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Table 2 Table of included studies (N = 33)

From: A mega-aggregation framework synthesis of the barriers and facilitators to linkage, adherence to ART and retention in care among people living with HIV

First author, year of publication

[reference]

Search dates

Participants

Issue

Context

Types of studies

Method of synthesis

Overall quality of review

Low- to middle-income country

High-income country

Ammon, 2018 [41]

3 June 2016 to 15 August 2016

N = 3145 participants: 2937 adolescents aged 10-19; 191 caregivers (parents, non-parental caregiver, biological relative, non-relative, or foster-carer) and 17 healthcare providers. Some adolescents living with HIV did not know about their HIV-positive status.

Adherence

Sub-Saharan Africa: n = 1 study each from Congo DRC, Ghana, Kenya, Rwanda, South Africa, Zambia, Zimbabwe, and n = 2 studies from Uganda.

None

11 studies: Qualitative (7), Quantitative (1) and Mixed Methods (3)

Thematic synthesis

Medium

Barroso, 2017 [42]

2008 to 2013

N = 6189 participants: n = 4830 PLHIV (2197 female and 1850 male, 783 unspecified) and n = 1359 included provider participants (caregivers, health care providers, traditional healers, local community leaders, pharmacists, policymakers, stakeholders, peer counsellors, facility managers, volunteers, and clinical trial coordinators).

Linkage

Adherence

China (5), Nigeria (5), South Africa (19), Tanzania (8), Uganda (16), and Zambia (9). All other locations for data collection contributed to fewer than five reports (Countries not reported)

Europe (9), US (28)

127 studies: Qualitative (127)

Thematic synthesis

Low

Bolsewicz, 2015 [43]

2003 to 2013

PLHIV, excluding drug users, mothers, adolescents, prisoners, sex workers in Canada, UK, and Australia

Linkage

Adherence

None

Canada (8), UK (3) and Australia (6)

 

Thematic synthesis

Medium

Bravo, 2010 [44]

1990 to November 2009

N = 4215 PLHIV including drug users and women caring for children < 18 years; n = 4022 in Quantitative and n = 193 Qualitative studies.

Linkage

Adherence

Botswana (1)

US (7), UK (1), France (1)

10 studies: Qualitative (5) and Quantitative (5)

Thematic meta-analysis

Low

Chop, 2017 [45]

Up to 18 February 2018

Women living with HIV

Adherence

Zambia (1), Swaziland (1) and Democratic Republic of Congo (1)

France (1)

4 studies: Qualitative (3) and Quantitative (1)

Thematic analysis

Low

Colvin, 2014 [46]

1 January 2008 to 26 March 2013

N = 875 308 participants: HIV-infected pregnant and/or postpartum women and/or health care providers delivering antenatal care, ART and/or PMTCT. A few studies included partners and/or family members.

Linkage

Adherence

Retention

Sub-Saharan Africa (38), Latin America (2), and Asia (2)

None

42 studies: Qualitative (14), Quantitative studies (25) and Mixed Methods (3)

Narrative meta-synthesis

Medium

Croome, 2017 [47]

2005 to 24 May 2016

N = 37175 Adult PLHIV

Adherence

Benin, Cote d'lvoire and Mali (1), Botswana (3), Burkina Faso (1), Cameroon (4), Cote d'lvoire (1), DRC (2), Ethiopia (20), Ethiopia and Uganda (1), Ghana (4), Guinea-Bissau (1), Kenya (16), Kenya and Malawi (1), Kenya and Uganda (1), Lesotho (1), Malawi (2), Mali (1), Mozambique (3), Namibia (4), Nigeria (13), Nigeria, Tanzania and Uganda (1), Rwanda (3), Senegal (1), South Africa (30), Tanzania (10), Tanzania, Uganda and Zambia (1), Togo (1), Uganda (19), Zambia (6), Zimbabwe (2)

None

154 studies: 83 Qualitative (83), Quantitative (67) and Mixed methods (4)

Thematic content analysis

Low

Engler, 2018 [48]

1996 to 10 March 2016

N = 1482 adult PLHIV (including men, women, men who have sex with men (MSM), intravenous drug user (IDU)

Adherence

None

US (35), Europe (3) (Switzerland, the Netherlands and Belgium), and Canada (2).

40 studies: Qualitative (40)

Thematic analysis

Low

Ferguson, 2012( [49])

1st January 2000 to 31st December 2010

N = 819 Pregnant women with HIV. Not all studies included reported sample size.

Retention

Kenya (1), South Africa (1), Tanzania (1), Zimbabwe (1), Malawi (2), Uganda (1)

None

7 studies: Qualitative (3) and Quantitative (4)

Thematic content analysis

Low

Flores, 2018 [50]

2008 to 2013

N = 3257 participants: 2263 PLHIV (740 men, 1008 women, 78 transgender individuals and 437 people with unspecified gender). 994 other people were included in the studies such as family members, friends, physicians, nurses, treatment advocates, caregivers, clinic staff, programme directors, social workers, and other key stakeholders.

