A Scoping Review of How High-Income Country HIV Guidelines Define, Assess, and Address Oral ART Adherence
Bibliographic record
Abstract
Background/Objectives: An optimal approach to addressing oral antiretroviral therapy (ART) adherence remains unclear in the research literature. This review aimed to identify definitions and thresholds of adherence, proposed methods and frequencies of evaluating adherence levels, barriers to adherence, and interventions to address adherence problems. Methods: A scoping review of HIV guidelines drew on guidance from the Joanna Briggs Institute. Eligible English and French guidelines and their updates concerned adults with HIV and oral ART from developed countries and international health organizations from 2017 to May 2023. Three databases were systematically searched, along with the gray literature. Then, a targeted search for omitted developed countries was conducted. Document selection and data charting were performed with two reviewers for 20% of records and full texts, followed by an independent review. Inductive–deductive content analysis of extracted data was performed using NVivo 14 software. Results: Twenty-four guidelines were identified from seven countries and two international health organizations. Only two defined ART adherence, and none offered a threshold for adequate adherence. Most guidelines (n = 22/24) reported adherence interventions, 20 guidelines (83%) identified adherence barriers, 20 guidelines (83%) noted variable methods to evaluate adherence, and 17 guidelines (71%) proposed a range of frequencies for assessing adherence. Conclusions: This review underscored a lack of consensus around adherence and its management. Very few guidelines defined adherence, none proposed an optimal threshold, and there was no agreement on how to gauge adherence. These gaps and variability raise questions about how clinicians manage adherence in practice. More systematic and preventative approaches to monitoring adherence may be needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.042 | 0.156 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.005 |
| Bibliometrics | 0.026 | 0.025 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".