A Dyad-Based Intervention to Improve Adherence to Antiretroviral Therapy among People with HIV who Inject Drugs in Kazakhstan: Results of a Randomized Controlled Trial

Davis A. Rozental E. Bolger N. Gulyayev V. Gulyayev P. Denebayeva A. Wen H. Cui J. Terlikbayeva A. Primbetova S. Samandas J. Altice F.L. Remien R.H. Mergenova G.
January 2026 Springer

AIDS and Behavior
2026 #30 Issue 1 1 - 13 pp.

Kazakhstan has one of the fastest-growing HIV epidemics in the world, concentrated in people who inject drugs (PWID) with suboptimal antiretroviral therapy (ART) adherence. We compared the efficacy of a dyad-based social support intervention to standard of care on increasing ART adherence among PWID in Kazakhstan. PWID with HIV and on ART for ≥ 3 months (‘index cases’) were recruited from Kazakhstan’s largest HIV clinic. PWID invited a treatment support partner (i.e., spouse, family member, or friend) to participate. Dyads were randomized 1:1 to a standard of care or intervention arm, the latter involving three intervention sessions in four weeks. Assessments were completed at baseline (pre-intervention), one-month (immediately post-intervention), and three-month and six-month follow-up. We used multilevel mixed models to examine changes in ART adherence among index cases over time between arms. Among the 66 index cases, those in the intervention arm who had a partner with HIV had a significantly higher adjusted mean change (AMC) in self-reported ART adherence immediately post-intervention (one-month follow-up) than index cases in the control arm with partners with HIV (AMC 16.55, 95% CI [2.77, 30.34], p = 0.038); this effect was maintained at the six-month follow-up (AMC 17.05, 95% CI [3.14, 30.95], p = 0.033). No significant differences between arms were found among index cases who had partners without HIV. No significant differences in electronic monitoring device-measured adherence or viral suppression were found between arms. The dyad-based intervention significantly increased self-reported ART adherence among PWID with partners with HIV, indicating the importance of considering dyad-level factors in interventions. Clinical Trial Registration: NCT03555396.

Antiretroviral therapy adherence , Dyad intervention , HIV , Kazakhstan , People who inject drugs

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School of Social Work, Columbia University, New York, NY, United States
Global Health Research Center of Central Asia, Almaty, Kazakhstan
Department of Psychology, Columbia University, New York, NY, United States
Almaty City AIDS Center, Almaty, Kazakhstan
Department of Psychology, Kenyon College, Gambier, OH, United States
School of Medicine & School of Public Health, Yale University, New Haven, CT, United States
Division of Gender, Sexuality, and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, NY, United States
Department of Epidemiology, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan

School of Social Work
Global Health Research Center of Central Asia
Department of Psychology
Almaty City AIDS Center
Department of Psychology
School of Medicine & School of Public Health
Division of Gender
Department of Epidemiology

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