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Effects of integrated interventions on transmission risk and care continuum outcomes in persons living with HIV: Meta-analysis, 1996-2014
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    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.


    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.


    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.


    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.

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