washington d.c., usa, 22-27 july 2012 adherence to haart and treatment outcomes in conflict-...
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Adherence to HAART and treatment outcomes in conflict-affected and forcibly displaced
populations: a systematic review
THPDE0205
J.B. Mendelsohn
P. Spiegel
M. Schilperoord
P.M. Njogu
D.A. Ross
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Background/Objective
• Optimal adherence (≥95% of tablets taken as prescribed) to HAART is required to achieve best outcomes
• Forcibly displaced populations may face actual or perceived challenges in maintaining optimal adherence and good outcomes
• Objective was to perform systematic review of the literature on adherence to HAART and treatment outcomes among conflict-affected and forcibly displaced populations
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Methods• MEDLINE, EMBASE, and Global Health
databases on OVID platform (1995-2011)• Terms included refugees, internally-
displaced, conflict-affected, forced migration
• Web of Science backwards citation review of work citing primary search results
• ReliefWeb and MSF websites searched for grey literature
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
ResultsOverall:• 297 records screened;17 reports identified (15 quantitative and 2
qualitative studies)• 94% (16/17) based in Sub-Saharan Africa• 56% (10/18) studied “conflict-affected” and/or internally-displaced
groups (one mixed group study counted twice)
Of quantitative studies:• 75% (11/15) were retrospective studies based on chart reviews• 40% (6/15) had a comparison group• 33% (5/15) included < 100 clients • 87-99.5% of clients were optimally adherent• Good treatment outcomes reported (variety of indicators used e.g.
CD4 changes, viral suppression, survival)
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Conclusions• Results to date are encouraging; but most
studies had relatively weak designs • Further studies are needed to support:
– HAART scale-up – Justifications for inclusion of conflict-affected/
forcibly-displaced groups in national treatment plans
• Need systematic and replicable measurement of adherence in future studies among these groups
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Acknowledgements
Daniel O’Brien, Ed Mills, Nathan Ford for helpful comments
Canadian Institutes of Health Research (Priority Announcement for HIV/AIDS)
The Parkes Foundation