Systematic Review and Network Meta-Analysis of Psychosocial Interventions on Antiretroviral Therapy Adherence

Antiretroviral therapy (ART) is crucial for prolonging the lives of people with human immunodeficiency virus (HIV), but adherence remains suboptimal. Psychosocial interventions show promise for improving ART adherence, yet no consensus exists on the most effective approach.

To identify the most effective psychosocial interventions for improving ART adherence in people with HIV.

Six databases (EMBASE, MEDLINE, Web of Science, CINAHL, PsycINFO, and CENTRAL) were searched from their inception to April 2024, yielding 35 studies with 7,808 participants. Traditional pairwise and network meta-analyses were conducted to compare psychosocial interventions. Meta-regression and subgroup analyses were performed to examine the relationships among intervention efficacy and participant characteristics as well as intervention duration.

Eight interventions were identified. Pairwise meta-analysis showed psychosocial interventions significantly improved ART adherence. Network meta-analysis found that multicomponent interventions were the most effective. Meta-regression showed no significant effect of participant characteristics on efficacy. The subgroup analyses found that multicomponent interventions were effective in both the short and long term, whereas case management had positive but less robust short-term effects.

Multicomponent interventions appear to be the most effective psychosocial strategy to promote ART adherence. However, feasibility and cost-effectiveness may constrain use in resource-limited settings. Future research should focus on identifying optimal and simplified intervention packages tailored to specific subpopulations of people living with HIV.