Multicomponent psychosocial interventions improve antiretroviral therapy adherence in people with HIV

This systematic review and network meta-analysis examined the efficacy of psychosocial interventions designed to improve antiretroviral therapy adherence in people with HIV. The study population comprised 7,808 individuals living with HIV. The setting for the included studies was not reported in the source data. The primary focus was on strategies to enhance adherence to antiretroviral therapy regimens. The review synthesized evidence from multiple studies to determine which psychosocial approaches yielded the best outcomes.

The analysis identified that multicomponent interventions were the most effective strategy for improving antiretroviral therapy adherence. These interventions typically combine multiple psychosocial strategies rather than relying on a single approach. The review found that these multicomponent interventions were effective in both the short and long term. This suggests that sustained engagement and multiple touchpoints may be necessary to maintain adherence over time.

Case management interventions were also evaluated within the review. The data indicated that case management had positive but less robust short-term effects compared to multicomponent approaches. This distinction highlights the importance of intervention complexity in driving adherence improvements. The review did not report specific effect sizes, absolute numbers, or confidence intervals for these comparisons. The direction of the effect was consistently toward improved adherence for the active interventions.

Subgroup analyses explored whether participant characteristics influenced intervention efficacy. The review found no significant effect of participant characteristics on efficacy. This suggests that the benefits of psychosocial interventions may be consistent across different patient subgroups. The study did not report specific adverse events, serious adverse events, discontinuations, or tolerability data. Safety information was not reported in the source material.

The authors noted that feasibility and cost-effectiveness may constrain the use of these interventions in resource-limited settings. While the efficacy data supports the clinical utility of multicomponent strategies, practical implementation barriers remain. The review did not provide specific funding or conflict of interest disclosures. These limitations should be considered when interpreting the generalizability of the findings to different healthcare environments.

Clinicians should consider that multicomponent psychosocial interventions appear to be the most effective strategy to promote antiretroviral therapy adherence. However, the lack of reported p-values, confidence intervals, and absolute numbers limits the precision of the quantitative conclusions. The absence of reported safety data means that adverse event profiles remain unknown based on this synthesis. Future research should address these gaps to provide a more complete picture for clinical decision-making.

Several questions remain unanswered regarding the optimal delivery methods and long-term sustainability of these interventions. The review did not report specific follow-up durations for the included studies. Understanding the specific components that drive efficacy in multicomponent interventions would also be valuable. Clinicians must balance the demonstrated efficacy with the practical constraints of resource availability when selecting interventions for their patients.