Linkage

Retention

South Africa (9), Uganda (6), Nigeria (4), Zimbabwe (4) and China (4); 20 = unspecified

US (22 reports)

69 studies: Qualitative (69)

Thematic meta-synthesis

Low

Gaston, 2013 [51]

1 January 2001 to 31 May 2012

African Americans LHIV Total n = 2846

Adherence

None

USA (16)

16 Studies: Qualitative (6) and Quantitative (10)

Thematic analysis

Low

Geter, 2018 [52]

January 2005 to December 2016

African American females living with HIV Total n = 830

Adherence

Retention

None

US (14)

14 studies: Qualitative (10) and Quantitative (4)

Thematic content analysis

Low

Govindasamy, 2012 [53]

01 January 2000 to 31 May 2011

PLHIV in sub-Saharan Africa and health care workers.

Linkage

South Africa (6), Uganda (6), Kenya (2), Tanzania (2), Zambia (2), and 1 study each from Ethiopia, Swaziland, Mozambique, and South Africa and Zimbabwe.

None

21 Studies: Qualitative (11), Quantitative (7) and Mixed Methods (3)

Thematic content analysis

Low

Heestermans, 2016 [54]

January 2002 to 27 October 2014.

161 922 Adult PLHIV

Adherence

Sub-Saharan Africa

 

146 studies: Qualitative (37), Quantitative (112) and Mixed methods (3)

Narrative synthesis

Low

Hodgson, 2014 [55]

1st January 2008 to 26 March 2013

Pregnant women and postpartum women infected with HIV

Linkage

Adherence

Retention

Ghana (1), Nigeria (1), Malawi (5), South Africa (6), Zimbabwe (2), Tanzania (2), Kenya (5), Uganda (3), Brazil (1), Rwanda (1), Zambia (1), Latin America (1)

Australia (1), US (3), France (1),

34 studies included in the review: Qualitative (12), Quantitative (16) and Mixed Methods (6)

Thematic analysis

Medium

Katz, 2013 [56]

Up until February 2013

PLHIV between 18 and 30 years old, providers of HIV care, single persons and those in intimate partnerships and persons with and without children. High-risk groups including men who have sex with men, injecting drug users and commercial sex workers.

Adherence

Uganda (9), South Africa (5), India (2), and 1 study each from DRC, Brazil, Botswana, Tanzania, Thailand, Egypt, Ethiopia, Vietnam, Nepal, Nigeria, Asia, Zambia, and China. Four countries were not reported.

US (1)

75 Studies: Quantitative (41) and Qualitative (34)

Meta-ethnography

Low

Knettel, 2018 [57]

January 2012 to June 2017

736 Pregnant and postpartum women on option B+.

Retention

Malawi (13), Uganda (4), Zimbabwe (3), Mozambique (2), and 1 each from Cameroon, Ethiopia, Rwanda, South Africa, and Tanzania

None

13 Studies: Qualitative (13)

Thematic analysis

Low

Lancaster, 2016 [58]

Up to 22 November 2013 and a second search up to 30 July 2015

N = 2721 Female sex workers living with HIV

Linkage

Adherence

Rwanda (1), Zimbabwe (2), Benin (2), Burkina Faso (1), Nigeria (1), Swaziland (1), Kenya (1), and Uganda (1).

None

10 studies: Qualitative (3), Quantitative (6) and Mixed Methods (3)

Thematic analysis

Low

Lankowski, 2014 [59]

Databases up until August 2011 and abstracts from 2002 to 2004 and from 2006 to 2011.

N = 69 506 Adults and children LHIV, HIV-infected HCW, HC Providers, HIV-infected rape victims, pregnant and postpartum women with HIV.

Linkage

Adherence

Retention

Uganda (10), Kenya (3), Zambia (2), Malawi (4), Nigeria (3), Corte d'Ivoire (1), Botswana (4), Tanzania (4), Togo (1), Ethiopia (1), South Africa (2), The Gambia (1), Namibia (1)

None

34 studies: Qualitative (16) and Quantitative (18)

Content analysis

Low

Lazuardi, 2018 [60]

1990 to 2016

PLHIV: including injecting drug users, pregnant women, MSM, transgendered people, women, men, and sero-discordant couples. Found information related to service providers, community members, TB patients, caregivers, and community organisers.

Linkage

Adherence

Retention

Indonesia (11)

None

11 studies: Qualitative (11)

Thematic analysis

Low

Li, 2016 [61]

1 January 2000 to 21 February 2015

Total: N = 192434 PLHIV including adults, children, adolescents, pregnant and postpartum women, and caregivers.

