Abstract This scoping review mapped multilevel public health strategies aimed at improving medication adherence in underserved populations and identified conditions that could facilitate equitable scaling up. Guided by the Population–Concept–Context (PCC) framework and reported according to PRISMA-ScR, a search was conducted in MEDLINE (PubMed), Embase, CINAHL, Scopus, LILACS, Global Health, Cochrane CENTRAL, and African Index Medicus from 2014 to 2025. Following de-duplication and two-stage screening, 16 empirical studies relating to hypertension/cardiovascular, human immunodeficiency virus (HIV), and tuberculosis care were included. The evidence was categorised into three strategy families: (i) proximal supports (e.g., monitoring/ structured reminders and simplification/regimen packaging); (ii) service-delivery redesign (e.g., adherence clubs, community/home delivery, differentiated refills, and task-sharing); and (iii) financing levers and enabling policy (e.g., demand-side support, insurance/financial protection). Across the studies, improvements were most consistently reported for persistence/retention and refill continuity. ‘Adherence’ was frequently measured using proxy indicators (e.g., medication possession ratio/proportion of days covered, visit/collection adherence), and clinical control outcomes were variably reported. Equity stratifiers were often described in the context of the study, but were analysed inconsistently in disaggregated form. Overall, the evidence suggests benefits of context-tailored bundles, but these are limited by proxy metrics, a lack of economic and equity analysis, heterogeneity, and short follow-up periods. Future studies should prioritise explicit equity-stratified reporting, standardised adherence and continuity outcomes, and pragmatic evaluations that incorporate feasibility, implementation fidelity, and economic endpoints, in order to inform the equitable, scalable adoption of multilevel adherence strategies.
Wiafe et al. (Tue,) studied this question.