Background
Methods
Search strategy
Inclusion and exclusion criteria
Study selection and quality appraisal
Data extraction and classification
Source | Year | Country | Design | Population | Setting | N | Outcome |
---|---|---|---|---|---|---|---|
Aloisis | 2002 | Italy | Longitudinal | HIV + adults | Clinic | 366 | Adherence |
Bardford | 2005 | Denmark | Cross sectional | HIV + adults | Clinic | 887 | Adherence |
Boyer | 2011 | Cameroon | Cross sectional | HIV + adults | Clinic | 2,381 | Adherence |
Carlucci | 2008 | Zambia | Cross sectional | HIV + adults | clinic | 424 | Adherence |
Charurat | 2010 | Nigeria | Longitudinal | HIV + adults | Clinic | 4,529 | Adherence |
Cunningham | 1999 | USA | Longitudinal | HIV + adults | Clinic | 2,864 | Initiation ART |
de Castilho | 2006 | Brazil | Longitudinal | HIV + adults | Clinic | 498 | Adherence |
Franke | 2011 | Peru | Longitudinal | HIV + adults | Clinic | 132 | Adherence |
Gebo | 2003 | USA | Cross sectional | HIV + adults | Clinic | 196 | Adherence |
Giday | 2010 | Ethiopia | Cross sectional | HIV + adults | Clinic | 510 | Adherence |
Grierson | 2011 | Australia | Cross sectional | HIV + adults | Clinic | 1,106 | Adherence |
Holmes | 2007 | USA | Longitudinal | HIV + adults | Clinic | 116 | Adherence |
Karcher | 2007 | Kenya | Longitudinal | HIV + adults | Clinic | 159 | Initiation ART |
Koku | 2011 | Ghana | Cross sectional | Female 15-49 | Community | 3,766 | HIV testing |
Kranzer | 2010 | South Africa | Longitudinal | HIV + adults | Clinic | 1,154 | Defaulting |
Kranzer_b | 2008 | Malawi | Cross sectional | People 18-59 | Community | 2,047 | HIV testing |
Li | 2010 | Thailand | Cross sectional | HIV + adults | Clinic | 386 | Adherence |
MacPhail | 2009 | South Africa | Cross sectional | People 15-24 | Community | 7,655 | HIV testing |
Martinez | 2008 | Uganda | Cross sectional | HIV + adults | Clinic | 421 | Initiation ART |
Mugavero | 2006 | USA | Cross sectional | HIV + adults | Clinic | 611 | Adherence |
Nam | 2010 | Vietnam | Cross sectional | HIV + adults | Clinic | 353 | Initiation ART |
Okonsy | 2011 | USA | Cross sectional | HIV + adults | Clinic | 558 | Adherence |
Peltzer | 2011 | South Africa | Cross sectional | HIV + adults | Clinic | 735 | Adherence |
Pettifor | 2010 | South Africa | Cross sectional | People over 15 years old | Community | 198 | HIV testing |
Pinheiro | 2002 | Brazil | Cross sectional | HIV + adults | Clinic | 195 | Adherence |
Remien | 2007 | Brazil | Cross sectional | HIV + adults | Clinic | 200 | Adherence |
Rintamaki | 2006 | USA | Cross sectional | HIV + adults | Clinic | 204 | Adherence |
Sambisa | 2010 | Zimbabwe | Cross sectional | People over 15 years old | Community | 12,254 | HIV testing |
Sarna | 2008 | India | Cross sectional | HIV + adults | Clinic | 310 | Adherence |
Sayles | 2006 | USA | Longitudinal | HIV + adults | Clinic | 1,910 | Adherence |
Sayles | 2009 | USA | Cross sectional | HIV + adults | Clinic | 202 | Adherence |
Van Servellen | 2005 | USA | Cross sectional | HIV + adults | Clinic | 85 | Adherence |
Wang | 2007 | China | Cross sectional | HIV + adults | Clinic | 181 | Adherence |
