Housing Stability and Medication Adherence among HIV-Positive Individuals in Antiretroviral Therapy

A Meta-Analysis of Observational Studies in the U.S

Rebecca Arden Harris, Xiaonan (Nan) Xue, Peter A. Selwyn

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND.: Previous research has produced inconsistent evidence of an association between housing stability and medication adherence among HIV-positive individuals in antiretroviral therapy. OBJECTIVE.: We conducted a meta-analysis of the housing–adherence relationship based on a comprehensive search of observational studies in the PubMed, Embase, and Cochrane databases (January 2000 – January 2016). Ten qualifying studies were identified representing 10,556 individuals. METHODS.: A random effects model was used to estimate overall effect size and 95% CI. Robustness of the estimate was determined by sensitivity analysis. Heterogeneity was assessed by meta-regression analysis, subgroup analysis, and quality effects estimation. Publication bias was evaluated with a funnel plot and the Egger and Begg tests. RESULTS.: The summary effect for the association between housing stability and medication adherence was positive and significant (standardized mean difference = 0.15; 95% CI = 0.02 – 0.29). The association was slightly larger in the quality effects analysis (SMD = 0.20, 95% CI = 0.01 – 0.39). Sensitivity analysis disclosed that the association was robust at the P = 0.09 level. Results of the subgroup and meta-regression analyses were nonsignificant. Publication bias was not detected. CONCLUSIONS.: Antiretroviral medication adherence is an increasing function of housing stability, but the magnitude of the effect is small. The finding challenges the view that unstable housing is incompatible with adherence, and questions the potential benefit of deferring ART initiation until the patient’s housing circumstances are improved.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
DOIs
StateAccepted/In press - Oct 19 2016

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Medication Adherence
Observational Studies
Meta-Analysis
HIV
Publication Bias
Regression Analysis
Therapeutics
Licensure
PubMed
Databases
Research

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

Cite this

@article{9c9e4692272a4f07a3cfacf46a89a063,
title = "Housing Stability and Medication Adherence among HIV-Positive Individuals in Antiretroviral Therapy: A Meta-Analysis of Observational Studies in the U.S",
abstract = "BACKGROUND.: Previous research has produced inconsistent evidence of an association between housing stability and medication adherence among HIV-positive individuals in antiretroviral therapy. OBJECTIVE.: We conducted a meta-analysis of the housing–adherence relationship based on a comprehensive search of observational studies in the PubMed, Embase, and Cochrane databases (January 2000 – January 2016). Ten qualifying studies were identified representing 10,556 individuals. METHODS.: A random effects model was used to estimate overall effect size and 95{\%} CI. Robustness of the estimate was determined by sensitivity analysis. Heterogeneity was assessed by meta-regression analysis, subgroup analysis, and quality effects estimation. Publication bias was evaluated with a funnel plot and the Egger and Begg tests. RESULTS.: The summary effect for the association between housing stability and medication adherence was positive and significant (standardized mean difference = 0.15; 95{\%} CI = 0.02 – 0.29). The association was slightly larger in the quality effects analysis (SMD = 0.20, 95{\%} CI = 0.01 – 0.39). Sensitivity analysis disclosed that the association was robust at the P = 0.09 level. Results of the subgroup and meta-regression analyses were nonsignificant. Publication bias was not detected. CONCLUSIONS.: Antiretroviral medication adherence is an increasing function of housing stability, but the magnitude of the effect is small. The finding challenges the view that unstable housing is incompatible with adherence, and questions the potential benefit of deferring ART initiation until the patient’s housing circumstances are improved.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.",
author = "Harris, {Rebecca Arden} and Xue, {Xiaonan (Nan)} and Selwyn, {Peter A.}",
year = "2016",
month = "10",
day = "19",
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T1 - Housing Stability and Medication Adherence among HIV-Positive Individuals in Antiretroviral Therapy

T2 - A Meta-Analysis of Observational Studies in the U.S

AU - Harris, Rebecca Arden

AU - Xue, Xiaonan (Nan)

AU - Selwyn, Peter A.

PY - 2016/10/19

Y1 - 2016/10/19

N2 - BACKGROUND.: Previous research has produced inconsistent evidence of an association between housing stability and medication adherence among HIV-positive individuals in antiretroviral therapy. OBJECTIVE.: We conducted a meta-analysis of the housing–adherence relationship based on a comprehensive search of observational studies in the PubMed, Embase, and Cochrane databases (January 2000 – January 2016). Ten qualifying studies were identified representing 10,556 individuals. METHODS.: A random effects model was used to estimate overall effect size and 95% CI. Robustness of the estimate was determined by sensitivity analysis. Heterogeneity was assessed by meta-regression analysis, subgroup analysis, and quality effects estimation. Publication bias was evaluated with a funnel plot and the Egger and Begg tests. RESULTS.: The summary effect for the association between housing stability and medication adherence was positive and significant (standardized mean difference = 0.15; 95% CI = 0.02 – 0.29). The association was slightly larger in the quality effects analysis (SMD = 0.20, 95% CI = 0.01 – 0.39). Sensitivity analysis disclosed that the association was robust at the P = 0.09 level. Results of the subgroup and meta-regression analyses were nonsignificant. Publication bias was not detected. CONCLUSIONS.: Antiretroviral medication adherence is an increasing function of housing stability, but the magnitude of the effect is small. The finding challenges the view that unstable housing is incompatible with adherence, and questions the potential benefit of deferring ART initiation until the patient’s housing circumstances are improved.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

AB - BACKGROUND.: Previous research has produced inconsistent evidence of an association between housing stability and medication adherence among HIV-positive individuals in antiretroviral therapy. OBJECTIVE.: We conducted a meta-analysis of the housing–adherence relationship based on a comprehensive search of observational studies in the PubMed, Embase, and Cochrane databases (January 2000 – January 2016). Ten qualifying studies were identified representing 10,556 individuals. METHODS.: A random effects model was used to estimate overall effect size and 95% CI. Robustness of the estimate was determined by sensitivity analysis. Heterogeneity was assessed by meta-regression analysis, subgroup analysis, and quality effects estimation. Publication bias was evaluated with a funnel plot and the Egger and Begg tests. RESULTS.: The summary effect for the association between housing stability and medication adherence was positive and significant (standardized mean difference = 0.15; 95% CI = 0.02 – 0.29). The association was slightly larger in the quality effects analysis (SMD = 0.20, 95% CI = 0.01 – 0.39). Sensitivity analysis disclosed that the association was robust at the P = 0.09 level. Results of the subgroup and meta-regression analyses were nonsignificant. Publication bias was not detected. CONCLUSIONS.: Antiretroviral medication adherence is an increasing function of housing stability, but the magnitude of the effect is small. The finding challenges the view that unstable housing is incompatible with adherence, and questions the potential benefit of deferring ART initiation until the patient’s housing circumstances are improved.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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SN - 1525-4135

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