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Adherence to HAART and treatment outcomes in conflict-affected and forcibly displaced populations: a systematic review T

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 . Background/Objective.

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Adherence to HAART and treatment outcomes in conflict-affected and forcibly displaced populations: a systematic review T

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  1. Adherence to HAART and treatment outcomes in conflict-affected and forcibly displaced populations: a systematic reviewTHPDE0205

    J.B. Mendelsohn P. Spiegel M. Schilperoord P.M. Njogu D.A. Ross
  2. 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
  3. 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
  4. Results Overall: 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)
  5. 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
  6. Acknowledgements Daniel O’Brien, Ed Mills, Nathan Ford for helpful comments Canadian Institutes of Health Research (Priority Announcement for HIV/AIDS) The Parkes Foundation
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