The role of education in adherence to Highly Active Antiretroviral Therapy (HAART): a systematic review

Background Suboptimal adherence to Highly Active Antiretroviral Therapy (HAART) is an emerging public health priority. There is contrasting evidence about the association between socio- demographic predictors and HAART adherence. The aim of this study was to perform a systematic review of the literature assessing the impact of educational level on adherence to treatment in HIV infected patients from 1999 to 2011. Methods A systematic search was performed using Pubmed and Scopus database. Key search terms used included ‘‘HAART’’, ‘‘adherence’’, ‘‘compliance’’ and ‘‘educational level’’. The inclusion criteria used for each study were: (a) the age of HIV-infected patients was eighteen or older (b) the patient residence was in developed countries. Studies focused on specific behavioral or psychosocial characteristics or HAART na ̈ıvepatientswereexcluded. Results Among 210 potentially relevant articles, 18 comparative observational studies, concerning an overall population of 7288, were included in the review. Around 60% of research designs were longitudinal. Papers differed by methodological adherence measurement: 10 studies used self-reported ques- tionnaire, 5 individual interview and 3 other tools as pills count. Eight out of 18 papers (39%-including 3692 indivi- duals) showed that subjects with low educational level were less likely to be adherent to HAART than subjects with higher level. Conclusions Educational level seems to be a noticeable factor to consider in policy and practice, in order to improve the HIV treatment adherence.