Medication Non-Adherence

Directly observed therapy may support adherence but can also disclose HIV status and create stigma risks. Non-adherence was the most frequently studied drug-related problem in the review. Measurement method strongly influenced apparent adherence in prison studies. Adherence in prisons varied substantially by condition, medication class, country, and measurement method. Criminal justice involvement among people living with HIV was associated with worse virological and adherence outcomes. Transfers between prison and justice settings disrupted medication continuity. Stigma was a recurring barrier to adherence, especially for HIV treatment. Depressive symptoms were associated with lower dose adherence in an Ethiopian prison study.