide care for people living with HIV/AIDS. This review identified 28 studies involving 39,776 study subjects that examined these questions. Centres with a lot of HIV/AIDS patients often had lower death rates. The number of patients needed to get these results was very different in each study so it is not clear what the right number is. Settings with case management had fewer deaths and had higher use of antiretroviral medications. There were several other promising interventions to increase antiretroviral use (using several health interventions at the same time and using computerized reminders), to reduce hospital admissions (using multiple health disciplines and increasing hours of operation), and reducing length of hospital stay (telephone notices and advice for providers). Unfortunately, the design of these studies, the small number of studies on each intervention and the lack of standard terms and definitions limits their usefulness to health providers and policy‐makers. This is especially true for developing countries as no studies were found from those settings.

Training, experience and volumes on outcomes for persons living with HIV/AIDS: A systematic review

The training and qualifications of providers treating patients with HIV/AIDS is very important. But equally important is an understanding of the impact of numbers of patients treated by providers on key medical outcomes (e.g. viral load measures, mortality, the receipt of anti‐retroviral medications, opportunistic infection (OI) prophylaxis as well as economic outcomes such as health care utilization or patient costs) in the care of persons living with HIV/AIDS. This systematic review examined studies from 1980‐2009 that identified both provider experience/qualifications as well as a volumes indicator (number of HIV/AIDS patients). Only four studies met the inclusion criteria for the final review. Given the varied methods of each study, a meta‐analysis was not possible.

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