Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review


  • Monica Malta,

    Corresponding author
    1. Social Science Department, Sergio Arouca School of Public Health (DCS/ENSP), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil,
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  • Steffanie A. Strathdee,

    1. Division of International Health and Cross Cultural Medicine, Department of Family and Preventive Medicine at University of California, San Diego (UCSD) School of Medicine, San Diego, CA, USA,
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  • Monica M. F. Magnanini,

    1. Institute of Public Health Studies, Federal University of Rio de Janeiro (IESC/UFRJ), Rio de Janeiro, Brazil and
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  • Francisco I. Bastos

    1. Health Information Department, Center for Scientific and Technological Information (DIS/CICT), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Monica Malta, Oswaldo Cruz Foundation, Rua Leopoldo Bulhoes, 1480—Room 905, Manguinhos, Rio de Janeiro, RJ 21041-210, Brazil. E-mail:


Aims  Adherence to highly active antiretroviral therapy (HAART) is a key predictor of survival for human immunodeficiency virus (HIV)-infected people. Suboptimal adherence among marginalized populations such as HIV-positive drug users could be associated with clinical failure and the emergence of viral resistance.

Objective  To conduct a systematic review of studies assessing adherence to HAART among HIV-positive drug users (DU) and identify factors associated with non-adherence to HIV treatment.

Data sources  Seven electronic databases were searched for peer-reviewed papers published in English, French, Spanish or Portuguese, from 1996 to 2007.

Study selection and data abstraction  Studies were excluded if they presented only qualitative data, were reviews themselves or assessed other populations without disaggregating data on DU. Findings on adherence were extracted and summarized.

Data synthesis  Forty-one studies were considered, which studied a total of 15 194 patients, the majority of whom were HIV-positive DU (n = 11 628, 76.5%). Twenty-two studies assessed adherence using patient self-reports, eight used pharmacy records, three used electronic monitoring [i.e. Medication Event Monitoring Systems (MEMS) caps], six studies used a combination of patient self-report, clinical data and MEMS-caps, and two analyzed secondary data. Overall, active substance use was associated with poor adherence, as well as depression and low social support. Higher adherence was found in patents receiving care in structured settings (e.g. directly observed therapy) and/or drug addiction treatment (especially substitution therapy).

Conclusion  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. Better adherence was identified among those engaged in comprehensive services providing HIV and addiction treatment with psychosocial support.