Recent Antiretroviral Therapy Models Implemented to Achieve Viral Suppression among People Living with Human Immunodeficiency Virus: A Systematic Review

Timothy Adejoh Attah; Solomon Jonathan Hussaini; Olamide Smart Aiyedogbon; Abubakar Adamu

doi:10.5772/intechopen.1009634

Abstract

This is a systematic review of interventions adopted to improve viral outcomes of people living with human immunodeficiency virus (PLHIV). A search was performed on Science Direct and NCBI to select peer-reviewed articles based on the inclusion criteria. Titles, abstracts and full text were screened and relevant articles were selected into the review. Financial incentives were found to improve viral suppression among PLHIV. Psychosocial intervention demonstrated varying virologic outcomes. Differentiated service delivery including task shifting, community ART and home-based ART had higher viral suppression compared to standard care. Technology-related interventions including personalized text messaging, and computer-based counseling improve viral suppression. Other interventions like integrated HIV care services and monitoring of drug resistance improved or maintained viral suppression. Many interventions have been adopted and have improved virologic outcomes across the globe. However, Other research should be conducted to ensure more robust evidence for optimizing virologic outcomes of PLHIV.

Keywords

human immunodeficiency virus
antiretroviral therapy
universal ART coverage
viral suppression
HIV models

Author Information

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Timothy Adejoh Attah *
- Department of Physical and Life Sciences, National Space Research and Development Agency, FCT-Abuja, Nigeria
Solomon Jonathan Hussaini
- Department of Physical and Life Sciences, National Space Research and Development Agency, FCT-Abuja, Nigeria
Olamide Smart Aiyedogbon
- AIDS Prevention Initiative, Public Health Initiatives, FCT-Abuja, Nigeria
Abubakar Adamu
- Department of Physical and Life Sciences, National Space Research and Development Agency, FCT-Abuja, Nigeria

*Address all correspondence to: attah_adejoh@yahoo.com

1. Introduction

Globally, antiretroviral therapy (ART) has been identified as the single significant cornerstone for maintaining the quality of life of people living with the human immunodeficiency virus (PLHIV). However, there are concerns about access to ART for PLHIV, especially in resource-limited areas. As of June 2021, the United Nations member State adopted the ambitious 95-95-95 target toward ensuring that 95% of PLHIV identify their status, 95% of PLHIV who know their status are on ART, and 95% of PLHIV on ART are virally suppressed by 2030 [1]. Globally, there are an estimated 40 million PLHIV, of which 95% know their status, 60% are on ART and 97% are virally suppressed [1, 2]. While there is significant progress in achieving these targets, there are disparities in coverage for ART among PLHIV, especially in low-and-middle-income countries (LMICs) where there are poor health infrastructures and resources to improve ART.

Given the need to address these limitations, there is a need for evidence-based interventions to improve access to ART for PLHIV. Numerous interventions and models have been adopted globally to first overcome the limitation of access to ART, ensure optimum health service delivery, and provide equitable and sustainable treatment for PLHIV while working toward achieving universal coverage in LMICs. However, it is important to understand the interventions that have been implemented to achieve a global decline in the prevalence of HIV. This will help to identify the successes and limitations of implemented strategies in addressing treatment gaps and achieving universal access to ART. Additionally, an adequate understanding of HIV interventions implemented can inform health policies to optimize treatment outcomes and achieve the ambitious UNAIDS targets.

Globally, the target toward eliminating HIV has focused on the prevention of new infections for those at risk and the improvement of the quality of life of PLHIV. Viral suppression, as indicated in the UNAIDS targets, is also critical in achieving the elimination of HIV across the globe by preventing transmission across the population and improving the quality of life among PLHIV. However, the major barrier to achieving viral suppression, especially in resource-limited areas, is the limited access to ART. Studies have shown that access to ART can be improved through various patient-centered and community-based models and interventions. However, some of these interventions have not been implemented in areas where they are needed or may help to improve access. According to the UNAIDS targets, about 23% of PLHIV do not have access to ART and 28% of ART are virally unsuppressed, despite 86% of PLHIV being aware of their status in 2023 [3]. This study reviews the non-pharmaceutic models and interventions implemented to achieve the third 95% of the UNAIDS targets since the global adoption of the 90-90-90 targets in 2014.

2. Method

2.1 Study design

A systematic review was conducted on NCBI and Science Direct to identify relevant articles on models adopted to achieve viral suppression among PLHIV across the globe.

2.2 Search term

Key search term used in this study were Effect of AND (((((((((((((differentiated care) OR (community ART)) OR (antiretroviral therapy)) OR (community pharmacy)) OR (task shifting)) OR (multi-month dispensing)) OR (long acting injectables)) OR (universal test and treat)) OR (Same-Day ART Initiation)) OR (SMS reminder)) OR (mobile app)) OR (electronic pill boxes)) OR (Antiretroviral therapy to key populations)) AND (HIV treatment outcomes), Model of care for HIV.

2.3 Inclusion criteria

In this review, only studies conducted after the UNAIDS adoption of the 90-90-90 targets were included in this review. Thus, peer-reviewed randomized controlled trials (RCT) and quasi-experimental studies (QES) published between 2015 and 2024 that included drug delivery/access interventions to improve ART access and had information on viral suppression were selected for inclusion in the review. Studies conducted before 2015 that utilized non-experimental study designs or had no information on viral suppression of PLHIV were excluded from the review.

2.4 Search strategy

We conducted a literature search in four stages. First, titles were screened and selected for relevance and inclusion in the next stage. This was followed by the screening of abstracts in which studies relevant to the search were included for the final screening of full-text, while articles that were irrelevant or did not meet the inclusion criteria were excluded. Finally, the full text of selected abstracts was screened for relevance, and studies that met the inclusion criteria were finally selected for inclusion into the review.

2.5 Quality assessment

Quality assessment was performed on the full text of all studies included in this review based on the inclusion criteria. As a result, we adopted the JBI assessment checklist for RCT and QES and this assessment was conducted by one independent reviewer. The checklist for RCT assessed the quality of randomization in terms of selection, concealment of allocation, blinding of study participants, study implementers, and outcome evaluators, as well as the group similarities and quality of statistical analysis (Table A1) [4]. The quality assessment of QES included an assessment of the study objectives, inclusion of comparison groups, multiple measurements, and analysis of study outcomes (Table A2) [5].

2.6 Data extraction and synthesis

Data that were relevant to this review were extracted such as first authors, date of publication, country, number of participants, study design and study objectives, intervention administered, period of recruitment and follow-up, and number of participants in intervention and control group. Also, data on statistics of the viral outcomes of PLHIV were extracted and included in the review, and data was synthesized to answer the study objectives.

3. Result

Based on the search term, Science Direct produced 50,474 and NCBI 4784 outputs of which 208 titles from Science Direct, 750 from NCBI and 12 from references were selected for inclusion. A total of 18 duplicates were removed, resulting in 952 titles selected for inclusion. Abstracts of these titles were screened, of which 813 were excluded, and 139 abstracts were retrieved for full-text screening. 56 of the full text were excluded, and 83 were retrieved for the final screening. Of the 83 full-text articles selected, 36 had no information on viral suppression (VS) and were excluded from the review. Finally, 47 articles met the inclusion criteria and were selected for the review (Figure 1).

Figure 1.
PRISMA flowchart of articles selected for participation.

Of the 47 studies selected in this review, nine studies were conducted in the United States and seven in Zimbabwe. Six studies were conducted in South Africa and Tanzania and three in Kenya and Nigeria. Only two studies were conducted in Vietnam, Zambia and Uganda. Also, only one study was conducted in China, Malaysia, and Russia. Four studies were conducted on populations from different countries, of which two were conducted in Uganda and Kenya, one in South Africa and Zambia, and one in Ukraine, Vietnam and Indonesia) (Table 1).

Country	Number of Studies
The United States	9
South Africa	6
Zambia	2
South Africa and Zambia	1
Nigeria	3
China	1
Uganda	2
Kenya	3
Uganda and Kenya	2
Tanzania	6
Zimbabwe	7
Vietnam	1
Malaysia	1
Russia	1
Ukraine, Vietnam and Indonesia	1
Zimbabwe and Lesotho	1

Table 1.

Number of articles selected by country of study.

