Cognitive behavioral therapy for antiretroviral therapy adherence and treatment outcomes among people living with HIV: a systematic review and meta-analysis

Cognitive behavioral therapy has emerged as a promising intervention to enhance antiretroviral therapy adherence among people living with HIV. Here we conducted a systematic review and meta-analysis to evaluate the efficacy of cognitive behavioral therapy to improve antiretroviral therapy adherence, HIV viral load, viral suppression and CD4 counts. A total of 20 randomized controlled trials involving 1,739 people living with HIV were included, with most of the studies categorized as having low risk of bias. We show that cognitive behavioral therapy was associated with improved antiretroviral therapy adherence, with more pronounced effects for people living with HIV with psychiatric comorbidities and in studies conducted in low- and middle-income countries. No statistically significant findings were observed for HIV viral load, viral suppression or CD4 counts. These findings support the efficacy of cognitive behavioral therapy in enhancing antiretroviral therapy adherence, particularly for those with psychiatric comorbidities and in low- and middle-income countries. However, the impact of cognitive behavioral therapy on HIV viral load, viral suppression and CD4 counts remains inconclusive. Cognitive behavioral therapy (CBT) is increasingly recognized for its potential to improve antiretroviral therapy adherence among people living with HIV. Here the authors conduct a systematic review and meta-analysis, revealing that CBT significantly enhances adherence, especially in individuals with psychiatric comorbidities and in low- and middle-income countries, although effects on viral metrics remain unclear.