Efficacy of the Patient Advocate Component in a Behavioral Intervention to Improve Treatment Adherence in the HIV Positive Population: A Systematic Review

Background: HIV/AIDS is a global health concern affecting as many as 39 million people worldwide. Viral spread persists secondary to patient non-compliance to antiretroviral therapy. Healthcare providers struggle to identify methods to improve adherence. Patient advocates (PAd) are being utilized as part of a behavioral intervention to improve patient compliance. PAds are highly trained in topics of HIV/AIDS disease and management to assist patients with education, motivation, and treatment adherence support. The studies reviewed here address the efficacy of the PAd component in HIV/AIDS treatment adherence. The significance of each study will be discussed and the overall quality of evidence will be evaluated using GRADE, a universal system utilized to determine quality of evidence and strength of treatment recommendations. Method: An exhaustive search of medical literature was conducted using three different databases to identify articles addressing this research question. The search was limited to articles published since the year 2001 that addressed the PAd component alone. Results: The search resulted in three articles suitable for this study. The three articles address the effect of the PAd component on treatment adherence and patient retention in care. Evidence from all three articles suggests that PAds significantly augment treatment adherence and encourage patients to remain in care. Conclusion: Current evidence suggests that PAds improve HIV/AIDS treatment adherence. However, further objective research is required through randomized controlled trials that will better address the criticism of validity and study design. Keywords: HIV/AIDS treatment adherence, patient advocate, treatment advocate, adherence counselor, ART, retention in care