Effects of telehealth-integrated interventions for smoking cessation and alcohol reduction among people living with HIV: a systematic review and meta-analysis

Abstract

Smoking and alcohol use are highly prevalent among people living with HIV (PLWH) and contribute to adverse health outcomes. Telehealth offers an accessible and scalable approach to behavioral support. However, previous reviews have generally focused on smoking or alcohol use separately. This systematic review and meta-analysis evaluated the effects of telehealth-integrated interventions on smoking cessation and alcohol-related outcomes among PLWH. PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to April 1, 2026, for randomized controlled trials (RCTs) of interventions targeting tobacco or alcohol use among PLWH. Eligible studies were quantitatively synthesized, and the certainty of evidence for four main outcomes was assessed using GRADE. Fifteen RCTs involving 2,212 PLWH were included. Compared with study-specific comparator conditions, telehealth-integrated intervention packages were associated with higher 7-day point-prevalence abstinence (RR = 2.07, 95% CI: 1.60–2.68) and 30-day point-prevalence abstinence (RR = 2.04, 95% CI: 1.31–3.19). For alcohol-related outcomes, limited evidence suggested that telehealth-integrated interventions may reduce mean drinks per drinking day (MD = −0.33, 95% CI: −0.58 – −0.08), whereas no clear between-group difference was observed in the number of drinking days in the past 30 days (MD = −0.02, 95% CI: −0.35 – 0.30). Exploratory subgroup analysis showed a larger smoking-cessation effect estimate at shorter follow-up (≤3 months) than at longer follow-up (>3 months) ( p for subgroup difference = 0.02). No statistically significant difference in effect estimates was detected across telehealth modalities ( p  = 0.45), and this finding should not be interpreted as evidence of equivalent efficacy. Current evidence suggests that telehealth-integrated interventions may improve short-term smoking cessation outcomes among PLWH and may reduce mean drinks per drinking day. However, evidence for alcohol-related outcomes remains limited. Further adequately powered RCTs with longer follow-up are needed to clarify the durability of smoking cessation benefits and alcohol-related effects. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251242171 . Registration number: CRD420251242171)