The use of antiretroviral therapy among HIV-infected individuals with serious mental illness: A realist synthesis

Rosetta Okeleke studied on the Master of Public Health Management and Leadership programme at ScHARR and graduated in January 2014 with a merit. It was Rosetta's interest and love for research and academia that prompted her to complete the MPH program. Since completing the program, Rosetta has continued to work for Lloyds Pharmacy Ltd as a Pharmacist Relief Manager.

The title of Rosetta's MPH dissertation project was 'The use of antiretroviral therapy among HIV-infected individuals with serious mental illness: A realist synthesis'.


Introduction: Though antiretroviral therapy (ART) transformed acquired immune deficiency syndrome (AIDS) from a fatal disease to a chronic one, inappropriate use is considered a reason for treatment failures. Adherence to ART by individuals with serious mental illness (SMI) is thought to be poor. This realist synthesis, that harnessed some aspects of the systematic review methodology, was undertaken to interrogate this claim.

Objectives: The aim of this review was to report a synthesis of evidence for the interrelationship between SMI and adherence to ART. It was undertaken using relevant studies to explore the impact of SMI on adherence to ART.

Method: Studies describing adherence to ART in patients with SMI and in the general public were identified from the following data sources: Medline, Embase, Psych Info, CINAHL, Web of Knowledge and Google Scholar by applying the acronym PICO. Relevant themes were identified at the onset from three core studies as demiregularities.These were proposed as statements and conceptualised into a framework. These concepts were then applied in coding subsequent studies for selection and appraisal purposes.

Results: A total of 17 relevant studies were identified. The relationship between SMI and adherence to ART in the included studies was best explained by applying the middle range theory ‘acceptance of patient’s role’. This demonstrated how encounters with doctors, belief in the care team, monetary incentives, mood disorder, persistence in risky behaviour, self efficacy, gender, prior use of psychiatric medication, age, awareness and knowledge, status disclosure and integration all impact on adherence to ART.

Conclusion:  The impact of SMI on adherence to ART may vary according to the type of SMI. This impact may operate via a mechanism of acceptance of the patient's role.

Key words: Realist synthesis, systematic review, serious mental illness, adherence to ART, acceptance of patient’s role.

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