Articles in this review assessed the effect of numerous non-pharmaceutical interventions on VS among PLHIV across the globe. These interventions were further divided into financial incentives, psychosocial support, differentiated care, the use of applications, and other interventions, respectively (Figure 2).

Figure 2.
Summary of interventions implemented to achieve viral suppression amongst PLHIV.

3.1 Financial incentives and viral suppression

A study conducted in Tanzania found that adults on ART who were administered short-term financial incentives had higher VS (84.9%) compared to those in standard care (80.6%) (RD: 4.6%, 95%CI: 1.5–11.0%) [6]. Also, another study in Tanzania found that after 6 months of intervention, small (93.8%) and large (94.9%) financial incentives increased the odds of VS when compared with standard care (87.1%) (aOR (small FI): 1.10, 95% CI: 1.03–1.17) [7]. In Nigeria, a study found that conditional economic incentives at 12 months increased VS from 21.8% at baseline to 31.9% after follow-up, while in the control group, VS reduced from 42.5% at baseline to 40.9% after follow-up (IRR: 1.01, 95% CI: 0.72–1.41), p:.96) [8]. Economic empowerment after 48 months was found to increase VS in a study conducted in Uganda (HR: 1.45, 995% CI: 1.07–1.95, p: .0155) [9] (Table 2).

