Effects of integrated interventions on transmission risk and care continuum outcomes in persons living with HIV

Abstract

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 target multiple problem behaviors simultaneously in an integrated approach (referred to as integrated interventions) may improve prevention and care outcomes of persons living with HIV (PLWH). 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 were designed to target at least two of the following behaviors among PLWH: HIV transmission risk behaviors, HIV care engagement, and medication adherence. Effect sizes (ESs) 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, 13 ESs) and had marginally significant effects on improving medication adherence behaviors (OR = 1.35, 95% CI = 0.98, 1.85, p = .063, 12 ESs) and undetectable viral load (OR = 1.46, 95% CI= 0.93, 2.27, p = .098, 7 ESs). 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. Conclusions Integrated interventions produced some favorable prevention and care continuum outcomes in PLWH. How to incorporate integrated interventions with other Combination HIV Prevention strategies to reach the optimal impact requires further research.

Durable Viral Suppression and Transmission Risk Potential Among Persons With Diagnosed HIV Infection: United States, 2012–2013

“…2,18, 19 Several integrated interventions that target multiple risk behaviors simultaneously have shown to improve risk reduction behaviors and care outcomes of HIV-infected person. 20 Those integrated interventions are additional resources for providers to consider when referring patients to more intensive interventions.…”

Acute Alcohol Consumption Directly Increases HIV Transmission Risk: A Randomized Controlled Experiment

“…71-74 ), but also with ART adherence promotion programs to help maintain HIV viral suppression in order to reduce viral transmissibility. 11 (see also 75 )…”

Integrated care of severe infectious diseases to people with substance use disorders; a systematic review

“…In the hospital setting, WHO defined integrated care as: “ an approach to strengthen people-centred health systems through the promotion of the comprehensive delivery of quality services across the life-course, designed according to the multidimensional needs of the population and the individual and delivered by a coordinated multidisciplinary team of providers working across settings and levels of care (…) ” [16]. However, this definition is arguably too broad and unspecific, hence, for the purpose of this paper we have chosen to alter the definition of integrated care to “comprehensive set of patient-centered health services that involve the care of chronic infectious disease as a part of coordinated services for people with SUD.” Integrate care models and collaborative health services may improve health outcomes to medical care, as well as reduce the burden of disease among people with physical and mental disorders [17], prevent severe infectious diseases [18], improve engagement in TB services [19], and increase patients adherence and staff satisfaction [11]. Systematic reviews suggest that the composition of the integrated models must be described in more detail to identify effective integrated care models that can be implemented in various settings [11, 18–20].…”

“…However, this definition is arguably too broad and unspecific, hence, for the purpose of this paper we have chosen to alter the definition of integrated care to “comprehensive set of patient-centered health services that involve the care of chronic infectious disease as a part of coordinated services for people with SUD.” Integrate care models and collaborative health services may improve health outcomes to medical care, as well as reduce the burden of disease among people with physical and mental disorders [17], prevent severe infectious diseases [18], improve engagement in TB services [19], and increase patients adherence and staff satisfaction [11]. Systematic reviews suggest that the composition of the integrated models must be described in more detail to identify effective integrated care models that can be implemented in various settings [11, 18–20]. Previous systematic reviews have mostly identified descriptive reports or cohort studies, and only few randomized controlled trials (RCTs) [11, 17, 21].…”