Oral antiretroviral adherence interventions in the era of U=U

Abstract

Antiretroviral therapy (ART) is a keystone of the public health response to HIV, making the support of adherence a point of focus in research and service delivery. Over the past decade, measurements of viral suppression have increasingly been used to evaluate interventions, with more robust study designs gaining traction. Effective approaches include adherence counselling beyond ART education (including mental health and wellbeing approaches), reducing burden of care, tackling structural and societal determinants of health, and using mHealth platforms to deliver interventions. Increasingly, single-strategy interventions are giving way to multicomponent approaches to respond to nuances in adherence behaviour. However, determining which effective strategy to offer and to whom, when, and how remain pressing questions if professionals in the field (eg, researchers, clinicians, and community health workers) are to reach the UNAIDS 95-95-95 goals in the recent context of decreased funding. As new long-acting treatments enter global formularies, interventions showing success with oral ART will probably remain relevant to inform service delivery in most contexts.