Author, Date, Country, sample size	Study objective, and Study design	Model adopted, period of observation	Number per intervention group	HIV outcome
Limbada et al., 2022, South Africa and Zambia, 2489 [10]	A randomized controlled trial (RCT) to assess virological suppression of models of care compared to standard of care at 12 months after enrollment	Home-based delivery (HBD), adherence club (AC), Standard of care (SoC), 12 months	Intervention HBD: 852 (34%) AC: 856 (34%) Control SoC: 781(31%)	12 months Known VS (Risk) (interv/SoC) HBD: 61.3% AC: 57.0% SoC: 49.7% 20–24 months Estimated VS HBD: 98.9% AC: 98.7% SoC: 99.2%
Fanfair et al., 2021, United States, 1893 [11]	An RCT to utilize Data to Care (D2C) model to identify out-of-care PLHIV and implement public health intervention to improve HIV care and outcome	Data to Care, August–October 2016(recruitment)-July 2018	Intervention D2C: 959 Control SoC: 935	VS D2C: 64.2% (P:.22) SoC: 61.5%
Samet et al., 2023, Russia, 225 [12]	An RCT to assess the effectiveness of multi-component pragmatic intervention, designed to link PWHIV in addiction treatment to HIV care and achieve viral load suppression	Linking Infectious and Narcology Care Part 2 (LINC-II) intervention, September 19 2018 to December 25, 2020	Intervention LINC-II: 111 Control SoC: 114	12 months VS LINC-II: 47% SoC: 23% Int/SoC aOR = 3.0, P:.0039 RR = 2.1
Patel et al., 2023, Kenya, 704 [13]	An RCT to evaluate if using higher frequency point of care (POC) viral load with targeted drug resistant monitoring (DRM) and clinical decision support (CDS) for children aged 1–14 years on ART could improve VS	POC viral load with targeted DRM testing and CDS (POCVL-DRM-CDS), March 2019–December 2020	Intervention POC-VL-DRM-CDS: 349 Control SoC: 355	VS (< 1000 c/ml) POCVL-DRM-CDS: 90.4% Control: 91.8% RR = 0.99, P:.55
Njau et al., 2024, Tanzania, 1990 [6]	A type 1 hybrid effectiveness-implementation cluster-randomized trial to evaluate the effectiveness of short-term financial incentives on viral suppression and retention in care among adults initiating ART at 32 HIV primary care clinics	Short-term financial incentives (S-TFI), May 28, 2021-March 7, 2022 (recruitment) to July 14, 2023 (intervention)	Intervention S-TFI: 1059 Control SoC: 931	12 months VS (<1000 c/ml) and RiC S-TFI: 84.9% SoC: 80.6% RD: 4.6% (1.5%–11.0%)
Fahey et al., 2020, Tanzania, 530 [7]	Three-arm parallel-group RCT to determine whether varied size of financial incentives for clinic attendance impact viral suppression among patients in ART.	Financial incentive for clinic attendance, April 24, 2018, to December 14, 2018 (randomization) to June 20, 2019 (follow-up)	Intervention 10,000TZS: 172 22,500 TZS: 174 Control No incentive: 184	6 Months VS (<1000 c/ml) 10,000TZS: 93.8% 22,500 TZS: 94.9% No incentive: 87.1% OR: 1.10/2500 TZS, (1.03–1.17) P = 0.0032
Wachira et al., 2023, Kenya, 328 [14]	A pilot RCT to assess the impact of a patient-centered intervention referred to as Enhanced Patient Care (EPC) on viral suppression among unsuppressed patients living with HIV in Kenya	Enhanced Patient-centered (EPC), provider-patient communication interventions, September 2017	Intervention PPC + EPC: 110 Control PPC+ SoC: 110 SoC: 108	6 months VS PPC + EPC: 84.4% (Ref) PPC+ SoC: 83.7% SoC: 64.4% aOR(PPC+ SoC) = 0.97 (0.45–2.08) aOR (SoC) = 0.36 (0.18–0.72)^*
Drain et al., 2020, South Africa, 390 [15]	An open-label non-inferiority RCT to assess whether task shifting changed treatment and care outcomes for adults on ART when compared to standard care	Task Shifting (TS), February 24 to August 23, 2017 (recruitment)	Intervention TS: 195 Control SoC: 195	12 months VS (<1000 c/ml) TS: 90.0% SoC: 78.0% RD: 12.3% (5.1–19.5%) p-value:.0013
Ruel et al., 2023, Kenya and Uganda, 1549 [16]	A cluster-RCT to evaluate the effect of the SEARCH-Youth intervention in increasing the proportion of participants (15–24 years) with viral suppression	SEARCH-Youth intervention, January 2019 to March 1, 2022	SEARCH-Youth:7 85 SoC: 764	24 months VS SEARCH-Youth: 88% (85–92) SoC: 80% (77–84%) RR: 1.10 (1.03–1.16) p-value:.0019
Mavhu et al., 2020, Zimbabwe, 500 [17]	A cluster-RCT to assess a peer-led differentiated service delivery intervention on HIV clinical and psychosocial outcomes among adolescents with HIV	Peer-led differentiated service delivery (PLDSD) intervention, August 15, 2016 to March 31, 2017 (recruitment) – 96 weeks	Zvandiri: 212 Control: 284	96 weeks VS ≥ 1000 c/μl Zvandiri: 22% Control: 36% aPR: 058 (0.36–0.94) P-value:.03
Miller et al., 2018, Ukraine, Vietnam, Indonesia, 1004 [18]	A RCT to assess the feasibility of a future controlled trial based on incidence of HIV, enrollment, retentions, uptake of intervention and efficacy of an integrated and flexible intervention on ART use, viral suppression and medication-assisted treatment (MAT) use.	(HAPTEN 074) intervention comprising systems navigation, psychosocial counseling, and ART at any CD4 count. February 2015 to June 2016 (recruitment) – 12–24 months	HTPN 074: 502 SoC: 502	52 weeks VS (<40 c/ml) HTPN: 74: 41% SoC: 24% PR: 1.7(1.3–2.2)
Ekwunife et al., 2022, Nigeria, 246 [8]	A cluster-RCT to evaluate the 1-year impact of conditional economic incentives and motivational interviewing on the health outcomes of adults living with HIV	Conditional economic incentives (CEI), December 1, 2018 to November 30, 2019	CEI: 119 Control: 127	12 Months VS (≤20 c/ml) CEI Baseline: 21.8% After follow-up: 31.9% Control Baseline: 42.5% After follow-up: 40.9% IRR: 1.01 (0.72–1.41) p-value: .96
Kwaghe et al., 2023, Nigeria, 171 [19]	A facility-based retrospective study to evaluate the effectiveness of community-based private sector pharmacies to expand ART	Community pharmacy, June 2018 to May 2021	Community pharmacy: 171	12 months Mean (median) VL Pre: 399.3(20.0) Post: 259.5(20.0) t-test: −0.51 p-value: .612
Dakum et al., 2021, Nigeria, 251 [20]	A quasi-experimental study to assess the effect of community antiretroviral therapy (ART) group on immunologic, virologic and clinical outcomes of stable adult ART patients	Community ART group (CAG), August 2017 (recruitment) Follow-up: 1 year	CAG: 251	12 months Log₁₀ VL Baseline: 3.5 (2.4–3.7) Follow-up: 3.7 (3.4–4.0) p-value:.40
Jiao et al., 2022, China, 576 [21]	An RCT to evaluate the effect of a differentiated digital intervention on ART adherence among men who have sex with men living with HIV	Differentiated digital intervention (DDI), October 19 2020–December 4 2020 (recruitment) Follow-up: October 19, 2020 to June 31, 2021	DDI: 288 SoC: 288	9 months VS RR: 1.39 (0.64–3.05) In-text message: 1.28 (0.15–10.59) Instant message: 0.85(0.27–2.62) Instant message + social media: 3.06(0.70–13.33)
Meya et al., 2022, Uganda, 1011 [22]	A quasi-experimental study to evaluate the impact of an intensive case management on HIV treatment outcomes	Intensive case management on HIV treatment outcomes, January 1, 2017 to December 31 2017 (pre-intervention), June 13, 2018 to June 30, 2019 (post-intervention)	Pre-intervention: 606 Post-intervention: 405	12 months VS Pre-intervention: 87% Post-intervention: 87%
Fatti et al., 2020, Zimbabwe, 4800 [23]	A three-arm unblinded pragmatic non-inferiority trial to compare multi-month dispensing (MMD) with community ART refill groups (CARG) vs. SoC ART delivery	MMD, CARG, August 2017 to February 2018, 12 months (follow-up), 5	Control arm (ART at three monthly intervals at facility): 1919 Intervention arm 1 (ART at three monthly intervals in CARG with annual clinical visits and consolations): 1335 Intervention arm 2 (ART at six-monthly intervals in CARG with annual clinic visits and consultations): 1546	12 months VS 3MF: 99.1% 3MC: 99.7 6MC: 92.9% RRR 3MC: 1.0 (1.0–1.0) p-value:.49 6MC: 0.9 (0.9–1.0) p-value:.070
Cowan et al., 2018, Zimbabwe, 2883 [24]	A cluster-RCT to assess the efficacy of targeted combination intervention for female sex workers	Sisters Antiretroviral Prevention Programme—an Integrated Response (SAPPH-IRe), 2014–2016	SAPPH-IRe: 1444 SoC: 1439	24 months VS < 1000 c/ml SAPPH-IRe: 72.0% (63.8–86.8%) SoC: 67.5% (61.4–73.1%) aRD: 5.3% (−4.0–14.6%) p-value:.20
Labhardt et al., 2018, South Africa, 278 [25]	Open-label 2-group RCT to determine whether offering same-day-based ART patients with HIV improves linkage to care and viral suppression in a rural high-prevalent setting	Same- day home-based ART (SDHBA), February 22, 2016 to September 17, 2017	SDHBA: 138 SoC: 140	VS < 100 c/ml SDHBA: 50.4% SoC: 34.3% aD: 16.0% (4.4–27.2%) p-value:.007
Abdulrahman et al., 2017, Malaysia, 242 [26]	A single0-blind parallel-group RCT to determine the effectiveness of mobile phone reminders (SMS and telephone call reminders) and peer counseling in improving adherence and treatment outcomes among HIV-positive patients on ART	Mobile phone reminders and peer counseling (MPRPC), January 2014 to December 2014	MPRPC: 121 SoC: 121	12 months VL Baseline MPRPC: 4.6 (4.44–4.78) SoC: 4.85 (4.67–5.02) Follow-up MPRPC: 1.4 (1.28–1.54) SoC: 1.76 (1.63–1.89) p-value:<.05
Wagner et al., 2021, United States, 166 [27]	A multi-site RCT to examine the effect of supporting treatment adherence readiness through training (START) on ART adherence and virologic suppression	START, follow-up (24 months)	START: 122 SoC: 93	6 months VS (<200 c/ml) START: 91.7% SoC: 83.3%% T: 1.17 p-value:.245 24 months VS (<200 c/ml) START: 67.3% SoC: 90.5% T: 1.12 p-value:.262
Fatti et al., 2021, Zimbabwe and Lesotho, 599 [28]	A cluster-RCT to determine effectiveness of community-based Differentiated Service Delivery (C-BDSD) for ART clients initiating DSD specifically within 12 months of ART initiation with single annual facility visits	C-BDSD, August 2017 to July 2019 (trial period)	3MC (CAG for 3 months): 128 6MC (CAG for 6 months): 259 SoC: 212	VS SoC: 99.3% 3MC: 98.6% 6MC: 98.1% 6MC: 98.1% RR (3MC/SoC): 0.99(0.97–1.02) p-value:.73 RR (6MC/SoC): 0.99 (0.96–1.01) p-value:.33 RR (6MC/SoC): 0.99 (0.96–1.03) p-value:.64
Gwadz et al., 2015, United States, 95 [29]	An RCT to examine a new culturally targeted multi-component intervention to address emotional, attitudinal, and social/ structural barriers to ART initiation and HIV car	Heart to Heart (HTH) intervention, 2012–2013	HTH: 47 SoC: 48	9 months VL HTH: 58.4 SoC: 40.0 OR: 1.80 (0.55–6.08) p-value:.296
Ssewamala et al., 2019, Uganda, 288 [9]	A cluster-RCT to test the effect of household economic empowerment (EE) among adolescents living with HIV in affected communities	EE, 2012–2018, 48 months (follow-up)	EE: 158 SoC: 130	48 months VS Hazard ratio: 1.45 (1.07–1.95) p-value:.0155
