Psychosocial interventions for improving engagement in care and health and behavioural outcomes for adolescents and young people living with HIV: a systematic review and meta‐analysis

Abstract

Introduction: Adolescents and young people comprise a growing proportion of new HIV infections globally, yet current approaches do not effectively engage this group, and adolescent HIV-related outcomes are the poorest among all age groups. Providing psychosocial interventions incorporating psychological, social, and/or behavioural approaches offer a potential pathway to improve engagement in care and health and behavioural outcomes among adolescents and young people living with HIV (AYPLHIV). Methods: A systematic search of all peer-reviewed papers published between January 2000 and July 2020 was conducted through four electronic databases (Cochrane Library, PsycINFO, PubMed and Scopus). We included randomized controlled trials evaluating psychosocial interventions aimed at improving engagement in care and health and behavioural outcomes of AYPLHIV aged 10 to 24 years. Results and discussion: Thirty relevant studies were identified. Studies took place in the United States (n = 18, 60%), sub-Saharan Africa (Nigeria, South Africa, Uganda, Zambia, Zimbabwe) and Southeast Asia (Thailand). Outcomes of interest included adherence to antiretroviral therapy (ART), ART knowledge, viral load data, sexual risk behaviours, sexual risk knowledge, retention in care and linkage to care. Overall, psychosocial interventions for AYPLHIV showed important, small-tomoderate effects on adherence to ART (SMD = 0.3907, 95% CI: 0.1059 to 0.6754, 21 studies, n = 2647) and viral load (SMD = À0.2607, 95% CI À04518 to À0.0696, 12 studies, n = 1566). The psychosocial interventions reviewed did not demonstrate significant impacts on retention in care (n = 8), sexual risk behaviours and knowledge (n = 13), viral suppression (n = 4), undetectable viral load (n = 5) or linkage to care (n = 1) among AYPLHIV. No studies measured transition to adult services. Effective interventions employed various approaches, including digital and lay health worker delivery, which hold promise for scaling interventions in the context of COVID-19. Conclusions: This review highlights the potential of psychosocial interventions in improving health outcomes in AYPLHIV. However, more research needs to be conducted on interventions that can effectively reduce sexual risk behaviours of AYPL-HIV, as well as those that can strengthen engagement in care. Further investment is needed to ensure that these interventions are cost-effective, sustainable and resilient in the face of resource constraints and global challenges such as the COVID-19 pandemic.

Mental health, longitudinal ART adherence, and viral suppression among adolescents and adults living with HIV in South Africa: a cohort study

“…Poor HIV treatment outcomes in adolescents and young adults highlight the need for interventions to improve care outcomes in this age group. A recent meta-analysis found that psychosocial interventions for adolescents and young people living with HIV showed small-to-moderate effects on adherence and viral load [49]. Scale-up of successful interventions to improve HIV outcomes of young people living with HIV should be a priority.…”

Conducting a randomised controlled trial of a psychosocial intervention for adolescents with type 1 diabetes during COVID-19: recommendations to overcome the challenges complicated by inconsistent public health guidelines on research

“…Thus, administering the RCT also involved a lot of direct face-to-face contact and communication with patients. Interestingly, some RCTs testing out psychosocial interventions did not experience similar challenges because they were able to recruit virtual patients, whereas we were not allowed to do so [ 12 , 13 ].…”

“…Sharing expertise and learning from other research studies who are in a similar situation is important [ 6 ], especially where there is little or varying public health guidelines on continuing research during a pandemic [ 1 ]. Although there are numerous papers reporting on managing clinical trials during the COVID-19 pandemic, there is very little addressing the challenges of conducting an RCT of a psychosocial intervention, which requires direct patient contact in a hospital setting [ 12 , 13 ].…”

Future directions for HIV service delivery research: Research gaps identified through WHO guideline development

“…A systematic review identified 30 randomized controlled trials of psychosocial interventions for adolescents and young adults [ 55 ]; most studies were carried out in the USA (18 studies) or sub-Saharan Africa (9 studies). Psychosocial interventions improved adherence to ART and increased the proportion of individuals with viral suppression.…”