Adherence to HAART for HIV Among Drug Users: A Systematic Review

To identify factors associated with non-adherence to HIV treatment among HIV-positive drug users (DU), the researchers concluded a systematic review of studies assessing adherence to highly active antiretroviral therapy (HAART) among this population. Seven electronic databases were searched for peer-reviewed papers published between 1996 and 2007 in English, Spanish, French or Portuguese. Studies were not included if their data were qualitative only; if they were reviews themselves; or if they assessed other populations without disaggregating data on DU.

Searching with these criteria identified 41 studies assessing 15,194 patients, of whom 76.5 percent (11,628) were HIV-positive DU. Of the studies, 22 used patient self-reports to assess adherence; eight used pharmacy records; three used electronic monitoring (i.e., Medication Event Monitoring Systems, or MEMS-caps); six utilized a combination of patient self-report, clinical data and MEMS-caps; and two analyzed secondary data.

Active substance use was associated with poor adherence, as well as with depression and low social support. Higher adherence was noted in patients being cared for in structured settings (e.g., directly observed therapy) and/or addiction treatment (particularly substitution therapy).

"While lower than other populations -- especially among users of stimulants, incarcerated DU, and patients with psychiatric comorbidities -- adherence to HAART among HIV-positive DU can be achieved," the authors concluded. "Better adherence was identified among those engaged in comprehensive services providing HIV and addiction treatment with psychosocial support."

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