Mageda et al., 2023, Tanzania, 45 [30]	A preliminary cluster-RCT to evaluate the effectiveness of a community-based interventions (Konga model) in addressing factors contributing to low viral load suppression among children living with HIV	Konga (patient-centered interventions aimed at reducing the viral loads of children in terms of measurements, follow-up 6 months)	Konga: 15 SoC: 30	VL Konga: 165.13 Control: 516.70 F: 4.3 p-value:.0414
Hickey et al., 2020, Uganda and Kenya, 6190 [31]	A community cluster-RCT to evaluate the effect of streamlines care among those who newly linked to care after universal HIV testing in the SEARCH trial among adolescents and adults (age > 15 years) PLHIV	SEARCH (differentiated service delivery model), addresses structural barriers to care, improve relationships between patients and clinic and enhance patient and clinician knowledge of HIV and ART, 2013–2017	SEARCH: 3394 SoC: 2796	36 years VS (<500 c/ml SEARCH: 67% SoC: 47% RR: 1.41 (1.05–1.91)
Schnall et al. 2022, United States, 200 [32]	A randomized controlled efficacy trial to determine the efficacy of WiseApp, a user-centered design mHealth intervention to improve ART adherence and suppression in PLWH	WiseApp (self-management app for PLWH), January 31, 2018, to April 13, 2021 (recruitment), 6 months (follow-up)	WiseApp: 99 SoC: 101	6 months VS WiseApp/SoC p-value:.89
Fox et al., 2019, South Africa, 569 [33]	A cluster-RCT to evaluate five differentiated ART delivery interventions and present an evaluation of two strategies (adherence club and decentralized medication delivery) for clinically stable patients	Adherence club and decentralized medication delivery, enrollment: March 2017 to March-2017, 18 months (follow-up)	AC: 275 SoC: 294 DMD: 232 SoC: 346	18 months VS (<250 c/ml) Adherence Club AC: 95.2% SoC: 94.4% RD: 0.4% (−6.2–7.0%) Decentralized ART delivery DMD: 98.4% SoC: 90.2% RD: 2.9% (−4.2–10.0%)
Hayes et al., 2019, Zambia, 48,301 [34]	A community RCT to report results from the HPTN 071 (PopART) and its impact on viral suppression	HTPN 071 (PopART), 2013–2018	Arm A: 12671 Arm B: 1304 Arm C (SoC): 12399	VS Arm A: 71.9% Arm B: 67.5% Arm C: 60.2% Adjusted VS prevalence Arm A: 1.16 (0.99–1.47) p-value:.071 Arm B: 1.08 (0.92–1.27) p-value:.297
Go et al., 2020, Vietnam, 440 [35]	A 3-group RCT to determine the effect of two clinic-based behavioral interventions of varying intensity on alcohol use and viral suppression among individuals with HIV and hazardous alcohol use	Combines intervention (Personalized feedback, Consideration of pros and cons, Strategies for managing risky moods and situations for alcohol use, Alcohol refusal skills, Managing negative thoughts), brief intervention (personalized feedback, consideration of pros and cons, Strategies for managing risky moods and situations for alcohol use). Recruitment (March 2016 to May 2017), follow-up (12 months)	Combined: 147 Brief: 147 SoC: 146	VS < 20 c/ml Combined: 83.1% Brief: 80.2% SoC: 78.1% p-value:.06
Wohl et al., 2017, United States, 405 [36]	An RCT to compare the effects of impact multi-dimensional intervention to promote care engagement after release, to standard care on sustaining viral suppression after community re-entry	individuals motivated to Participate in Adherence, Care and Treatment (impact), March 2012 to February 2015 (recruitment), 24 weeks (follow-up)	impact: 195 SoC: 186	VS < 50 c/ml impact: 62% SoC: 63% aOR: 0.92 (0.55–1.54)
DiPrete et al., 2019, United States, 405 [37]	An impact trial aims to examine differences in ART adherence between study arms and provide an overall assessment of adherence to ART after release from prison	impact, recruitment (March 2012 to February 2015), follow-up (24 weeks)	impact: 195 (128) SoC: 186 (125)	6 months VS impact: 61% SoC: 61% p-value: >.05
Brijkumar et al., 2020, South Africa, 109 [38]	A quasi-experimental study to determine if viral load monitoring could be improved and the impact on these changes on virologic suppression	Package intervention (fact sheet on demographics, serial CD4 count and VL results; clinical chart in flow sheet for monthly visit; viral load sample log, and high viral load register), May 2014 to July 2018	Mkuze: 37 Jozini: 60 Bethesda: 12 109	VS (effect) Mkuze Total effect: 39.3% p-value:<.001 RR: 0.89 p-value:<.01 Bethesda CDC Total effect: 9.3% p-value:.12 RR: 0.86 p-value:.58 Jozini Total effect: 36.2% p-value:<.01 RR: 1.70 p-value:<.01
Sunpath et al., 2022, South Africa, 116 [39]	A pre and post implementation evaluation to assess the impact of the viral load champion model adapted to identify support and coordinate the management of individuals with virologic failure on first-line ART in a setting with limited electronic-abased record capacity	Viral load champion model, initiation (January 2017), pre-intervention (December 2015 to December 2016), post-intervention (January 2017 to December 2017)	Post-intervention: 56 Pre-intervention: 60	12 months VF Median Post-intervention: 19,443 (4751–82,910) Pre-intervention: 16,963 (5621–144,977) p-value:.64
Abuogi et al., 2022, Kenya. 1331 [40]	A cluster-RCT to evaluate the impact of two evidence-based behavioral interventions on adherence and retention in women living with HIV	Mother-Infant Visit Adherence and Treatment Engagement (MOTIVATE), December 2015 to August 2017	Text messaging only: 263 Community mentor mothers: 262 SoC: 253 cMM and text message: 264	12 months VS Text messaging only Undetectable: 44.9% <1000 c/ml: 6.6% >1000c/ml: 5.7% Community mentor mothers Undetectable: 44.8% <1000 c/ml: 9.4% >1000c/ml: 4.8% cMM and text message Undetectable: 51.5% <1000 c/ml: 7.8% >1000c/ml: 4.5% SoC Undetectable: 44.4% <1000 c/ml: 16.5% >1000c/ml: 6.0% P-value:.900
Cowan et al., 2024, Zimbabwe, 2137 [41]	A cluster open label-RCT to evaluate the effect of risk-differentiated, peer-led support for female sex workers	May 15, 2019, to June 1, 2019 (enrollment), follow-up (June 1, 2019, to December 13, 2021)	AMETHIST: 2131 SoC: 2137	12 months VS Intervention: 93.5% SoC: 88.8% aRD: 5·8% (2·7 to 8·8)
Ferrand et al., 2017, Zimbabwe, 470 [42]	An open-label RCT to assess the effect of community-based support for caregivers of HIV-infected children and adolescents who are key mediators to children engaging with care, on treatment outcomes	Community-based support (CBS), January 2013 to January 2015 (enrollment), follow-up (12 months)	CBS: 166 SoC: 168	12 months VF (≥400 c/mL) or mortality CBS: 33% SoC: 49% aOR: 0.46 (0.23–0.89) p-value:.02
Garofalo et al., 2016, United States, 133 [43]	An open-label RCT of a two-way personalized daily text messaging intervention to improve adherence to ART among 105 poorly adherent HIV-positive adolescents and young adults (16–29 years)	Personalized daily text message reminders (PDTMR), October 2010 to February 2014	PDTMR: 51 SoC: 54	6 months VS ≤ 75 copies/ml PDMTR: 70.8% SoC: 60.0% p-value:.272
Dow et al., 2020, Tanzania, 128 [44]	A random group treatment trial to establish the feasibility and acceptability of the Sauti ya Vijana (SYV): the voice of youth, intervention in preparation for a fully powered effectiveness trial	Sauti ya Vijana (SYV): the voice of youth, June 2016 to July 2017, 6 months (follow-up)	SYV: 55 SoC: 38	6 months VS < 400 c/ml SYV Baseline: 65.8% F6 months: 65.8% SoC Baseline: 64.8% 6 months: 74.5%
Pascoe et al., 2019, South Africa, 730 [45]	A cluster-RCT to evaluate the effect of a package of adherence interventions on the impact of fast-track treatment initiation counseling (FTIC) on ART initiation, adherence and retention	fast-track treatment initiation counseling (FTIC), January to December 2016 (recruitment), 18 months (follow-up)	FTIC: 362 SoC: 368	18 months VS < 400 c/ml FTIC Pre-intervention: 61.1% Pos intervention: 61.0% SoC Pre-intervention: 61.2% Post-intervention: 63.9% RD:-0.1 (−1.9–1.8%) DID: −1.9% (−9.1–5.4%)
Wagner et al., 2023, Tanzania, 391 [46]	A cluster-RCT to assess whether integrated depression care model is superior to usual care in helping women adhere to each step of the PMTCT care continuum, via depression alleviation	Maternal depression treatment in HIV (M-DEPTH), 42 months (follow-up)	M-DEPTH: 191 SoC: 200	VS < 400 c/ml OR: 1.19 (0.73–1.93)
Mukama et al., 2024, Uganda, 2668 [47]	An RCT to evaluate the effectiveness and responsiveness of differentiated HIV/AIDS service delivery models (DSDMs) implemented to enhance ART access and outcomes for patients while addressing Tuberculosis (TB)-HIV integration	Facility-based individual management (FBIM) model and non-facility base individual management (nFBIM) such as; CCLAD, CDDP, and the FTDR models. 12 months	Intervention CCLAD: 689(26.3%) CDDP: 546(20.9%) FTDR: 735(28.1%) Control FBIM: 645(24.7%)	12 months VS CCLAD: 94.4% CDDP: 96.9% FTDR: 96.5% FBIM: 76.3%
Melvin and Gipson. 2019, United States, 231 [48]	A quasi-experimental study to determine whether an integrated model of HIV care influenced linkage to health care, adherence to antiretroviral therapy, and viral load	Integrated HIV care services(ICS) model, January 1, 2015 through December 31, 2017	ICS: 231	VS 2015: 59% 2016: 76% 2017: 81%
Haas et al., 2023, Zimbabwe, 516 [49]	An RCT to assess the effect of a lay health worker-led psychological intervention on ART adherence, virologic suppression, and mental health symptoms.	Friendship Bench (FB) intervention, October 2018 to December 2019.	Intervention FB: 244 Control SC: 272	VS, Odd Ratio Month 6: 2.20(0.79 to 6.14) Month 12: 1.60(0.42 to 6.05)
Chinoda et al., 2020, Zimbabwe, 840 [50]	An RCT to evaluate the feasibility and effectiveness of a peer-led mental health support intervention on virological suppression, mental health and quality of life in ALHIV.	CATS-PST Model, 48 weeks	CATS: 840	12 months VF at Baseline CATS-PST: 840(30%) CATS Standard: 840(43%) Power: 85% at 0.25 coefficient variation VF post-intervention CATS-PST: 840(8%) CATS Standard: 840(16%) Power: 87%
Kurth et al., 2016, USA, 494 [51]	RCT aimed to adapt a computer-based counseling tool, demonstrated to reduce HIV-1 viral load and sexual risk transmission in a population of English-speaking adults, for use during routine clinical visits for an HIV-positive Spanish-speaking population (CARE+ Spanish)	Computer Assessment and Rx Education for HIV-positives (CARE+), 12 months	Intervention CARE+ Spanish: 226 Control SC: 207	Detectable VL CARE+ Spanish: 78 (34.5) Control: 76 (36.7) P = .69
Lyatuu et al., 2022, Tanzania, 3341 [52]	An RCT to evaluate the effect of a peer-mother interactive program on PMTCT outcomes among pregnant women on antiretroviral treatment (ART) in routine healthcare	peer-mother adherence support, January 1, 2018, to December 31, 2019	Intervention Peer-mother: 1957 Control SoC: 1384	VS (95%CI) Peer-mother: 92% (91, 93) SoC: 91% (90, 92)

