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HIV Medication Adherence Efficacy Review Methods

The PRS efficacy review process for identifying HIV medication adherence (MA) evidence-based behavioral interventions (EBIs) is conducted using well-established systematic procedures for searching and reviewing the intervention research literature. The information presented below describes the MA search strategy for identifying relevant articles, MA study eligibility criteria for inclusion in the review, and MA study coding procedures for reviewing the quality of the evidence. A detailed overview of the PRS search strategy is available in the article Developing a comprehensive search strategy for evidence based systematic reviews in the open access journal Evidence Based Library and Information Practice.

Once included in the review, the PRS MA efficacy criteria are used to determine if an HIV medication adherence behavioral intervention is best-evidence or good-evidence.

MA Search Strategy

Using a comprehensive and systematic search strategy, PRS developed a cumulative database of the HIV, AIDS, and STD prevention research literature. This cumulative database is continually updated using both automated and manual searches conducted annually to keep the HIV/AIDS and STD behavioral prevention literature up-to-date.

The automated search component involves searching the following electronic bibliographic databases: CINAHL, EMBASE, MEDLINE, and PsycINFO for articles focusing on HIV/AIDS, antiretroviral therapy or treatment, and adherence.

The manual search consists of regularly reviewing 16 journals to identify articles not yet indexed in the electronic databases. These journals were selected based on previous publication record of HIV adherence intervention studies. Quarterly, PRS team members screen all issues of the journals published within the previous 3 months to locate relevant articles. In addition, PRS also examines the reference lists of published articles, HIV/AIDS Internet listservs, and unpublished manuscripts submitted by study authors.

For each eligible intervention study, the PRS cumulative database is searched to identify all articles reporting descriptive or outcome data from the same intervention. All articles describing the same intervention study are considered linked reports and are included in the review process for that study. Additional details about these search strategies and procedures can be obtained by contacting PRS.

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MA Study Eligibility

Once articles are identified through the systematic search, they are screened to determine eligibility for the PRS medication adherence efficacy review. To be included in this review, studies must meet each of the following inclusion criteria:

  • HIV Medication Adherence Intervention with:
    • Educational / behavioral component OR
    • Treatment delivery methods or monitoring devices to facilitate adherence
  • Published or accepted for publication in a peer–reviewed journal
  • Conducted in the United States or a U.S. territory
  • Outcome evaluation report with a comparison arm
  • Report any of the following relevant outcome data:
    • Behavioral measures of adherence: EDM (e.g., MEMs caps), pill count, pharmacy refill, self-report
    • Biologic measure of adherence: HIV viral load

Interventions that focus on the following types of prevention are not currently included in the PRS medication adherence efficacy review:

  • Interventions comparing treatment efficacy or adherence outcomes of different medication treatment regimens

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MA Study Coding Procedures

Pairs of trained content analysts independently code each eligible study using the PRS MA efficacy criteria. This coding includes all linked articles reporting information on the same intervention study. All discrepancies between coder pairs are reconciled.

If the study does not report critical information needed to determine intervention efficacy, the PRS team contacts the principal investigator of the study to obtain the missing information or to seek additional clarification. The final efficacy determination for each study is reached by PRS team consensus.

HIV Medication Adherence Manual Search Journal List (n=16)

AIDS and Behavior
AIDS Patient Care and STDs
Annals of Behavioral Medicine
Antiviral Therapy
Clinical Infectious Diseases
Cognitive and Behavioral Practice
Drug and Alcohol Dependence
Health Psychology
International Journal of STD & AIDS
JAIDS Journal of Acquired Immune Deficiency Syndromes
Journal of HIV/AIDS & Social Services
Journal of the Association of Nurses in AIDS Care
Journal of the International Association of Physicians in AIDS Care
Patient Education and Counseling

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