Implementation of therapeutic adherence in adult patients diagnosed with HIV. A Systematic Review

Bacground:In 2022, globally, 39 million people were living with HIV, with 1.3 million new infections reported (UNAIDS, 2024). In Italy, there were 5,900 new infections among adults in 2022 (UNAIDS, 2024). Merely 29.8 million individuals accessed antiretroviral therapy (ART) that year, and adherence rates ranged from 33% to 88% (Enriquez et al., 2014; Garofalo, 2015). Nonadherence to ART is costly, leading to drug resistance and transmission of resistant strains (Enriquez et al., 2014). ART, involving at least two or usually three antiretroviral drug classes, suppresses viral replication (Günthard et al., 2014). Despite its efficacy, challenges such as daily dosing, lifelong treatment, and side effects persist. This systematic review aims to comprehensively assess interventions promoting medication adherence among adult HIV patients and describe their impact on clinical and psychosocial outcomes. The central question addressed is: What interventions and strategies exist for medication adherence among adult HIV patients? Objective: The research objective is to systematically map and summarize available knowledge on interventions promoting medication adherence among adult HIV patients and to describe the state of the art regarding the impact of these interventions on clinical and psychosocial outcomes. Method: We will do a Systematic Review Data Source and Search Strategy: We will register the review in Prospero. We will utilize the following databases for our comprehensive search: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and Cochrane. We will employ keywords and Boolean operators in our research, and we will use the Covidence/Rayyan management review program. The review process, including the inclusion of cited articles, will be carried out by two researchers and a supervisor. Population: Adult patients diagnosed with HIV (≥ 18 years) Exposure: Interventions aimed at promoting medication adherence, encompassing various forms of patient education, counseling, support, health promotion, reminders, resource provision, supervision, and consultation. Outcome: Implementation of therapeutic adherence Study Design: Primary quantitative studies, including randomized controlled trials (RCTs), controlled clinical trials (CCTs), case-control studies, cohort studies, cross-sectional studies, controlled before-and-after studies, and interrupted time series. Inclusion Criteria: Randomized controlled trials, quasi-experimental studies (non-randomized controlled trials), and single-arm pre-test/post-test studies, comparative studies, cohort studies, cross-sectional studies focused on interventions or strategies to promote medical adherence in HIV adult patients as primary or secondary outcomes. Study published in English or Italian from 2014 to January 2024. Availability of abstracts. Exclusion Criteria: Pediatric patient. Systematic Reviews. Qualitative Study. Unpublished Study (e.g. conference abstract, trial protocol). Grey Literature.