Economic Strengthening for Retention in HIV Care and Adherence to Antiretroviral Therapy - A Review of the Evidence

To address the economic drivers of poor HIV care and treatment outcomes, household economic strengthening (HES) initiatives are increasingly being implemented with biomedical and behavioral approaches. The evidence linking HES with HIV outcomes is growing, and this evidence review aimed to comprehensively synthesize the research linking 15 types of HES interventions with a range of HIV prevention and treatment outcomes. The review was conducted between November 2015 and October 2016 and consisted of an academic database search, citation tracking of relevant articles, examination of secondary references, expert consultation, and a gray literature search.

Given the volume of evidence, the results are presented and discussed in three papers, each focused on a different HIV outcome area. This is the third paper in the series and focuses on the 38 studies on retention in HIV care, ART adherence, morbidity, and HIV-related mortality. Monthly food rations and conditional cash transfers are associated with improvements in care-seeking and medication pick-up. Transportation assistance, income generation and microcredit show positive trends for care and treatment, but evidence quality is moderate and based heavily on integrated interventions. Clinical outcomes of CD4 count and viral suppression were not significantly affected in most studies where they were measured.