Autumn Barnes is an undergraduate senior at Duke University studying global health and public policy. Over the course of her undergraduate career she has developed an interest in HIV and other STDs, opioid abuse and the opioid epidemic, and prison reform. In the past she has participated in a study abroad program in Germany and a DukeEngage independent project in Rhode Island working with a harm reduction and opioid dependency nonprofit. Outside of her thesis, she is currently involved in a research project centered around sickle cell in Uganda, is the president of the Public Policy Major’s Union and is the Vice President of the Global Health Major’s Union. Post-graduation, she plans to continue her studies through obtaining a Masters of Public Health, as well as pursue work in the public sector.

Honors Thesis:

Addressing Barriers to HIV Treatment Retention and ART Adherence Through Behavioral Interventions: A Scoping Review of People Living with HIV Who Inject Drugs

Faculty Advisor: Professor Tiarney Ritchwood

Abstract: The world is facing dual crises of human immunodeficiency virus (HIV) and the opioid epidemic. Those with a comorbidity of opioid dependence and HIV face unique barriers to retaining or engaging in HIV treatments and adhering to antiretroviral therapy (ART) regimens. Behavioral interventions within the past ten years have addressed treatment retention and ART adherence with positive results. This prompts further study on their ability to address barriers to treatment retention and ART adherence and their applicability on a wider scale.

In this scoping review, in-depth searches and data charting of current literature produced 13 studies identifying 32 individual, societal and structural barriers to achieving treatment retention and ART adherence for people living with HIV (PLWH) who inject drugs. Behavioral interventions utilizing various methodologies have addressed these barriers. Results comparing behavioral interventions showed some were more efficacious than others in improving treatment retention and ART adherence for PLWH who inject drugs. However this improvement did not differ from the standard of care and were not sustained over time. In locations where evaluations of behavioral interventions were identified, local, political and societal structures complicate dissemination and implementation outside of the research setting.

Global policies must focus on improving structural barriers to HIV care, fund race- and gender-based research, expand treatment options and accessibility, and adapt interventions to low-resource, high conflict areas. Future research must focus on evaluating and improving existing behavioral interventions to justify their efficacy over the standard of care and should adapt to the developing COVID-19-influenced public health sphere.