title: A systematic review of antiretroviral adherence interventions for HIV-infected people who use drugs.
abstract: 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.
authors.affiliation: Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510-2283, USA.
authors.forename: Meredith Camp
authors.initials: MC
authors.lastname: Binford
authors.forename: Shoshana Y
authors.initials: SY
authors.lastname: Kahana
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D057189:Checklist; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D015497:HIV-1; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D014481:United States / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents