A conceptual model of alcohol use and adherence to antiretroviral therapy: systematic review and theoretical implications for mechanisms of action
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Alcohol consumption is one of the most prevalent correlates of antiretroviral therapy (ART) adherence, yet causal processes underlying this association remain largely unexplored. The goal of this systematic review was to develop a conceptual model that describes the causal effect of alcohol consumption on ART nonadherence. We reviewed 230 studies that examined the association between alcohol consumption and ART adherence with three primary aims: (1) to replicate and extend previous reviews of the literature, (2) to summarize and critique study designs capable of answering questions about temporal overlap and (3) to summarize potential mechanisms of action. A model of alcohol-associated ART nonadherence was proposed to guide future work, integrating general theories of ART adherence and theory on the psychological and behavioral effects of alcohol intoxication. The conceptual model describes two mechanistic processes-prospective memory impairment and interactive toxicity beliefs/avoidance behaviors-involved in alcohol-associated intentional and unintentional nonadherence, respectively. This model can be used to guide future research on the causal processes involved in the frequently observed correlation between alcohol consumption and adherence.
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Unhealthy alcohol use among people with HIV is associated with significant health-related consequences, including mortality, lack of viral suppression, less ART utilization, and sub-optimal adherence to ART.
“Unhealthy alcohol use is prevalent among people with HIV (PWH) and associated with significant health-related consequences.”
From A Randomized Feasibility/Acceptability Trial of Acceptance and Commitment Therapy for People with HIV Who Drink at Unhealthy Levels. (2026) · cites this paper as [10]
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Barriers to Antiretroviral Treatment in Ethiopia: A Qualitative Study
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Viral Rebound Among Persons With Diagnosed HIV Who Achieved Viral Suppression, United States
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The Role of Alcohol on Antiretroviral Therapy Adherence Among Persons Living With HIV in Urban India
Schensul, S. L., Ha, T., Schensul, J. J., Vaz, M., Singh, R., Burleson, J. A., & BRYANT, K. J. (2017) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2017.78.716 · Cited by 27 · see citing works
Ware, D. P., Palella, F. J., Chew, K. W., Friedman, M. R., DʼSouza, G., Ho, K. S., & Plankey, M. W. (2019) · AIDS Patient Care and STDs · doi:10.1089/apc.2019.0057 · Cited by 27 · see citing works
Moucheraud, C., Stern, A. F., Ahearn, C., Ismail, A., Nsubuga-Nyombi, T., Ngonyani, M. M., Mvungi, J., & Ssensamba, J. T. (2019) · AIDS Patient Care and STDs · doi:10.1089/apc.2019.0053 · Cited by 27 · see citing works
Antiretroviral therapy adherence strategies used by patients of a large HIV clinic in Lesotho
Axelsson, J., Hallager, S., & Barfod, T. S. (2015) · Journal of Health Population and Nutrition · doi:10.1186/s41043-015-0026-9 · Cited by 26 · see citing works
Conroy, A. A., Ruark, A. H., McKenna, S. A., Tan, J. Y., Darbes, L. A., Hahn, J. A., & Mkandawire, J. (2019) · AIDS and Behavior · doi:10.1007/s10461-019-02653-y · Cited by 25 · see citing works
Sileo, K. M., Kizito, W., Wanyenze, R. K., Chemusto, H., Musoke, W., Mukasa, B., & Kiene, S. M. (2018) · AIDS Care · doi:10.1080/09540121.2018.1524564 · Cited by 23 · see citing works
Kekwaletswe, C. T., Jordaan, E., Nkosi, S., & Morojele, N. K. (2016) · AIDS and Behavior · doi:10.1007/s10461-016-1595-3 · Cited by 22 · see citing works
Hershow, R. B., Zuskov, D., Mai, N. V. T., Chander, G., Hutton, H. E., Latkin, C. A., Vuong, N. D., Sripaipan, T., Lancaster, K. E., Hà, T. V., et al. (2018) · Substance Use & Misuse · doi:10.1080/10826084.2017.1392986 · Cited by 22 · see citing works
Manzano-García, M., Pérez‐Guerrero, C., de Sotomayor, M. Á., Cortés, M. D. L. A. R., Almeida, C., & Morillo‐Verdugo, R. (2018) · Annals of Pharmacotherapy · doi:10.1177/1060028018766908 · Cited by 21 · see citing works
Mata-Marín, J. A., Martínez-Osio, M. H., Arroyo-Anduiza, C. I., Berrospe-Silva, M. D. L. Á., Chaparro-Sánchez, A., Cruz-Grajales, I., Cruz-Herrera, J. E., Uribe-Noguéz, L. A., Gaytán‐Martínez, J., & Jerónimo-Morales, M. (2019) · BMC Research Notes · doi:10.1186/s13104-019-4576-6 · Cited by 20 · see citing works
Kalichman, S. C., Katner, H. P., Hill, M., Kalichman, M. O., & Hernandez, D. B. (2019) · Journal of the International Association of Providers of AIDS Care (JIAPAC) · doi:10.1177/2325958219826612 · Cited by 16 · see citing works
Walter, N. T., & Bayen, U. (2015) · Psychopharmacology · doi:10.1007/s00213-015-4110-z · Cited by 15 · see citing works
Song, G., Sanchez, M. A., Nolan, M. T., Liu, T., & Savage, C. L. (2018) · Journal of Addictions Nursing · doi:10.1097/jan.0000000000000220 · Cited by 15 · see citing works
Laws, M. B., Rose, G. S., Beach, M. C., Lee, Y., Rogers, W. H., Velasco, A. B., & Wilson, I. B. (2015) · Patient Education and Counseling · doi:10.1016/j.pec.2015.02.014 · Cited by 13 · see citing works
Kalichman, S. C., Horne, R., Katner, H. P., & Hernandez, D. B. (2018) · Journal of Behavioral Medicine · doi:10.1007/s10865-018-9987-7 · Cited by 13 · see citing works
Schensul, J. J., Ha, T., Schensul, S. L., Sarna, A., & BRYANT, K. J. (2017) · AIDS and Behavior · doi:10.1007/s10461-017-1916-1 · Cited by 12 · see citing works
Smith-Spark, J. H., Moss, A. C., & Dyer, K. R. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01325 · Cited by 11 · see citing works
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HIV Treatment for Alcohol and Non-Injection Drug Users in El Salvador
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Madhombiro, M., Marimbe-Dube, B., Dube, M., Kaiyo-Utete, M., Paradzai, A., Chibanda, D., Rusakaniko, S., van der Watt, A. S. J., & Seedat, S. (2018) · HIV/AIDS - Research and Palliative Care · doi:10.2147/hiv.s150095 · Cited by 7 · see citing works
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Pengpid, S., & Peltzer, K. (2014) · Journal of Psychology in Africa · doi:10.1080/14330237.2014.980628 · Cited by 2 · see citing works
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Rural Veterans with HIV and Alcohol Use Disorder receive less video telehealth than urban Veterans
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Unhealthy Alcohol Use in People Living with HIV: A Narrative Review
Kizito, S., Ssewamala, F. M., Saba, S. K., Nabunya, P., Tutlam, N. T., & Mutumba, M. (2026) · Current HIV/AIDS Reports · doi:10.1007/s11904-026-00799-8
- Authors
- Woolf-King, S. E., Sheinfil, A. Z., Ramos, J., Foley, J. D., Moskal, D., Firkey, M., Kellen, D., & Maisto, S. A.
- Affiliations
- Department of Psychology, Syracuse University, Syracuse, NY, USA
- Syracuse University (US)
- ORCID
- Venue
- Health Psychology Review
- Publisher
- Informa UK Limited
- Published
- 2020-08-20
- Volume
- 16
- Issue
- 1
- Pages
- 104-133
- ISSN
- 1743-7199 (ISSN-L)
- 1743-7202
- PMC
- PMC8972079
- OpenAlex
- W3047328158
- Cited by
- 23
- References
- 120
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 2 · 2023: 5 · 2022: 5 · 2021: 3
- FWCI
- 0.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (K01AA02167, R34AA026246, K05AA016928)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- alcohol consumption, antiretroviral therapy adherence, HIV, alcohol intoxication, avoidance behavior, mechanism of action, causal processes, conceptual model
- MeSH terms
- Alcohol Drinking, Humans, HIV Infections, Anti-HIV Agents, Medication Adherence
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