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

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

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

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)

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

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