Der debate of “lumping” and “splitting” that persists for systematic reviews as a whole [39]. Decision-makers need to engage with evidence at the level that is most appropriate to the decision that they are facing. Health policy makers need an overall model of the factors to be overcome for successful implementation of a prevent nd-treat policy. Such a generalisable model can be provided by a meta-ethnography which makes rich use of the data for interpretation and conceptual development. Local decision makers also deal with specific implementation strategies, around a specific drug such as isoniazid, in a specific population living with HIV/AIDS. A thematic synthesis can thus identify specific factors that need to be overcome and will typically present individual study level data that can contribute to a greater ��-Amatoxin site understanding of context. The decision-maker will therefore be interested in how findings in their population of interest diverge from findings in a general population facilitating identification of any factors that require special consideration.Our review offers several implications for research and practice. Many of these are consonant, or indeed extend, findings from Rowe and colleagues [25]. Interventions that may improve adherence to ChaetocinMedChemExpress Chaetocin latent TB and HIV/AIDS care in resource poor settings would include provisions that facilitate attendance at the clinics, particularly in rural areas and for those populations requiring frequent follow up. It is clearly important to ensure that the clinic environment is welcoming for HIV-positive patients by maintaining confidentiality and encouraging staff to be friendly and supportive. Previous studies conducted in Kenya and Zambia, confirm that the poor quality of physicians’ interpersonal skills negatively affect adherence to treatment [40,41]. One of the limitations of this review, due to the use of patients as the primary informants in the primary studies, is that the methodology cannot usually identify the absence of important components such as clinical leadership and clear policy guidelines [25]. A complementary perspective would be offered by interviewing clinical staff delivering the services. Similarly the needs for training, supervision and support are also latent, except where specific issues (e.g. poor communication skills) are perceived by the patient. Future studies need to incorporate and test existing theoretical and conceptual understandings of adherence to TB preventive therapy in PLWHA. They also need to seek to generate a more indepth understanding of how these complex factors interact with one another. Implementation research on adherence improvement strategies, guided by models derived from a sound conceptual understanding of adherence, will be critical for improving the persistently low levels of adherence to IPT amongst PLWHA.ConclusionAdherence to IPT in PLWHA is influenced by the interactions of multiple factors. Accordingly, no one single strategy, such as, patient education or financial support for patients, will help improve adherence rates. A multi-pronged strategy that incorporates current understanding of the complexity of the interactive factors at play and that seeks to engage patients through a holistic, participatory and contextually tailored support is critical. Our systematic review of the available qualitative evidence confirms, from multiple studies across diverse contexts, that adherence to preventive therapy for TB is: “underpinned by complex in.Der debate of “lumping” and “splitting” that persists for systematic reviews as a whole [39]. Decision-makers need to engage with evidence at the level that is most appropriate to the decision that they are facing. Health policy makers need an overall model of the factors to be overcome for successful implementation of a prevent nd-treat policy. Such a generalisable model can be provided by a meta-ethnography which makes rich use of the data for interpretation and conceptual development. Local decision makers also deal with specific implementation strategies, around a specific drug such as isoniazid, in a specific population living with HIV/AIDS. A thematic synthesis can thus identify specific factors that need to be overcome and will typically present individual study level data that can contribute to a greater understanding of context. The decision-maker will therefore be interested in how findings in their population of interest diverge from findings in a general population facilitating identification of any factors that require special consideration.Our review offers several implications for research and practice. Many of these are consonant, or indeed extend, findings from Rowe and colleagues [25]. Interventions that may improve adherence to latent TB and HIV/AIDS care in resource poor settings would include provisions that facilitate attendance at the clinics, particularly in rural areas and for those populations requiring frequent follow up. It is clearly important to ensure that the clinic environment is welcoming for HIV-positive patients by maintaining confidentiality and encouraging staff to be friendly and supportive. Previous studies conducted in Kenya and Zambia, confirm that the poor quality of physicians’ interpersonal skills negatively affect adherence to treatment [40,41]. One of the limitations of this review, due to the use of patients as the primary informants in the primary studies, is that the methodology cannot usually identify the absence of important components such as clinical leadership and clear policy guidelines [25]. A complementary perspective would be offered by interviewing clinical staff delivering the services. Similarly the needs for training, supervision and support are also latent, except where specific issues (e.g. poor communication skills) are perceived by the patient. Future studies need to incorporate and test existing theoretical and conceptual understandings of adherence to TB preventive therapy in PLWHA. They also need to seek to generate a more indepth understanding of how these complex factors interact with one another. Implementation research on adherence improvement strategies, guided by models derived from a sound conceptual understanding of adherence, will be critical for improving the persistently low levels of adherence to IPT amongst PLWHA.ConclusionAdherence to IPT in PLWHA is influenced by the interactions of multiple factors. Accordingly, no one single strategy, such as, patient education or financial support for patients, will help improve adherence rates. A multi-pronged strategy that incorporates current understanding of the complexity of the interactive factors at play and that seeks to engage patients through a holistic, participatory and contextually tailored support is critical. Our systematic review of the available qualitative evidence confirms, from multiple studies across diverse contexts, that adherence to preventive therapy for TB is: “underpinned by complex in.