Is AI useful in psychotherapeutic education?

Antiretroviral therapy (ART) adherence is critical to achieving viral suppression and reducing the spread of HIV. Though HIV transmission and mortality have decreased globally [], they have substantially increased over the past decade in regions where the HIV epidemics are fueled by drug injection, which is a major driver of HIV in seven of the 10 world regions, including Eastern Europe and Central Asia (EECA), Southeast Asia, the Middle East, Latin America, and Appalachia and other rural areas in the U.S [, ]. EECA has the fastest growing rate of new HIV infections globally and an increase in AIDS-related deaths [, ]. Opioids account for most of the drug injection in this region [-]. In EECA countries, as in many other areas of the world, people who inject drugs (PWID) with HIV have suboptimal outcomes, including decreased likelihood to be prescribed ART [], which undermines treatment as prevention strategies []. Because PWID with HIV are embedded within social networks that have an elevated risk for HIV, improving adherence to ART may reduce sexual and parenteral HIV transmission to partners and to the broader community []. In Kazakhstan, the majority of people with HIV (PWH) are PWID (8.3% HIV prevalence among PWID [], though triangulation studies suggest major under-reporting) [], with low levels (49.5%) of PWID with HIV on ART []. Among those on ART in Kazakhstan, only 55% are virally suppressed, indicating significant adherence challenges []. Although some physicians are reluctant to prescribe ART to PWID [, , , ], studies have found that PWID with HIV can achieve similar levels of ART adherence found among PWH who have never used illicit drugs, particularly with social support [, ]. Studies on ART adherence interventions among PWID with HIV in low- and middle-income countries (LMIC) are limited [, ], which is problematic given the large HIV epidemics among PWID in these countries [, ]. Without evidence-based interventions (EBIs) to promote adherence among PWID, an effective response to the HIV epidemic is unlikely. Given that the EECA has among the highest prevalence of PWID and prevalence of HIV among PWID in the world [], the region is an optimal location to develop and adapt adherence EBIs for PWID. A dyad-based intervention holds promise for improving ART adherence among PWID. Access to social support from trusted partners, family members, friends, and others in their social network is critical in achieving ART adherence among PWID with HIV [-]. Yet most HIV interventions focus on individuals as a unit of change, ignoring social dynamics and the important role that intimate partners and others in their social network play in risk behaviors and HIV treatment engagement and adherence [, ]. Dyad-based interventions have several advantages over individual approaches, including: (1) promoting mutual responsibility in protecting each other from HIV transmission and/or improving each other’s health and ART adherence; (2) highlighting the relationship context and its connection to HIV acquisition and disease progression; and (3) creating a safe environment to discuss sensitive topics, such as sexual concurrency, needle-sharing, and medication adherence []. Furthermore, though dyadic analyses have been applied to HIV risk-taking [], there have been few dyadic analyses of ART adherence.