The Efficacy of Clinic-Based Alcohol Reduction Interventions on Antiretroviral Therapy Adherence Among Men in Malawian Fishing Communities: A Systematic Review

Men in Malawian fishing communities on Lake Malawi experience high rates of alcohol use and suboptimal antiretroviral therapy (ART) adherence, leading to adverse HIV outcomes. Clinic-based interventions to reduce alcohol consumption present a potential strategy to enhance ART adherence in this population. This systematic review aimed to synthesise existing evidence on the effectiveness of clinic-based alcohol reduction interventions for improving ART adherence among men living with HIV in Lake Malawi’s fishing communities. A systematic search of electronic databases was performed. Peer-reviewed studies evaluating clinic-based interventions designed to reduce alcohol consumption and measure ART adherence outcomes among men in these communities were included. Studies were screened, selected, and their data extracted and synthesised narratively. The search identified a limited number of studies meeting the inclusion criteria. The available evidence, while scarce, suggests a positive association between clinic-based alcohol reduction interventions and improved self-reported ART adherence. One study reported a notable increase in the proportion of men achieving optimal adherence post-intervention. Preliminary evidence indicates that clinic-based alcohol reduction interventions may improve ART adherence among men in Malawian fishing communities. However, the current evidence base is insufficient to draw definitive conclusions. Further robust research, including randomised controlled trials employing objective adherence measures, is required. Programmes should consider integrating targeted alcohol reduction support into routine HIV clinic services for this population whilst additional evidence is generated. HIV, antiretroviral therapy adherence, alcohol reduction, men, fishing communities, Malawi, sub-Saharan Africa, intervention This review consolidates the current knowledge on a specific intervention for a key population, underscores a critical evidence gap, and guides future research and programming priorities in the region.