Table 2.

Viral load outcomes in studies selected into the review.

Note: VS = viral suppression; SoC = standard of care; p = significance level at 95% confidence; + = plus; RD = risk difference; RR = risk ratio; aRR = adjusted risk ratio; DID = difference in difference; aOR = adjusted odds ratio; <=less than; c/ml = copies per miles; VF = viral failure; VL = viral load; ul = micro liters.

3.2 Psychosocial support, training and viral suppression

In a study conducted in the United States, 58.4% of PLHIV on heart to heart intervention were virally suppressed compared to 40.0% of PLHIV on standard care, but this was not statistically significant (p > .05) [29]. Another study conducted in the US found that PLHIV on 6 months of Supporting Treatment Adherence Readiness through Training (START) intervention had higher VS (91.7%) compared to those on standard care (83.3%), but this finding was not statistically significant [27]. About 62% of the participants individuals motivated to Participate in Adherence, Care and Treatment (IMPACT) intervention were virally suppressed compared to 63% of those on standard care aOR: 0.92 (0.55–1.54) [36]. Another study in the US found that after 24 weeks of incarceration, VS among those on IMPACT intervention (61%) was not significantly different from participants on standard care (61%) (p-value>.05) [37]. Also, friendship bench intervention increased the odds of VS at six months (aOR: 2.2, 95%CI: 0.79–6.14) and at 12 months (aOR: 1.6, 95% CI: 0.42–6.05) when compared to baseline VS [49]. Peer-led mental health support intervention reduced the proportion of adolescents that were virally suppressed from 30% at baseline to 8% after 48 weeks and also for standard care from 43–16%) [50]. An intervention titled Voice of Youth was found to maintain the proportion of youths with VS at baseline and 6 months after implementation (65.8%) compared to 64.8%/74.5% in the standard group [44]. Maternal depression treatment in HIV (M-DEPTH) was also found to increase the odds of VS in the intervention group compared to the control (OR: 1.19, 95%CI: 0.73–193) in a study conducted on women on prevention of mother-to-child transmission care [46].

In Vietnam, the combined intervention of personalized feedback, consideration of pros and cons, and strategies for managing risky moods and situations for alcohol increased VS (83.1%) compared to brief intervention (80.2%) and standard care (78.1%), but this was not statistically significant (p:.06). A study was conducted in Ukraine, Vietnam and Indonesia found that the HTPN medication-assisted treatment increased VS (74.41%) compared to standard care (24%) (PR: 1.7, 95%CI: 1.3–2.2) [18]. A study conducted in Uganda and Kenya also found that adolescents and adult PLHIV in the SEARCH program had a higher proportion of participants with VS (47%) compared to those in standard care (47%) after three years of follow-up (RR: 1,41, 95% CI: 1.05–1.91) [26, 31]. Another study conducted in Kenya and Uganda found that PLHIV aged 15–24 years on SEARCH-Youth intervention (life stage assessment tool, alternative clinic access, rapid viral load feedback and provider E-collaborative) had higher proportion of participants that were virally suppressed (88%, 95% CI: 85–92%) compared to standard care (80%, 95% CI: 77–84%) (RR: 1.10, 95% CI: 1.03–1.16, p:.0019). Fast-track treatment initiation counseling maintained VS at about 61% of the PLHIV while standard care increased from 61.2% to 63.9% after 18 months [45]. Another study found that 72.0% (63.8–86.8%) of the female sex workers on sisters antiretroviral prevention program were virally suppressed compared to 5.3% (−4.0–14.6%) on standard care after 12 months of follow-up (aRD: 5.3%, 95%CI: −4.0-14.6%, p:.20) (Table 2) [24].

3.3 Differentiated care and viral suppression

A study conducted in South Africa reported that 90% of PLHIV on task shifting intervention had VS compared to those on standard care (78%) (RD: 12.3%, 95% CI: 5.1–19.5%, p:.0013) [15]. Another study found a higher proportion of PLHIV on same-day, home-based ART (SDHBA) (50.4%) was virally suppressed compared to standard care (34.3%) (aRD: 16.0%, 95%CI: 4.4–27.2%, p:.007) [25]. Adherence club (95.2%) produced higher PLHIV with VS compared to standard care (94.4%) (RD: 0.4, 95%CI: −6.2-7.0%), and decentralized ART delivery (98.4%) produced more virally suppressed PLHIV compared to standard care (90.2%) for clinically stable PLHIV (RD: 2.9, 95%CI: −4.2-10.0%) [33]. A total of seven studies were conducted in Zimbabwe, of which one study found that after 96 weeks, a lesser proportion of adolescents PLHIV on peer-led differentiated service delivery (22%) had VS compared to those on standard care (36%) (aPR: 0.58, 95%CI: 0.36–0.94, p:.03) [17]. Another RCT on multi-month dispensing with community ART refill groups found that those on three monthly intervals (99.7%) and six-monthly intervals (92.9%) community ART had higher VS compared to those in standard care (99.1%) [3MC (RR): 1.0(1.0–1.0), p:.49; 6MC: 92.9%(0.9–1.0), p:.70] [23]. Another similar study found that female sex workers on differentiated peer-led support intervention had higher VS (93.5%) compared to standard care (aRD: 5.8% (2.7–8.8) after 12 months of follow-up [41]. Community-based support for caregivers of HIV-infected children and adolescents reduced the proportion of participants with VS (33%) compared to those on standard care (49%) with statistical significance (aOR: 0.46, 95%CI: 0.23–0.89, p:.02) [42]. A study found that there was a slightly higher proportion of pregnant women on ART in the peer-mother adherence group with VS (92%, 95%CI: 91–93%) compared to those on standard care (91%, 95%CI: 90–92%) [52]. Community pharmacy in a study conducted in Nigeria was also found to reduce the viral load from 399.3c/ml in pre-intervention to 259.5c/ml in pos intervention, but this was not significant (p:.612) [19]. According to a study in Nigeria, although there was an increase in the log₁₀ of the viral load of stable PLHIV on ART after one year of intervention (log₁₀: 3.5/3.7, p:.40), this was not statistically significant [20]. A study conducted in South Africa and Zambia found that a higher proportion of the participants in home-based delivery (61.3%) and adherence club (57.0%) had VS compared to those on standard care (49.7%) ART [10]. However, this study also found that although >95% of participants in home-based delivery (98.9%) and adherence club (98.7%) had VS, this was lower compared to those in standard of care (99.2%) [10]. Another study in Zimbabwe and South Africa found that three months (98.6%) and six months (98.1%) community ART delivery compared to standard care (99.3) did not significantly affect VS after 12 months of follow-up [RR(3MC): 0.99, 95%CI: 0.97–1.02, p:.73; RR(6MC): 0.99, 95%CI: 0.96–1.03, p:.64)] [28]. A community-based intervention targeted to reduce viral load in children (Konga) in Tanzania also found that after 6 months of intervention, the viral load was significantly lower in the intervention group (165.13 c/ml) compared to standard care (516.70 c/ml) (F: 4.3, p:.0414) (Table 2) [30].

