{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T18:34:56Z","timestamp":1786473296120,"version":"build-2736575974"},"update-to":[{"DOI":"10.1371\/journal.pmed.1005189","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000}}],"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["04510242410063"],"award-info":[{"award-number":["04510242410063"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes and hypertension are major public health challenges in sub-Saharan Africa, yet treatment control remains poor. Patient adherence to key treatment pillars (medication, lifestyle advice, and self-monitoring) is essential for treatment control, yet adherence across these pillars has not been comprehensively synthesized. We conducted a systematic review and meta-analysis to map adherence to medication, lifestyle advice, and self-monitoring for type 2 diabetes and hypertension in sub-Saharan Africa, and applied a network analysis to identify cross-cutting determinants as priority candidates for future interventional studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>\n                      We searched six academic databases, and Google Scholar, for observational and interventional studies in adults with type 2 diabetes or hypertension in sub-Saharan Africa published between January 1, 2004, and May 14, 2026. Risk of bias was assessed using Newcastle\u2013Ottawa Scale and Cochrane RoB 2. We used random-effects models to pool adherence proportions and conducted subgroup analyses and meta-regressions. Cross-cutting determinants were identified using interactive network analysis with noteworthiness scores. We included 312 studies with 108,014 participants from 28 countries. Pooled adherence was 67% (95% CI [60, 73]) for antidiabetic medications, 51% (95% CI [44, 58]) for antihypertensive medications, 44% (95% CI [38, 49]) for dietary recommendations, 42% (95% CI [37, 47]) for physical activity, 85% (95% CI [82, 88]) for alcohol abstinence, 95% (95% CI [94, 96]) for smoking cessation, 18% (95% CI [12, 27]) for glucose monitoring, and 28% (95% CI [16, 45]) for blood pressure monitoring. Overall self-care adherence was 37% (95% CI [30, 46]) for type 2 diabetes and 35% (95% CI [29, 42]) for hypertension. Heterogeneity was high (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009&gt;\u200995%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 throughout). Education, self-efficacy, and social support emerged as cross-cutting determinants most consistently associated with adherence. A key limitation is the high statistical heterogeneity, which persisted despite random-effects modeling and subgroup analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adherence across treatment pillars is suboptimal. Education, self-efficacy, and social support represent priority candidates for future interventional studies aimed at improving adherence. The review was registered with PROSPERO (CRD42024626793).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1005189","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:31:19Z","timestamp":1785778279000},"page":"e1005189","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adherence to medications, lifestyle advice, and self-monitoring for type 2 diabetes and hypertension in sub-Saharan Africa: A systematic review, meta-analysis, and interactive network analysis"],"prefix":"10.1371","volume":"23","author":[{"given":"Angeliki","family":"Apostolou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reuben","family":"Simfukwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4798-3831","authenticated-orcid":true,"given":"Adrias","family":"Saint","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget","family":"Mushani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Chekhchar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9667-2076","authenticated-orcid":true,"given":"Pearl","family":"Aovare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7459-6914","authenticated-orcid":true,"given":"Kouamivi M.","family":"Agboyibor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3032-405X","authenticated-orcid":true,"given":"Karlijn A. 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