Watt | 2009 | Tanzania | Cross sectional | HIV + adults | Clinic | 340 | Adherence |
Country group | Source | Clinical | Disclosure | Location | Violence | Risk behavior | Health system | Health Beliefs | Psychosocial | Social support | SES | Stigma |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Low and low middle income countries
| Boyer | x | . | . | . | x | x | . | . | x | x | x |
Carlucci | x | . | . | . | . | x | . | . | . | . | x | |
Charurat | x | x | . | . | . | x | . | . | . | x | . | |
Franke | x | . | . | . | x | . | . | x | x | x | x | |
Giday | x | . | . | . | x | . | . | . | x | x | . | |
Karcher | x | . | . | . | . | . | . | . | . | . | . | |
Koku | . | . | . | . | x | . | x | x | . | x | x | |
Martinez | x | . | . | . | x | . | . | x | . | . | . | |
Nam | x | x | . | . | x | x | . | . | x | x | . | |
Sarna | x | . | . | . | . | x | . | x | . | x | . | |
Watt | . | . | . | . | . | x | . | x | . | . | . | |
Kranzer_b | . | . | x | . | . | . | . | . | . | x | . | |
Sambisa | . | . | . | . | x | . | x | . | . | x | x | |
High and upper middle income countries
| Aloisis | x | . | . | . | x | . | . | . | . | . | . |
Bardford | x | . | . | . | x | x | . | x | x | . | . | |
Cunningham | . | . | . | . | . | . | . | x | . | x | . | |
De Castilho | x | . | . | . | x | . | . | x | . | . | . | |
Gebo | . | . | . | . | x | . | x | . | x | x | . | |
Grierson | x | . | . | . | x | x | x | x | . | . | x | |
Holmes | . | . | . | . | x | . | . | . | . | x | . | |
Kranzer | x | . | . | . | . | . | . | . | . | . | . | |
Li | x | x | . | . | . | x | . | x | x | x | x | |
Mugavero | . | . | . | . | x | . | . | x | . | x | . | |
Okonsy | x | . | . | . | . | . | . | . | x | . | . | |
Peltzer | x | . | . | . | x | . | . | x | x | x | x | |
Pettifor | x | x | . | . | . | x | x | . | . | . | x | |
Pinheiro | x | . | . | . | . | . | . | . | . | x | . | |
Remien | x | . | . | . | . | . | . | x | . | . | . | |
Rintamaki | x | . | . | . | . | . | . | . | . | . | x | |
Sayles _a | . | . | . | . | . | . | . | x | . | . | x | |
Sayles_b | x | . | . | x | x | . | . | x | . | x | . | |
Vanservellen | x | . | . | . | . | x | x | x | x | . | . | |
Wang | x | . | . | . | . | x | . | . | . | . | . | |
Mc Phail | x | x | . | . | x | . | x | . | . | . | x |
Statistical analysis
Results
Study selection
Study characteristics
Factors measured by quantitative surveys to study access to HIV/AIDS-care in high- and low-income countries
Low income countries | High income countries | ||||
---|---|---|---|---|---|
Rank | % | Rank | % | ||
1 |
Socio-demographic factors
|
92%
|
1
|
Clinical factors
|
76%
|
2 |
Clinical factors
|
69%
|
2
|
Socio-demographic factors
|
52%
|
3 |
Socio-economic factors
|
69%
|
3
|
Psychosocial factors
|
52%
|
4 |
Health behavior factors
|
54%
|
4
|
Health behavior factors
|
48%
|
5 |
Health system factors
|
46%
|
5
|
Socio-economic factors
|
38%
|
6 | Psychosocial factors | 38% | 6 | Stigma and discrimination | 33% |
7 | Stigma and discrimination | 38% | 7 | Health system factors | 29% |
8 | Social and family support | 31% | 8 | Social and family support | 29% |
9 | Knowledge and beliefs | 15% | 9 | Knowledge and beliefs | 24% |