3.4 Application, daily reminder and viral suppression

A study found that there was no significant difference in the VS of PLHIV in the United States on WiseApp self-management app intervention compared to the standard ART care (p:.89) [32]. Personalized daily text message reminder (PDTMR) in the United States had an insignificantly higher proportion of PLHIV with VS compared to those on standard care (70.8%/60.0%, p:.272) [43]. Another study found that the proportion of PLHIV with detectable viral load in the computer-based counseling tool group compared to standard care was insignificant (34.5%/36.7%, p:.69) [51]. A quasi-experimental study conducted to identify support and coordinate management of individuals with virologic failure on first-line ART in electronic-based limited settings found a significantly lower risk of VS in PLHIV on package intervention (fact sheet on demographics, serial CD4 count and viral load result, clinical chart in flowsheet for monthly visit, viral load sample log and high viral load register) in Mkuze (RR: 0.89, p < .01) and a higher risk in Jozini (RR: 1.70, p < .01) compared to standard care [38]. However, this variation in VS was insignificant in Bethesda CDC (RR: 0.86, p:.58) [38]. A study found that mother-infant visit adherence and treatment engagement through text messaging only (44.9%), community mentor mothers (44.8%) and joint intervention (51.5%) resulted in higher proportion of women on ART with undetectable viral load compared to those on standard care (44.4%) although insignificant [40]. A study found that after enhanced patient-centered, provider-patient communication intervention for six months, participants in the intervention group receiving standard care (83.7%) were less likely to be virally suppressed than those receiving provider-patient communication and enhanced patient care (84.4%), although insignificant [14]. However, those in only standard care (64.4%) were less likely than those receiving provider-patient communication and enhanced patient care to be virally suppressed (aOR: 0.36, 95%CI: 0.18–0.72) [14]. In China, differentiated digital intervention was found to increase the risk of VS when compared with those on standard care for in-text messages (RR: 1.28, 95%CI: 0.15–10.59) and instant message+social media (RR: 3.06, 95%CI: 0.70–13.33) while instant message only (RR: 0.85, 95%CI: 0.27–2.62) reduced the risk of VS [21]. In Malaysia, a study found that mobile phone reminders significantly reduced viral load from 4.6 (4.44–4.78) at baseline to 1.4 (1.28–1.54) after follow-up compared to 4.85 (4.67–5.02) at baseline and 1.76 (1.63–1.89) after follow-up for those on standard care (p < .05) [16]. A study conducted in the United States found that there was no significant difference in VS of participants who were enrolled in data-to-care intervention (64.5%) compared to those on standard ART care (61.5%) (P = 0.22) (Table 2) [11].

3.5 Other interventions and viral suppression

A quasi-experimental study conducted in the United States also found an increase in the proportion of PLHIV on integrated HIV care services intervention with VS (81%) in 2017 compared to 76% in 2016 and 59% in 2015 [48]. In Kenya, a study found that after one year of follow-up, a similar proportion of PLHIV in Point of Care viral load with targeted drug resistance monitoring and clinical decision support (90.4%) compared to standard care (91.8%) were virally suppressed (RR = 0.99, P:.55) [13]. In a study conducted in Uganda, the rate of VS was maintained after 1 year post-intensive case management on HIV treatment intervention at 87% [22]. A study conducted in Russia found that 12 months VS was higher in PLHIV integrated into linking infectious disease and narcology intervention (47%) compared to those on standard care (23%) (aOR: 3.0, p:.0039) (Table 2) [12].

4. Discussion

This study reviewed the impact of the implementation of HIV-service delivery interventions since the adoption of the 90–90-90 targets in 2014 with a focus on viral suppression. However, these targets were further reviewed to the global achievement of 95–95-95 targets, with the third target indicating that 95% of PLHIV on ART are virally suppressed. In recent times, innovative approaches have been implemented to improve service delivery for PLHIV with a focus on ease of access, efficiency and quality in improving patient outcomes.

HIV-service delivery models such as the DSD have recently been adopted across resource-limited regions as a patient-centered approach that provides targeted strategies to eliminate the barriers of access to care such as finance, convenience and distance from healthcare facilities. This review found that the implementation of various differentiated care service delivery was effective in improving virologic outcomes of PLHIV [53, 54]. The model is a patient-centered approach that provides a peer support system that fosters community engagement and mitigates the impact of stigma associated with assessing HIV care in healthcare facilities. As a result, DSD promotes retention in care and adherence to treatment. A meta-analysis of studies conducted in over 26 countries across the globe found that PLHIV with optimal adherence had a lower risk of virologic failure compared to their counterparts with sub-optimal adherence [55]. Another study conducted in South Africa reported a relationship between optimal adherence to treatment and virologic suppression among PLHIV [56]. The implementation of differentiated service delivery for PLHIV could potentially promote personalized care while maintaining optimal clinical outcomes and achieving the UNAIDS target of eliminating HIV.

Financial incentives have been identified as one of the interventions implemented to promote access to care for numerous diseases including HIV. This intervention is efficient in resource-limited areas where the transportation cost can negatively affect the ability to access healthcare and health-seeking behaviors among PLHIV. All studies in our review found that financial incentives or economic empowerment was effective in improving VS among PLHIV [7, 57, 58]. This intervention eliminates the economic barrier to accessing healthcare services and the dependence on personal funds to access ART, while promoting adherence to treatment. Findings from studies in this review is consistent with other studies that have found financial incentives to be effective in improving uptake of ART, adherence and retention in care [59, 60].

In our review, numerous psychosocial interventions were implemented for PLHIV on ART. These interventions have been implemented to provide psychosocial support that promotes health-seeking behaviors among PLHIV, especially high-risk populations like incarcerated inmates, adolescents and pregnant women. Although these interventions have been shown to improve VS, it is important that context-specific psychosocial interventions are implemented to meet the needs of the PLHIV at risk of virologic failure and address psychological barriers to adherence and retention in care.

Technology has been found to improve the ART cascade as studies have shown improvement in the effectiveness of ART among PLHIV. However, some technological interventions did not significantly improve VS among ART clients. Technology can help track the level of adherence to medication and clinical outcomes of PLHIV, and data can be used to implement strategies to promote health outcomes among non-adherent clients or those with poor HIV outcomes. However, the feasibility of this strategy in some regions remains a major concern as there are limited resources to effectively implement this intervention.

Studies included in this review found promising potentials of the various models in improving VS among PLHIV. However, there are some unmet needs impeding the achievement of the third 95 of the UNAIDS target. Some of the key challenges include the inability to scale-up these service delivery interventions across all high-risk populations due to limited resources in LMIC. Additionally, stigma remains a major concern that continuously prevent PLHIV from seeking care especially among high-risk populations like transgender, men sleeping with men and sex workers. Adolescent HIV care is faced with challenges like the poor institution of adolescent-friendly clinics and adherence support, which prevent care seeking for this group and poor adherence to treatment. Also, there are limited studies on HIV care and the risk of chronic co-morbidities among aging population. The occurrence of disease pandemics has been found to disrupt HIV care delivery. Thus, the decentralized model could play a significant role in eliminating this barrier. It is important that these gaps are addressed with much focus on implementing a patient-centered approach that promotes trust, equity, quality, innovation and a strengthened health system.

Some limitations were identified in this review. This study is a review and, as a result does not infer causality. Also, various cut-offs were adopted to determine viral suppression, which prevented comparison between groups and across similar interventions. The study was conducted on various sub-populations and during different follow-up periods, limiting our ability to compare between groups. However, this review is robust and provides information on the models adopted to improve VS across the globe. This data can be used in implementing public health strategies aimed at improving virological outcomes of PLHIV while achieving the third 95 of the UNAIDS ambitious targets.

5. Conclusion

This review finds that supportive interventions tailored toward the needs of PLHIV such as financial incentives and differentiated service delivery, can enhance VS among PLHIV. While psychosocial support and technology-driven interventions improved VS of PLHIV, there is no significant evidence for these findings; hence, there is a need for further research to better understand these approaches. Thus, it is recommended that health programs improve financial incentives, especially in resource-limited settings, to improve access to ART. Also, strategies should be implemented to promote the decentralization of ART into communities, as this can help improve clinical outcomes and barriers to accessing care. It is important that comprehensive psychosocial support systems and initiatives to empower PLHIV are developed and implemented to strengthen adherence to ART and improve virologic outcomes. Additionally, there is a need to set adequate structures that promote good health outcomes among aging populations, and it is important that adolescent-friendly clinics and social support interventions are implemented to promote trust in the health system and improve HIV care-seeking behaviors among adolescent populations.

