Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention.

Although HIV services are expanding, few have reached the scale necessary to support universal viral suppression of individuals living with HIV. The purpose of this systematic review was to summarize the qualitative evidence evaluating public health HIV interventions to enhance linkage to care, antiretroviral drug (ARV) adherence, and retention in care. We searched 19 databases without language restrictions. The review collated data from three separate qualitative evidence reviews addressing each of the three outcomes along the care continuum. 21,738 citations were identified and 24 studies were included in the evidence review. Among low and middle-income countries in Africa, men living with HIV had decreased engagement in interventions compared to women and this lack of engagement among men also influenced the willingness of their partners to engage in services. Four structural issues (poverty, unstable housing, food insecurity, lack of transportation) mediated the feasibility and acceptability of public health HIV interventions. Individuals living with HIV identified unmet mental health needs that interfered with their ability to access HIV services. Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care, shaping the context of service delivery among important subpopulations.

Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence.

INTRODUCTION: Qualitative research on antiretroviral therapy (ART) adherence interventions can provide a deeper understanding of intervention facilitators and barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking. METHODS: We searched 19 databases to identify studies presenting primary qualitative data on the experiences, attitudes and acceptability of interventions to improve ART adherence among PLHIV and treatment providers. We used thematic synthesis to synthesize qualitative evidence and the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess the confidence of review findings. RESULTS: Of 2982 references identified, a total of 31 studies from 17 countries were included. Twelve studies were conducted in high-income countries, 13 in middle-income countries and six in low-income countries. Study populations focused on adults living with HIV (21 studies, n=1025), children living with HIV (two studies, n=46), adolescents living with HIV (four studies, n=70) and pregnant women living with HIV (one study, n=79). Twenty-three studies examined PLHIV perspectives and 13 studies examined healthcare provider perspectives. We identified six themes related to types of interventions, including task shifting, education, mobile phone text messaging, directly observed therapy, medical professional outreach and complex interventions. We also identified five cross-cutting themes, including strengthening social relationships, ensuring confidentiality, empowerment of PLHIV, compensation and integrating religious beliefs into interventions. Our qualitative evidence suggests that strengthening PLHIV social relationships, PLHIV empowerment and developing culturally appropriate interventions may facilitate adherence interventions. Our study indicates that potential barriers are inadequate training and compensation for lay health workers and inadvertent disclosure of serostatus by participating in the intervention. CONCLUSIONS: Our study evaluated adherence interventions based on qualitative data from PLHIV and health providers. The study underlines the importance of incorporating social and cultural factors into the design and implementation of interventions. Further qualitative research is needed to evaluate ART adherence interventions.

Facilitators of HCV treatment adherence among people who inject drugs: a systematic qualitative review and implications for scale up of direct acting antivirals.

BACKGROUND: While the public health benefits of new HCV treatments depend on treatment adherence, particularly among people who inject drugs (PWID), several social and medical factors can jeopardize treatment adherence. The aim of this study is to examine the qualitative literature on facilitators to HCV treatment adherence among PWID. METHODS: We searched six databases to identify qualitative research studies on HCV treatment adherence facilitators among PWID. Two reviewers independently extracted and analyzed data using PRISMA guidelines and the CASP tool to evaluate study quality. RESULTS: From ten studies representing data from 525 participants, three major themes emerged across studies: logistical facilitators within health systems enhanced HCV treatment adherence, positive social interactions between PWID and staff provided positive feedback during treatment, and HCV treatment may complicate the addiction recovery process. CONCLUSIONS: Although PWID face several barriers to adherence, we identified treatment adherence facilitators that could be incorporated into clinical practice.

'I can coexist with HIV': a qualitative study of perceptions of HIV cure among people living with HIV in Guangzhou, China.

Little is known about perceptions of HIV cure among people living with HIV (PLHIV), despite them being crucial stakeholders in ongoing HIV cure research. A qualitative research study was conducted in Guangzhou, China, to explore the perceptions of HIV cure among PLHIV in relation to their views on HIV treatment, stigma and social identity. We conducted in-depth interviews with 22 PLHIV from September 2014 to June 2015. Our qualitative data revealed three major themes: (1) Representations of HIV cure: PLHIV generally thought HIV cure was distant from them; (2) Possibility of HIV cure: ideas about the possibility of HIV cure ranged from optimism to scepticism and pessimism; and (3) Life without HIV cure: some participants had adjusted well to the chronic condition of HIV and ART adherence. Although some PLHIV looked forward to HIV being cured, most of the PLHIV in our study had little interest in it. On the contrary, many felt it is more important and realistic to have access to better ART medication and more education for the general public to decrease HIV stigma today rather than develop a cure for tomorrow.

