A systematic review aimed at studying the influence of educational attainment of HAART compliance

Background The introduction of Highly Active Antiretroviral Therapy (HAART) has definitely improved the quality of HIV patients’ life, although its benefits depend on a strict compliance to therapy. Compliance can be considered as a dynamic process influenced by several variables that include some modifiable determinants such as education. The knowledge of its influence on compliance can lead to change the approach to the HIV patients. The aim of this study is to understand if educational attainment conditions HAART compliance. Methods The present search represents an update of a previous review on the same topic. Studies were selected using Boolean strings in PubMed and Scopus as databases. A snowball analysis was executed too in order to widen the number of articles. Inclusion criteria were: post-HAART era (1996), concerning adult patients ( 18 years), written in English. A data abstraction form was used to abstract and to record study details by two researchers. Methodological quality of studies was furtherly evaluated through Newcastle-Ottawa Scale (NOS). Results Out of 3502 articles, 32 observational studies (10 cohort and 22 cross-sectional) were included in the review. Total sample regarded 19321 people. In 41% of studies adherence was assessed through self-report, in 34% through interviews and in the rest (25%) adherence was measured through other methods or combined ones. 37% of selected studies were conducted in Developing and Emerging Countries (mostly African or Asiatic ones). In 58% of these studies and in 30% of studies set in Developed Countries a low level of education was found to influence HAART compliance. Conclusions Our research suggests that education attainment is an important factor to be considered in strategies aimed at improving HAART compliance in both Developing and Emerging Countries and Developed ones, although educational systems can not be compared completely. Key message: HAART compliance is a complex process in which socioeconomic determinants have to be considered in order to improve it