Adherence

Botswana, Tanzania and Uganda (1), Peru (1), Ukraine (1), Zambia (1), Rwanda (1), Ethiopia (1), Uganda (1), Nepal (2), Cuba (1), Southern Malawi (1), Uganda and Zimbabwe (1), China (2), Tanzania (3), South Africa (3)

US (14), Netherlands (1), Canada (1), Australia (1), Belgium and Netherlands (1), Switzerland (1)

39 studies: Qualitative (39)

Thematic analysis

Medium

Lytvyn, 2017 [62]

1 January 2000 to 11 February 2017

N = 1165: Women considering pregnancy (140), pregnant women (408), and postpartum women (602). Couples desiring and/or intending to have children (15) also included.

Adherence

Puerto Rico (1), Nigeria (1), Kenya (2), Swaziland (2), Malawi (2), India (1), South Africa (1), Zimbabwe (1), and

Australia (1), US (3)

15 Studies: Qualitative (15)

Meta-ethnography

High

Merten, 2010 [63]

2000 to 2008

N = 2044+ Community members, policy makers, PLHIV, health workers, female HIV+ patients, healthcare actors, In-school and out-of-school youth, patients who attended the ARV clinic, counsellors, HIV+ patients on ART for 6 months, care givers, family care givers, key informants, HIV+ patients from IDP camps, treatment partners

Adherence

Uganda (6), Zambia (5), South Africa (6), Burkina Faso (1), Malawi (2), Tanzania (5), Botswana (2), Kenya (1), Nigeria (1), Ethiopia and Uganda (1), Burkina Faso, Cote d'Ivoire and Mali (1), Nigeria, Tanzania and Uganda (1)

None

32 studies: Qualitative (32)

Meta-ethnography

Low

Mey, 2016 [64]

January 2000 to 15 December 2015

PLHIV, Men, women, MSM, caregivers of children who are HIV positive, CAM workers (traditional healers/alternative medicines)

Linkage

Adherence

Retention

None

Australia (21)

35 Studies: Qualitative (14), Quantitative (14), Mixed Methods (6), and Case Report (1)

Narrative synthesis

Low

Mills, 2006 [65]

Up to June 2005

PLHIV and caregiver Total: N = 12902

Adherence

12 studies were conducted in developing countries included four from Brazil and one each from Uganda, Cote d’Ivoire, South Africa, Malawi, Botswana, Costa Rica, Romania, and China.

US (56), Canada (3), UK (3), Italy (2), France (2), The Netherlands (2), Australia (1), Belgium (1) and Switzerland (1). The studies conducted in developing countries included Brazil (1) and Botswana (1) Two studies were multi-national: (countries not reported).

84 studies: Qualitative (37) and Quantitative (47)

Content analysis

High

Morales-Aleman, 2014 [66]

Jan 2002 to April 2013

N = 121 Hispanic and Latino PLHIV

Linkage

Adherence

Retention

None

USA (4)

3 studies: Qualitative (3) and Quantitative (1)

Thematic analysis

Low

Omonaiye, 2018 [67]

Up to December 2017

HIV-positive pregnant women (include number)

Adherence

Kenya (3), Swaziland (1), Uganda (2), South Africa (1), Cote d'voire (2), Tanzania (1), Malawi (4), Mozambique (1)

None

15 Studies: Qualitative (9) and Mixed Methods (6)

Thematic content analysis

Medium

Reisner, 2009 [68]

1999 to 2008

N = 5179 HIV-positive youth and adolescents and pregnant adolescents.

Adherence

None

US (14)

14 Studies: Qualitative (4), Quantitative (7) and Mixed Methods (3)

Thematic content analysis

Low

Santer, 2014 [69]

1996 to 2011

N = 96 Caregivers of children aged 0 -18 years

Adherence

None

Belgium (1) and US (2)

3 Studies: Qualitative (3)

Thematic analysis

Low

Vervoort, 2007 [70]

1996 to 2005

N = 1053 Adult PLHIV

Adherence

Not specified

Not specified

24 studies containing qualitative data.

Thematic content analysis

Low

Vitalis, 2013 [71]

Up to July 2011

HIV-positive pregnant and postpartum women between the ages of 12 to 58 years receiving ART.

Adherence

Africa (7), Brazil (2) and Puerto Rico (1)

USA (8), and Australia (1)

18 studies: Quantitative (15) and Qualitative (3)

Content analysis

Low

Wasti, 2012 [72]

1996 to 2010

N = 4782 Adult PLHIV who have been prescribed ART. Quantitative Studies n = 4372; qualitative studies n = 152 and mixed methods studies n = 258

Adherence

India (10), China (4), Thailand (3), Cambodia (1).

None

18 studies: Quantitative (12), Qualitative (4) and Mixed Methods (2)

Thematic analysis

Low

Williams, 2018 [73]

January 2005 to March 2016

Adolescent ages 9-20 years living with HIV

Linkage

Adherence

Retention

Zimbabwe (2), South Africa (3), Kenya (3), Botswana (1), Zambia (3), Tanzania (1), Uganda (1), Uganda and Zimbabwe (1), Tanzania (2), and Botswana and Tanzania (1)

None

18 studies: Qualitative (18)

Meta-ethnography

Low