10 | Communication and disclosure | 15% | 10 | Communication and disclosure | 14% |
11 | Community characteristics | 8% | 11 | Domestic Violence | 5% |
12 | Domestic Violence | 0% | 12 | Community characteristics | 0% |
Reported risk factors significantly associated with access to HIV/AIDS services across countries
Reported protective factors significantly associated with access to HIV/AIDS services across countries
Combined effect sizes associated with adherence
Socio-demographic | Pool ES | CI 95% | p value* | Pool studies | I2
|
---|---|---|---|---|---|
Male
| 0.77 | 0.48-1.24 | 0.28 | 7 | 61.3% |
High income countries | 0.94 | 0.57-1.55 | 0.81 | 4 | 54.6% |
Low income countries |
0.16
|
0.04-0.66
|
0.01
| 3 | 0.0% |
Female
| 1.05 | 0.97-1.13 | 0.27 | 7 | 49.1% |
High income countries |
1.29
|
1.06-1.58
|
0.01
| 4 | 34.6% |
Low income countries | 0.99 | 0.91-1.08 | 0.85 | 3 | 0.0% |
Married
| 1.10 | 0.85-1.42 | 0.46 | 2 | 0.0% |
High income countries | 1.10 | 0.84-1.45 | 0.49 | 1 | - |
Low income countries | 1.10 | 0.56-2.16 | 0.78 | 1 | - |
Single
|
2.49
|
1.51-4.12
|
0.00
| 3 | 0.0% |
High income countries | 1.53 | 0.42-5.56 | 0.52 | 1 | - |
Low income countries |
2.72
|
1.58-4.69
|
0.00
| 2 | - |
Separated/divorced
| - | - |
-
| - | - |
High income countries | - | - |
-
| - | - |
Low income countries | 1.07 | 0.42-2.73 | 0.89 | 2 | 0.0% |
Age less than 20
| 1.14 | 0.96-1.37 | 0.14 | 2 | 60.1% |
High income countries | 0.47 | 0.96-1.37 | 0.13 | 1 | - |
Low income countries |
1.18
|
0.98-1.42
|
0.08
| 1 | - |
Age less than 30
|
1.04
|
1.01-1.07
|
0.01
| 2 | 0.0% |
High income countries | - | - |
-
| - | - |
Low income countries |
1.04
|
1.01-1.07
|
0.01
| 2 | 0.0% |
Age 20-30
|
1.38
|
1.21-1.58
|
0.00
| 5 | 60.2% |
High income countries | 1.30 | 0.86-1.94 | 0.21 | 3 | 20.2% |
Low income countries |
1.39
|
1.21-1.60
|
0.00
| 2 | 74.0% |
Age 30-50
| 1.08 | 0.97-1.19 | 0.16 | 6 | 0.0% |
High income countries | 1.06 | 0.77-1.46 | 0.72 | 4 | 0.2% |
Low income countries | 1.08 | 0.97-1.20 | 0.17 | 2 | 0.0% |
Age over 50 years
| 0.80 | 0.59-1.08 | 0.14 | 5 | 59.4% |
High income countries |
0.55
|
0.41-0.75
|
0.00
| 4 | 0.0% |
Low income countries |
6.68
|
3.15-14.15
|
0.00
| 1 | - |
No education
|
1.76
|
1.19-2.60
|
0.01
| 3 | 0.0% |
High income countries | 1.69 | 0.82-3.48 | 0.16 | 1 | - |
Low income countries |
1.78
|
1.12-2.85
|
0.02
| 2 | 0.0% |
Primary education
| 0.98 | 0.85-1.13 | 0.80 | 4 | 9.3% |
High income countries | 0.99 | 0.86-1.15 | 0.91 | 3 | 0.0% |
Low income countries | 0.30 | 0.06-1.49 | 0.14 | 1 | - |
Secondary education
| 1.04 | 0.95-1.14 | 0.43 | 10 | 60.4% |
High income countries | 1.03 | 0.95-1.28 | 0.75 | 6 | 73.7% |
Low income countries | 1.04 | 0.94-1.15 | 0.47 | 4 | 19.8% |
Tertiary education
| 0.85 | 0.58-1.24 | 0.39 | 3 | 60.9% |
High income countries | 0.69 | 0.45-1.07 | 0.10 | 2 | 44.8% |
Low income countries | 1.56 | 0.73-3.34 | 0.25 | 1 | - |
Socio-cultural | Pool ES | CI 95% | p value* | Pool studies | I2
|
---|---|---|---|---|---|
Low self-efficacy
| 1.025 | 0.57-1.85 | 0.94 | 3 | 63.1% |
High income countries |
2.13
|
1.03-4.41
|
0.01
| 2 | 0.0% |
Low income countries |
1.75
|
1.91-1.31
|
0.04
| 1 | - |
