Interventions to enhance HIV medication adherence among individuals using substances: a systematic review and critique of the literature

Medication adherence is essential to achieve sustained viral suppression for individuals living with human immunodeficiency virus (HIV). The use of alcohol and substances may interfere with medication adherence and lead to adverse outcomes. Thus, this review sought to examine the literature on behavioral interventions that improve medication adherence among individuals with HIV who are using alcohol or drugs. Articles were included if they met the following criteria: (a) included individuals diagnosed with HIV (b) were published in English between January 1, 2000 and June 15, 2023, (c) evaluated a behavioral intervention to increase medication adherence, (d) reported at least one medication adherence outcome, (e) were randomized controlled trials or quantitative pre-post designs, and (f) were comprised primarily of individuals using alcohol or drugs. Twenty-two papers representing 20 unique studies were included in the review. Most were undertaken in the United States. Multiple interventions demonstrated efficacy in increasing medication adherence among individuals using alcohol or substances. Interventions with structural intervention components or delivered via text/mHealth also demonstrated relatively consistent efficacy support. Findings were mixed regarding reductions in alcohol and/or substance use, as well as sustaining improvement in medication adherence. Recommendations for future trials include diversifying recruitment methods and examining scalability.