Acknowledgments

The authors acknowledge the independent reviewer for assessing the quality of studies included in this review.

Conflict of interest

The authors declare no conflict of interest.

Appendix

Table A1.

Quality assessment of randomized controlled trials.

Table A2.

Quality assessment of quasi-experimental studies.

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40. Abuogi LL, Onono M, Odeny TA, et al. Effects of behavioural interventions on postpartum retention and adherence among women with HIV on lifelong ART: The results of a cluster randomized trial in Kenya (the MOTIVATE trial). Journal of the International AIDS Society. 2022;25:e25852
41. Cowan FM, Machingura F, Ali MS, et al. A risk-differentiated, community-led intervention to strengthen uptake and engagement with HIV prevention and care cascades among female sex workers in Zimbabwe (AMETHIST): A cluster randomised trial. The Lancet Global Health. 2024;12:e1424-e1435
42. Ferrand RA, Simms V, Dauya E, et al. The effect of community-based support for caregivers on the risk of virological failure in children and adolescents with HIV in Harare, Zimbabwe (ZENITH): An open-label, randomised controlled trial. Lancet Child Adolescent Health. 2017;1:175-183
43. Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016;20:1049-1059
44. Dow DE, Mmbaga BT, Gallis JA, Turner EL, Gandhi M, Cunningham CK, et al. A group-based mental health intervention for young people living with HIV in Tanzania: Results of a pilot individually randomized group treatment trial. BMC Public Health. 2020;20:1358
45. Pascoe SJ, Fox MP, Huber AN, Murphy J, Phokojoe M, Gorgens M, et al. Differentiated HIV care in South Africa: The effect of fast-track treatment initiation counselling on ART initiation and viral suppression as partial results of an impact evaluation on the impact of a package of services to improve HIV treatment adherence. Journal of the International AIDS Society. 2019;22:e25409
46. Wagner GJ, Gwokyalya V, Faherty L, et al. Effects of M-DEPTH model of depression care on maternal HIV viral suppression and adherence to the PMTCT care continuum among HIV-infected pregnant women in Uganda: Results from a cluster randomized controlled trial at pregnancy completion. AIDS and Behavior. 2023;27:2902-2914
47. Mukama SC, Nakawesi JS, Bindeeba DS, Ezajobo S, Mugisa A, Senyimba C, et al. Evaluating antiretroviral therapy service delivery models through lot quality assurance sampling in Central Uganda. HIV AIDS (Auckl). 2024;16:337-354
48. Melvin SC, Gipson J. The open arms healthcare Center’s integrated HIV care services model. Preventing Chronic Disease. 2019;16:E135
49. Haas AD, Kunzekwenyika C, Manzero J, et al. Effect of the friendship bench intervention on antiretroviral therapy outcomes and mental health symptoms in rural Zimbabwe: A cluster randomized trial. medRxiv. 2023;6(7):e2323205
50. Chinoda S, Mutsinze A, Simms V, et al. Effectiveness of a peer-led adolescent mental health intervention on HIV virological suppression and mental health in Zimbabwe: Protocol of a cluster-randomised trial. Global Mental Health (Cambridge). 2020;7:e23
51. Kurth AE, Chhun N, Cleland CM, Crespo-Fierro M, Parés-Avila JA, Lizcano JA, et al. Linguistic and cultural adaptation of a computer-based counseling program (CARE+ Spanish) to support HIV treatment adherence and risk reduction for people living with HIV/AIDS: A randomized controlled trial. Journal of Medical Internet Research. 2016;18:e195
52. Lyatuu GW, Naburi H, Mwashemele S, et al. Effect of peer-mother interactive programme on prevention of mother-to-child HIV transmission outcomes among pregnant women on anti-retroviral treatment in routine healthcare in Dar es Salaam, Tanzania. PLOS Global Public Health. 2022;2:e0000256
53. Jobarteh K, Shiraishi RW, Malimane I, Samo Gudo P, Decroo T, Auld AF, et al. Community ART support groups in Mozambique: The potential of patients as partners in care. PLoS One. 2016;11:e0166444
54. Decroo T, Telfer B, Dores CD, White RA, Santos ND, Mkwamba A, et al. Effect of community ART groups on retention-in-care among patients on ART in Tete Province, Mozambique: A cohort study. BMJ Open. 2017;7:e016800
55. Bezabhe WM, Chalmers L, Bereznicki LR, Peterson GM. Adherence to antiretroviral therapy and Virologic failure: A meta-analysis. Medicine. 2016;95:e3361
56. Nachega JB, Hislop M, Nguyen H, Dowdy DW, Chaisson RE, Regensberg L, et al. Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in Southern Africa. Journal of Acquired Immune Deficiency Syndromes. 2009;51:65-71
57. Kingsada A. Can financial incentives improve access to care? Evidence from a French experiment on specialist physicians. Social Science & Medicine. 2024;352:117018
58. Lavergne MR. Financial incentives for physicians to improve health care. CMAJ: Canadian Medical Association Journal. 2017;189:E1505
59. Krishnamoorthy Y, Rehman T, Sakthivel M. Effectiveness of financial incentives in achieving UNAID fast-track 90-90-90 and 95-95-95 target of HIV care continuum: A systematic review and Meta-analysis of randomized controlled trials. AIDS and Behavior. 2021;25:814-825
60. Metsch LR, Feaster DJ, Gooden L, et al. Effect of patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use: A randomized clinical trial. JAMA. 2016;316:156-170
61. Agwu AL, Yusuf HE, D’Angelo L, et al. Recruitment of youth living with HIV to optimize adherence and virologic suppression: Testing the design of technology-based community health nursing to improve antiretroviral therapy (ART) clinical trials. JMIR Research Protocols. 2020;9:e23480
62. Kalichman SC, Kalichman MO, Eaton LA. Phone-delivered intervention to improve HIV Care for Young People Living with HIV: Trial to inform implementation and utility. Journal of Acquired Immune Deficiency Syndromes. 2023;94:227-234
63. Jiao K, Ma J, Lin Y, et al. Effectiveness of instant versus text messaging intervention on antiretroviral therapy adherence among men who have sex with men living with HIV. Digit Health. 2024;10:20552076241257447

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1.Introduction
2.Method
3.Result
4.Discussion
5.Conclusion
Acknowledgments
Conflict of interest
Appendix

References

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Peptide-Based Fusion Inhibitors Targeting 6-HB: Resistance to HIV-1 outside of Cells

By Guodong Liang, Yan Huang, Jinlin Wang, Xin Gao, Yuting Zhao, Lu Ga, Yan Zhao, Yuheng Ma, Yunfeng Xiao, Taoran Wang, Yihui Jin and Ruijuan Li

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[31] 31. Hickey MD, Ayieko J, Kwarisiima D, et al. Improved viral suppression with streamlined care in the SEARCH study. Journal of Acquired Immune Deficiency Syndromes. 2020;85:571-578

[32] 32. Schnall R, Sanabria G, Jia H, Cho H, Bushover B, Reynolds NR, et al. Efficacy of an mHealth self-management intervention for persons living with HIV: The WiseApp randomized clinical trial. Journal of the American Medical Informatics Association. 2023;30:418-426

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[37] 37. DiPrete BL, Pence BW, Golin CE, Knight K, Flynn PM, Carda-Auten J, et al. Antiretroviral adherence following prison release in a randomized trial of the imPACT intervention to maintain suppression of HIV viremia. AIDS and Behavior. Sep 2019;23(9):2386-2395

[38] 38. Brijkumar J, Johnson BA, Zhao Y, et al. A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa. BMC Infectious Diseases. 2020;20:836

[39] 39. Sunpath H, Pillay S, Hatlen T, Murphy RA, Marconi VC, Moosa M-YS, et al. A nurse-led intervention to improve management of virological failure in public sector HIV clinics in Durban, South Africa: A pre- and post-implementation evaluation. South African Medical Journal. 2021;111:299-303

