The Association of Antiretroviral Therapy Adherence and Employment Status in Men and Women from Low-, Middle- and High-Income Countries : A Systematic Review and Meta-Analysis Nachega, Jean B.; Uthman, Olalekan A.; Peltzer, Karl; Richardson, Lindsey A.; Mills, Edward J.; Amekudzi, Kofi; Ouédraogo, Alice
OBJECTIVE: To assess the association between employment status of HIV-infected individuals and antiretroviral therapy (ART) adherence. METHODS: We searched the following databases from January 1980 to September 2014 for studies reporting ART adherence and employment status: MEDLINE, EMBASE, SCI Web of Science, NLM Gateway and Google scholar, and performed a manual search of the retrieved articles’ bibliographies. Two independent reviewers extracted data on adherence and study characteristics. A random-effects model was performed to pool measures of association. Sensitivity, heterogeneity, and publication bias were also assessed. FINDINGS: Of 172 eligible articles, 28 studies involving 8,743 HIV-infected individuals were included. Eight studies were carried out in the United States, and three studies each were carried out in Ethiopia, India and South Africa. The meta-analysis yielded a pooled Odds Ratio of 1.85 (95% Confidence Interval [CI] 1.58 to 2.28, p-value=0.0001) demonstrating that employed HIV-infected patients from low-income countries had greater odds of having achieved optimal antiretroviral adherence than unemployed patients. The association was not significant for studies from middle-income countries (OR = 0.94, 95% CI 0.62 to 1.42, p-value = 0.76) and was significant among studies from high-income countries (OR = 1.33, 95% CI 1.02 to 1.74, p-value = 0.03). In addition, the magnitude of the association between employment status and optimal ART adherence decreased with increasing year of publication. CONCLUSION: HIV-infected individuals who were currently employed (mainly from low- and high-income countries) at the time of the study were more likely to have achieved optimal ART adherence than their unemployed counterparts. Further research is needed to shed lights about specific mechanisms by which employment status impacts HIV treatment adherence as well as on the effectiveness of employment creation program interventions to positively impact HIV treatment adherence, disease progression and quality of life.
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