Federal University of Sao Paulo (Unifesp), Botucatu, Brazil.
University of Toronto, Toronto, Ontario, Canada.
Health Educ Behav. 2023 Dec;50(6):738-747. doi: 10.1177/10901981221148966. Epub 2023 Feb 6.
Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher mortality. It is a frequently observed reason for treatment abandonment, with people who misuse drugs showing a 10 to 25 times higher risk of HIV than the general population. The authors conducted a systematic review and meta-analysis to assess the efficacy of contingency management (CM) to improve adherence to antiretroviral therapy in people living with HIV and substance use disorder (SUD). The inclusion criteria consisted of studies written in English, Italian, Spanish, German, and French; studies conducted with humans; and clinical trials that combined SUD treatment with CM for people living with HIV. Two hundred twenty-two articles were identified, five met all inclusion criteria, and three provided enough data to perform the meta-analysis. We considered treatment adherence by measuring the increase in the CD4 count as our primary outcome. We found a significant increase in treatment adherence in the patient group compared with the control groups during the intervention phase. Positive findings did not persist after the cessation of the incentives. The meta-analysis showed that the intervention improved patient adherence by 2.69 (95% confidence interval: [0.08, 0.51]; = .007) compared with the control group during the intervention period. All short-term CM studies converged on a positive result for adherence to antiretroviral therapy.
艾滋病毒（human immunodeficiency virus）感染者药物滥用与死亡率升高有关。这是治疗中断的常见原因，药物滥用者感染艾滋病毒的风险比一般人群高 10 至 25 倍。作者进行了一项系统评价和荟萃分析，以评估应急管理（contingency management，CM）在提高艾滋病毒感染者和物质使用障碍（substance use disorder，SUD）患者对抗逆转录病毒治疗的依从性方面的疗效。纳入标准包括用英语、意大利语、西班牙语、德语和法语撰写的研究；以人为对象进行的研究；以及将 SUD 治疗与针对艾滋病毒感染者的 CM 相结合的临床试验。确定了 222 篇文章，其中 5 篇符合所有纳入标准，3 篇提供了足够的数据进行荟萃分析。我们通过测量 CD4 计数的增加来衡量治疗依从性，作为我们的主要结果。我们发现，在干预阶段，与对照组相比，患者组的治疗依从性显著提高。在激励措施停止后，积极的发现并没有持续下去。荟萃分析显示，与对照组相比，干预组在干预期间患者的依从性提高了 2.69（95%置信区间：[0.08, 0.51]；P =.007）。所有短期 CM 研究都得出了抗逆转录病毒治疗依从性的积极结果。