[40] 40. Abuogi LL, Onono M, Odeny TA, et al. Effects of behavioural interventions on postpartum retention and adherence among women with HIV on lifelong ART: The results of a cluster randomized trial in Kenya (the MOTIVATE trial). Journal of the International AIDS Society. 2022;25:e25852

[41] 41. Cowan FM, Machingura F, Ali MS, et al. A risk-differentiated, community-led intervention to strengthen uptake and engagement with HIV prevention and care cascades among female sex workers in Zimbabwe (AMETHIST): A cluster randomised trial. The Lancet Global Health. 2024;12:e1424-e1435

[42] 42. Ferrand RA, Simms V, Dauya E, et al. The effect of community-based support for caregivers on the risk of virological failure in children and adolescents with HIV in Harare, Zimbabwe (ZENITH): An open-label, randomised controlled trial. Lancet Child Adolescent Health. 2017;1:175-183

[43] 43. Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016;20:1049-1059

[44] 44. Dow DE, Mmbaga BT, Gallis JA, Turner EL, Gandhi M, Cunningham CK, et al. A group-based mental health intervention for young people living with HIV in Tanzania: Results of a pilot individually randomized group treatment trial. BMC Public Health. 2020;20:1358

[45] 45. Pascoe SJ, Fox MP, Huber AN, Murphy J, Phokojoe M, Gorgens M, et al. Differentiated HIV care in South Africa: The effect of fast-track treatment initiation counselling on ART initiation and viral suppression as partial results of an impact evaluation on the impact of a package of services to improve HIV treatment adherence. Journal of the International AIDS Society. 2019;22:e25409

[46] 46. Wagner GJ, Gwokyalya V, Faherty L, et al. Effects of M-DEPTH model of depression care on maternal HIV viral suppression and adherence to the PMTCT care continuum among HIV-infected pregnant women in Uganda: Results from a cluster randomized controlled trial at pregnancy completion. AIDS and Behavior. 2023;27:2902-2914

[47] 47. Mukama SC, Nakawesi JS, Bindeeba DS, Ezajobo S, Mugisa A, Senyimba C, et al. Evaluating antiretroviral therapy service delivery models through lot quality assurance sampling in Central Uganda. HIV AIDS (Auckl). 2024;16:337-354

[48] 48. Melvin SC, Gipson J. The open arms healthcare Center’s integrated HIV care services model. Preventing Chronic Disease. 2019;16:E135

[49] 49. Haas AD, Kunzekwenyika C, Manzero J, et al. Effect of the friendship bench intervention on antiretroviral therapy outcomes and mental health symptoms in rural Zimbabwe: A cluster randomized trial. medRxiv. 2023;6(7):e2323205

[50] 50. Chinoda S, Mutsinze A, Simms V, et al. Effectiveness of a peer-led adolescent mental health intervention on HIV virological suppression and mental health in Zimbabwe: Protocol of a cluster-randomised trial. Global Mental Health (Cambridge). 2020;7:e23

[51] 51. Kurth AE, Chhun N, Cleland CM, Crespo-Fierro M, Parés-Avila JA, Lizcano JA, et al. Linguistic and cultural adaptation of a computer-based counseling program (CARE+ Spanish) to support HIV treatment adherence and risk reduction for people living with HIV/AIDS: A randomized controlled trial. Journal of Medical Internet Research. 2016;18:e195

[52] 52. Lyatuu GW, Naburi H, Mwashemele S, et al. Effect of peer-mother interactive programme on prevention of mother-to-child HIV transmission outcomes among pregnant women on anti-retroviral treatment in routine healthcare in Dar es Salaam, Tanzania. PLOS Global Public Health. 2022;2:e0000256

[53] 53. Jobarteh K, Shiraishi RW, Malimane I, Samo Gudo P, Decroo T, Auld AF, et al. Community ART support groups in Mozambique: The potential of patients as partners in care. PLoS One. 2016;11:e0166444

[54] 54. Decroo T, Telfer B, Dores CD, White RA, Santos ND, Mkwamba A, et al. Effect of community ART groups on retention-in-care among patients on ART in Tete Province, Mozambique: A cohort study. BMJ Open. 2017;7:e016800

[55] 55. Bezabhe WM, Chalmers L, Bereznicki LR, Peterson GM. Adherence to antiretroviral therapy and Virologic failure: A meta-analysis. Medicine. 2016;95:e3361

[56] 56. Nachega JB, Hislop M, Nguyen H, Dowdy DW, Chaisson RE, Regensberg L, et al. Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in Southern Africa. Journal of Acquired Immune Deficiency Syndromes. 2009;51:65-71

[57] 57. Kingsada A. Can financial incentives improve access to care? Evidence from a French experiment on specialist physicians. Social Science & Medicine. 2024;352:117018

[58] 58. Lavergne MR. Financial incentives for physicians to improve health care. CMAJ: Canadian Medical Association Journal. 2017;189:E1505

[59] 59. Krishnamoorthy Y, Rehman T, Sakthivel M. Effectiveness of financial incentives in achieving UNAID fast-track 90-90-90 and 95-95-95 target of HIV care continuum: A systematic review and Meta-analysis of randomized controlled trials. AIDS and Behavior. 2021;25:814-825

[60] 60. Metsch LR, Feaster DJ, Gooden L, et al. Effect of patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use: A randomized clinical trial. JAMA. 2016;316:156-170

[61] 61. Agwu AL, Yusuf HE, D’Angelo L, et al. Recruitment of youth living with HIV to optimize adherence and virologic suppression: Testing the design of technology-based community health nursing to improve antiretroviral therapy (ART) clinical trials. JMIR Research Protocols. 2020;9:e23480

[62] 62. Kalichman SC, Kalichman MO, Eaton LA. Phone-delivered intervention to improve HIV Care for Young People Living with HIV: Trial to inform implementation and utility. Journal of Acquired Immune Deficiency Syndromes. 2023;94:227-234

[63] 63. Jiao K, Ma J, Lin Y, et al. Effectiveness of instant versus text messaging intervention on antiretroviral therapy adherence among men who have sex with men living with HIV. Digit Health. 2024;10:20552076241257447

Recent Antiretroviral Therapy Models Implemented to Achieve Viral Suppression among People Living with Human Immunodeficiency Virus: A Systematic Review

Viral Infectious Diseases Annual Volume 2025

Abstract

Keywords

Author Information

Timothy Adejoh Attah *

Solomon Jonathan Hussaini

Olamide Smart Aiyedogbon

Abubakar Adamu

1. Introduction

2. Method

2.1 Study design

2.2 Search term

2.3 Inclusion criteria

2.4 Search strategy

2.5 Quality assessment

2.6 Data extraction and synthesis

3. Result

Figure 1.

Table 1.

Figure 2.

3.1 Financial incentives and viral suppression

Table 2.

3.2 Psychosocial support, training and viral suppression

3.3 Differentiated care and viral suppression

3.4 Application, daily reminder and viral suppression

3.5 Other interventions and viral suppression

4. Discussion

5. Conclusion

Acknowledgments

Conflict of interest

Appendix

Table A1.

Table A2.

References

Peptide-Based Fusion Inhibitors Targeting 6-HB: Resistance to HIV-1 outside of Cells

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Recent Antiretroviral Therapy Models Implemented to Achieve Viral Suppression among People Living with Human Immunodeficiency Virus: A Systematic Review

Viral Infectious Diseases Annual Volume 2025

Abstract

Keywords

Author Information

Timothy Adejoh Attah *

Solomon Jonathan Hussaini

Olamide Smart Aiyedogbon

Abubakar Adamu

1. Introduction

2. Method

2.1 Study design

2.2 Search term

2.3 Inclusion criteria

2.4 Search strategy

2.5 Quality assessment

2.6 Data extraction and synthesis

3. Result

Figure 1.

Table 1.

Figure 2.

3.1 Financial incentives and viral suppression

Table 2.

3.2 Psychosocial support, training and viral suppression

3.3 Differentiated care and viral suppression

3.4 Application, daily reminder and viral suppression

3.5 Other interventions and viral suppression

4. Discussion

5. Conclusion

Acknowledgments

Conflict of interest

Appendix

Table A1.

Table A2.

References

Continue reading from the same book

Viral Infectious Diseases Annual Volume 2025

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