A Systematic Review of Antiretroviral Adherence Interventions for HIV-Infected People Who Use Drugs
HIV-infected persons who use drugs (PWUDs) are particularly vulnerable for suboptimal combination antiretroviral therapy (cART) adherence. A systematic review of interventions to improve cART adherence and virologic outcomes among HIV-infected PWUDs was conducted. Among the 45 eligible studies, randomized controlled trials suggested directly administered antiretroviral therapy, medication-assisted therapy (MAT), contingency management, and multi-component, nurse-delivered interventions provided significant improved short-term adherence and virologic outcomes, but these effects were not sustained after intervention cessation. Cohort and prospective studies suggested short-term increased cART adherence with MAT. More conclusive data regarding the efficacy on cART adherence and HIV treatment outcomes using cognitive behavioral therapy, motivational interviewing, peer-driven interventions and the integration of MAT into HIV clinical care are warranted. Of great concern was the virtual lack of interventions with sustained post-intervention adherence and virologic benefits. Future research directions, including the development of interventions that promote long-term improvements in adherence and virologic outcomes, are discussed.
KeywordsAntiretroviral therapy Intervention Adherence Persons who use drugs (PWUDs) HIV and drug use Combination antiretroviral therapy (cART) Viral load HIV treatment outcomes Antiretroviral adherence interventions Behavioral aspects of HIV management Substance abuse
The authors would like to acknowledge Paula Dellamura and Kathleen R. Hamill for their editorial assistance in the preparation of this manuscript and all study authors who responded to inquiries about relevant papers. We would also like to thank the National Institutes on Drug Abuse for career development support (K24 DA017072 for FLA). The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of the National Institutes on Drug Abuse or any of the sponsoring organizations, agencies, or the U.S. government.
Binford: none; Kahana: none; Altice: consultant for Bristol-Myers Squibb, honoraria and travel/accomodation assistance from Bristol-Myers Squibb, Merck, Genentech and Simply Speaking.
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