- Association between antiretroviral therapy adherence and employment status: systematic review and meta-analysis Nachega JB1, Uthman OA2, Peltzer K3, Richardson LA4, Mills EJ5, Amekudzi K6, Ouédraogo A6. • 1Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 503 Parran Hall, 130 DeSoto Street, Pittsburgh, PA 15261, United States of America (USA). • 2Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, England . • 3Department of Psychology, University of Limpopo, Turfloop, South Africa . • 4Department of Sociology, University of British Columbia, Vancouver, Canada . • 5Stanford Prevention Research Center, Stanford University, Stanford, USA . • 6HIV/AIDS and the World of Work Branch (ILOAIDS), International Labour Organization, Geneva, Switzerland . Bull World Health Organ. 2015 Jan 1;93(1):29-41. doi: 10.2471/BLT.14.138149. Epub 2014 Oct 30. Abstract in English, Arabic, Chinese, French, Russian, Spanish OBJECTIVE: To assess the association between the employment status of human immunodeficiency virus (HIV)-infected individuals and adherence to antiretroviral therapy (ART). METHODS: We searched the Medline, Embase and Cochrane Central Register of Controlled Trials databases for studies reporting ART adherence and employment status published between January 1980 and September 2014. Information from a wide range of other sources, including the grey literature, was also analysed. Two independent reviewers extracted data on treatment adherence and study characteristics. Study data on the association between being employed and adhering to ART were pooled using a random-effects model. Between-study heterogeneity and sources of bias were evaluated. FINDINGS: The meta-analysis included 28 studies published between 1996 and 2014 that together involved 8743 HIV-infected individuals from 14 countries. The overall pooled odds ratio (OR) for the association between being employed and adhering to ART was 1.27 (95% confidence interval, CI: 1.04-1.55). The association was significant for studies from low-income countries (OR: 1.85, 95% CI: 1.58-2.18) and high-income countries (OR: 1.33, 95% CI: 1.02-1.74) but not middle-income countries (OR: 0.94, 95% CI: 0.62-1.42). In addition, studies published after 2011 and larger studies showed less association between employment and adherence than earlier and small studies, respectively. CONCLUSION: Employed HIV-infected individuals, particularly those in low- and high-income countries, were more likely to adhere to ART than unemployed individuals. Further research is needed on the mechanisms by which employment and ART adherence affect each other and on whether employment-creation interventions can positively influence ART adherence, HIV disease progression and quality of life. Similar articles • Review Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis.[AIDS. 2012] • Review Socioeconomic factors in adherence to HIV therapy in low- and middle-income countries.[J Health Popul Nutr. 2013] • Review Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection.[Cochrane Database Syst Rev. 2012] • Review Consumer-providers of care for adult clients of statutory mental health services.[Cochrane Database Syst Rev. 2013] • Review Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries.[Cochrane Database Syst Rev. 2012] Cited by 1 PubMed Central article • Dose-response relationship between methadone dose and adherence to antiretroviral therapy among HIV-positive people who use illicit opioids.[Addiction. 2015]
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