Lack of social support
| |||||
High income countries |
1.04
|
1.01-1.08
|
0.02
| 2 | 0.0% |
Low income countries | - | - |
-
| - | - |
No depression
|
0.89
|
0.83-0.96
|
0.00
| 2 | 0.0% |
High income countries | 0.92 | 0.82-1.04 | 0.17 | 1 | - |
Low income countries |
0.88
|
0.80-0.96
|
0.01
| 1 | - |
Stigma
|
2.17
|
1.52-3.09
|
0.00
| 2 | 62.1% |
High income countries | 3.70 |
1.92-7.42
|
0.00
| 1 | - |
Low income countries | 1.74 |
1.14-2.65
|
0.01
| 1 | - |
Abuse of alcohol
|
1.75
|
1.41-2.18
|
0.00
| 6 | 59.8% |
High income countries |
1.43
|
1.09-1.86
|
0.01
| 4 | 24.0% |
Low income countries |
2.72
|
1.84-1.69
|
0.00
| 2 | 32.7% |
Abuse of drugs
|
1.86
|
1.48-2.33
|
0.01
| 9 | 1.1% |
High income countries |
1.89
|
1.49-2.41
|
0.00
| 6 | 23.2% |
Low income countries | 1.58 | 0.78-3.22 | 0.21 | 3 | 0.0% |
Discussion
Source | Year | Country | Outcome | Measurement instrument |
---|---|---|---|---|
Family support
| ||||
Boyer | 2011 | LIC | Adherence | Self-reported |
Bardford | 2005 | HIC | Non adherence | Self-reported |
Li | 2010 | HIC | Adherence | Adapted from FAD |
Social support
| ||||
Vanservellen | 2005 | HIC | Adherence | MOS scale |
Li | 2010 | HIC | Adherence | Adapted from MOS Scale |
Franke | 2011 | LIC | Adherence | Duke-UNC Functional Social Support Questionnaire |
Peltzer | 2010 | HIC | Adherence | Adapted Social Support Questionnaire |
Okonsy | 2011 | HIC | Adherence | Rates social support 1 to 10 |
Giday | 2010 | LIC | Adherence | Own questions |
Self-efficacy
| ||||
Franke | 2011 | LIC | Adherence | ACTG |
Remien | 2007 | HIC | Adherence | ACTG |
Vanservellen | 2005 | HIC | Adherence | ACTG |
Watt | 2009 | LIC | Adherence | 10 item scale adapted |
Depression
| ||||
Martinez | 2008 | LIC | Initiation ART | Hopkins Symptoms Checklist |
Franke | 2011 | LIC | Adherence | Hopkins Symptoms Checklist |
Peltzer | 2010 | HIC | Adherence | CES-D |
Vanservellen | 2005 | HIC | Adherence | CES-D |
Mugavero | 2006 | HIC | Adherence | BSI |
Sarna | 2008 | LIC | Adherence | BDI |
Bardford | 2005 | HIC | Non adherence | ACTG |
Li | 2010 | HIC | Adherence | Thai Department of Mental Health |
Source
| Year | Country | Outcome | Measurement instrument |
Patient-provider relationship
| ||||
Bardford
| 2005 | HIC | Non adherence | Self-reported |
Vanservellen
| 2005 | HIC | Adherence | Satisfaction survey |
Watt
| 2009 | LIC | Adherence | 9 item scale adapted from Panpanich 2004 |
Quality of life
| ||||
Franke
| 2011 | LIC | Adherence | Medical Outcomes Study HIV Health Survey |
Peltzer
| 2010 | HIC | Adherence | WHOQOL-HIVBREF |
Stigma
| ||||
Rintamaki
| 2006 | HIC | Adherence | 3 items from PMAQ |
Franke
| 2011 | LIC | Adherence | Berger Scale |
Carlucci
| 2011 | LIC | Adherence | Own scale |
Pettifor
| 2004 | HIC | HIV testing | Genberg scale |
Li
| 2010 | HIC | Adherence | Adapted from Herek and Capitanio |
Sayles _a
| 2009 | HIC | Adherence | Own scale |
Koku
| 2011 | LIC | HIV testing | 2003-GDHS |
Dicrimination
| ||||
Boyer
| 2011 | LIC | Adherence | Self reported |
Grierson
| 2011 | HIC | Adherence | Self reported |
Peltzer
| 2010 | HIC | Adherence | Own 7 items scale |
Pettifor
| 2004 | HIC | HIV testing | Genberg scale |