Effects of integrated interventions for reducing HIV transmission risk and improving care continuum outcomes among persons living with HIV in the United States: A systematic review and meta-analysis, 1996-2014

Background. Reducing HIV infection and improving outcomes along the continuum of HIV care are high priorities of the U.S. National HIV/AIDS Strategy. Interventions that address multiple issues faced by persons living with HIV (PLWH) simultaneously  (referred to as integrated interventions) may optimize prevention and care outcomes. This systematic review and meta-analysis examines the effects of integrated interventions. 

Methods. A systematic review, including both electronic and hand searches, was conducted to identify randomized controlled trials (RCTs) published between 1996 and 2014 that addressed at least two of the following issues faced by PLWH: HIV transmission risk behaviors, HIV care engagement, and medication adherence. Effect sizes were meta-analyzed using random-effects models.

Results. Fifteen RCTs met the inclusion criteria. Integrated interventions significantly reduced sex without condoms (odds ratio [OR] = 0.74, 95% CI = 0.59, 0.94, p = .013) and had marginally significant effects on improving medication adherence behaviors (OR = 1.35, 95% CI = 0.98, 1.85, p = .063) and undetectable viral load (OR = 1.46, 95% CI= 0.93, 2.27, p = .098). Significant intervention effects on at least two outcomes were seen in RCTs tailored to individual needs, delivered one-on-one, or in settings where PLWH received services or care. A limited number of studies prevented further examination of intervention strategies that work best for specific subgroups.

Conclusions. Integrated interventions that address multiple issues at one time produced some favorable prevention and care outcomes in PLWH. The extent to which integrated interventions work for subgroups of PLWH requires further research.