OBJECTIVES: HIV-1 infections have been prevalent in South Africa over the past half-century. While the efficacy of antiretroviral treatments has been studied, the effect on how adherence levels impact this efficacy is relatively uncertain. The study aims to explore the adherence levels of patients with HIV-1 undergoing antiretroviral treatments (ART) and regimens, and how this impacts treatment efficacy.

METHODS: A targeted literature review of published compliance and adherence levels in HIV-1 in South Africa were identified and extracted through Medline via Ovid. Measurements used, general trends, factors affecting adherence/compliance and efficacy were evaluated.

RESULTS: Twelve studies met the requirements for inclusion; eleven assessed ART (pooling multiple ART regimens), and one assessed an individual ART (Efavirenz-based) regimen. Adherence was measured differently across the studies using the following indicators: currently taking ART, drug detection in plasma, pill count adherence, and pharmacy refill data. General trends reported adherence levels (median/mean) of above 61%. Factors affecting adherence included secondary education, physical health, self-management, pregnancy status, viral load status, breadwinner status, HIV-RNA status, resistance mutation, workplace status, suboptimal baseline adherence, urban or rural resident status, and marital status. Effects of adherence on efficacy was reported in 8 studies ranging from mean to cumulative adherence. The evidence suggests that adherence was associated with increased level of efficacy.

CONCLUSIONS: This review found that adherence to ART by patients is dependent on several variables. Most cohorts in the included studies did not fully adhere to ART therapy. Various scales were used to measure adherence levels; however, the most appropriate measure is unknown. Further research is needed on a global level to identify a gold standard measurement of adherence to HIV-1 treatment regimens and to gain a more robust understanding on adherence impact on ART efficacy.