Gifting and sharing cigarettes in a rural Chinese village: a cross-sectional study.

OBJECTIVES: Quantitative measurement of the prevalence of cigarette sharing and gifting in a town in rural China and evaluation of the impact of these practices on individual smoking habits and family expenditures. METHODS: An interview-based cross-sectional study of 105 households in rural Hunan, China tabulated household cigarette gifting and expenditures. Individual smoking and cigarette sharing activities were also recorded among 198 household members aged >15 years who were resident for at least 6 months. RESULTS: With regard to sharing cigarettes, 92% of men and 19% of women reported being offered a cigarette within the past week. Among previous and current smokers who had attempted to quit smoking, 90% reported that their friends had tried to dissuade them from quitting by tempting them with cigarettes. Concerning gifting cigarettes, 74% of households reported sending packaged cigarettes as gifts during the Chinese New Year Festival at an average expense of 2.8% of household annual income. Although households received an average of 12.4% of their annual cigarette consumption in the form of gifts during the Chinese New Year Festival, no association was found between the amount of cigarettes received by a household and the annual cigarette consumption for that household. CONCLUSIONS: Both gifting and sharing cigarettes are common in rural China. Gifting of cigarettes during the New Year Festival is a significant expenditure affecting both smoking and non-smoking households and may be an opportunity for additional mass media marketing. Among current and former smokers, sharing cigarettes in China is a major impediment to smoking cessation.

Cigarette sharing and gifting in rural China: a focus group study.

OBJECTIVES: To understand the reasons behind gifting and sharing cigarettes in China's rural areas and how these practices contribute to smoking initiation and hamper smoking cessation efforts. METHODS: A convenience sample of 31 current smokers and nonsmokers was selected from a rural farming town in Hunan, China. Participants were divided into 6 focus groups according to gender and smoking status. Focus groups discussed the reasons behind gifting and sharing cigarettes as well as the effect these practices have on tobacco initiation and cessation. RESULTS: In rural China, individual cigarettes are primarily shared as a mechanism to convey respect and intimacy. Packs of cigarettes are given primarily due to their convenience as well as being well liked by both smokers and nonsmokers. Sharing individual cigarettes by both peers and older relations contributed to individuals beginning to smoke. Sharing cigarettes among friends was also a major hindrance to smoking cessation. CONCLUSIONS: Gifting and sharing cigarettes significantly contribute to smoking in rural China. Future tobacco control efforts should discourage both these activities to reduce tobacco usage. Tobacco control measures should also aim to inform adults about the health consequences of giving cigarettes to adolescents. Similarly, more information on the benefits of smoking cessation should be provided to China's rural elderly population. This information could lead to increased community support of cessation efforts and ultimately result in reductions in smoking in rural China.

Tobacco as a social currency: cigarette gifting and sharing in China.

INTRODUCTION: China produces and consumes more tobacco than any other country in the world and as such is at the forefront of the world tobacco epidemic. Many studies have recently emerged that directly or indirectly reference the acts of giving and sharing cigarettes as a major contributor to China's high tobacco usage. The goal of this report is to review relevant literature relating to sharing and gifting cigarettes as well as provide useful historic and cultural contexts. Important differences between the act of giving individual cigarettes and the gifting of packaged cigarettes are explored as well as explanations for how both these practices have influenced current tobacco control efforts. METHODS: Available Chinese and English sources on gifting and sharing cigarettes in China published between 1991 and 2011 were reviewed and discussed with a cultural and historical background. RESULTS: The practices of gifting and sharing cigarettes strongly contribute to smoking initiation as well as failure to quit smoking among Chinese males. Historical and cultural roots have reinforced these practices and hampered efforts to reduce tobacco use in China. CONCLUSIONS: Traditional tobacco control efforts should be combined with culture-specific approaches to reduce tobacco usage in China. The regular exchange of cigarettes normalizes smoking across society and promotes tobacco's acceptability. Great efforts should be taken not only to minimize these practices among males but also to discourage their adoption by females.