Barriers and facilitators to linkage, adherence and retention in care among HIV positive patients : an overview of qualitative systematic reviews using mega-aggregation framework synthesis

Hendricks, Lynn Avril (2019-04)

Thesis (MMed)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Background: People living with Human Immunodeficiency Virus (PLHIV) continue to struggle with the complexities related to having a chronic disease and integrating antiretroviral treatment (ART) and care into their daily lives. This overview aimed to assess existing evidence related to self-reported barriers and facilitators to linkage to ART, adherence to ART and retention in care for PLHIV and to identify gaps in the evidence. Methods: The novel pragmatic approach of mega-aggregation framework synthesis was developed, described and applied in this overview using Kaufman’s interpretation of the socio-ecological framework. We included qualitative systematic reviews, up to July 2018, and used a systematic and rigorous approach to select reviews and extract data. We assessed methodological quality using an amended version of the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews. Results: We included 33 systematic reviews, from low, middle and high income countries and included 1 111 964 HIV positive children and adults. Methodological quality varied considerably across reviews. Using the mega-aggregative framework approach, we found 544 unique third order concepts, from the included systematic reviews, and reclassified the third order concepts into 45 fourth order themes within the individual, interpersonal, community, institutional and structural levels of the Kaufman HIV Behaviour Change model. Our overview found that the main barriers and facilitators to linkage, adherence and retention such as psychosocial personal characteristics of perceptions of ART, desires, fears, experiences of HIV and ART, coping strategies and mental health, were interwoven with other factors on the interpersonal, community, institutional and structural level. Conclusions: High quality qualitative review level evidence on self-reported barriers and facilitators of linkage, adherence and retention in care is lacking for adults and even more so for children. Overviews are useful in the identification of evidence gaps to inform new review questions and researchers are encouraged to build on the method of mega-aggregative framework synthesis as the place of overviews become more prominent with the growing body of qualitative reviews. Systematic review registration: The protocol of this overview was registered on PROSPERO (CRD42017078155) on 17 December 2017.

AFRIKAANSE OPSOMMING : Agtergrond: Mense wat met 'n Menslike Immuniteitsgebreksvirus (HIV) leef, sukkel steeds met die kompleksiteite wat verband hou met 'n chroniese siekte en die integrasie van antiretrovirale behandeling (ART) en sorg vir hul daaglikse lewens. Hierdie oorsig was daarop gemik om bestaande bewyse wat verband hou met self-gerapporteerde hindernisse en fasiliteerders te evalueer om aan ART te koppel, aan te pas by ART en behoud in die sorg vir PLHIV en om gapings in die getuienis te identifiseer. Metodes: Die nuwe pragmatiese benadering van mega-aggregasie raamwerk sintese is ontwikkel, beskryf en toegepas in hierdie oorsig deur Kaufman se interpretasie van die sosio-ekologiese raamwerk te gebruik. Ons het tot en met Julie 2018 kwalitatiewe sistematiese oorsigte ingesluit, en gebruik 'n sistematiese en streng benadering om resensies te kies en data te onttrek. Ons het metodologiese kwaliteit geassesseer met 'n gewysigde weergawe van die Joanna Briggs Instituut se kritiese beoordelingskontrolelys vir sistematiese resensies. Resultate: Ons het 33 sistematiese resensies ingesluit, van lae-, middel- en hoëinkomste-lande en 1 111 964 HIV-positiewe kinders en volwassenes ingesluit. Metodologiese kwaliteit het aansienlik gewissel oor resensies. Deur die mega-aggregatiewe raamwerkbenadering te gebruik, het ons 544 unieke derde orde konsepte, uit die ingesluit sistematiese oorsigte, gekry en die derde orde konsepte in 45 vierde orde temas binne die individuele, interpersoonlike, gemeenskaps-, institusionele en strukturele vlakke van die Kaufman HIV Behvaiour Change Model herklassifiseer. Ons oorsig het bevind dat die vernaamste struikelblokke en fasiliteerders van koppeling, aanhouding en behoud, soos psigososiale persoonlike eienskappe van persepsies van kuns, begeertes, vrese, ervarings van MIV en KUNS, hanteringstrategieë en geestesgesondheid, met ander faktore op die interpersoonlike, gemeenskaps-, institusionele en strukturele vlak. Gevolgtrekkings: Hoë gehalte kwalitatiewe hersieningsvlakbewyse op selfversorgde struikelblokke en fasiliteerders van skakeling, handhawing en behoud in sorg, ontbreek aan volwassenes en selfs meer vir kinders. Oorsig is nuttig in die identifisering van getuienisgapings om nuwe hersieningsvrae in te lig. Navorsers word aangemoedig om voort te bou op die metode van mega-aggregatiewe raamwerk sintese, aangesien die plek van oorsigte meer prominent word met die groeiende liggaam van kwalitatiewe oorsigte. Sistematiese oorsigregistrasie: Die protokol van hierdie oorsig is op 17 Desember 2017 geregistreer op PROSPERO (CRD42017078155).

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105823
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