Interventions to Improve HIV Care and Treatment Outcomes Among People with HIV Who Have Substance Use Disorder or At-Risk Substance Use: A Narrative Review

Abstract

Substance use adversely affects engagement in HIV care, adherence to medication, and HIV viral suppression. This review assessed the scope of US interventions designed to promote positive outcomes along the HIV care continuum for people with HIV who have substance use disorder (SUD) or at-risk substance use. A literature search identified 27 interventions published in peer-reviewed articles found on PubMed and PsycINFO databases between January 1, 2019, and December 31, 2023. Common strategies to improve HIV care continuum outcomes included support for HIV medication adherence, motivational interviewing, medications to treat SUD, contingency management, cognitive-behavioral skills building, patient navigation, mindfulness practice, and low-barrier entry to care. Contingency management (offering financial or material incentives for attaining desired outcomes) alone or combined with other strategies was most consistently associated with positive HIV outcomes, but more research is needed to understand how these outcomes can be sustained. Few intervention studies addressed or measured linkage to care (12%) or retention in care (15%), despite a clear need to better engage this population. Further innovation is needed to improve HIV engagement and retention among people with SUD or at-risk substance use.