Despite widespread availability of life-saving antiretroviral therapy (ART) in sub-Saharan Africa, AIDS remains one of the leading causes of death among adolescents living with HIV (ALHIV) in sub-Saharan Africa. The purpose of this article was to review the state of the science regarding interventions to improve ART adherence and/or HIV care retention among ALHIV throughout sub-Saharan Africa. The primary aim of this review was to describe the impact of peer support interventions in improving treatment outcomes (i.e., ART adherence and retention in HIV care) among ALHIV in sub-Saharan Africa. The secondary aim of this review was to determine whether these interventions may be efficacious at improving mental health outcomes. We identified 27 articles that met the eligibility criteria for our review, and categorized each article based on the type of peer support provided to ALHIV—individualized peer support, group-based support, and individualized plus group-based support. Results regarding the efficacy of these interventions are mixed and most of the studies included were deemed moderate in methodological quality. Although studies evaluating group-based peer support interventions were the most common, most of these studies were not associated with retention, adherence, or mental health outcomes. More robust, fully powered studies are needed to strengthen our knowledge base regarding peer support for ALHIV.
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References
1.
SlogroveAL, SohnAH. The global epidemiology of adolescents living with HIV: Time for more granular data to improve adolescent health outcomes. Curr Opin HIV AIDS, 2018; 13(3):170–178.
2.
Global AIDS Monitoring 2019. Indicators for Monitoring the 2016 Political Declaration on Ending AIDS; 2018. Available from: www.unaids.org/sites/default/files/media_asset/global-aids-monitoring_en.pdf [Last accessed: October20, 2021].
3.
MavhuW, BerwickJ, ChirawuP, et al.Enhancing psychosocial support for HIV positive adolescents in Harare, Zimbabwe. PLoS One, 2013; 8(7):e70254.
4.
KimMH, MazengaAC, YuX, et al.High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: Barriers and associated factors. J Int AIDS Soc, 2017; 20(1):21437.
5.
NachegaJB, HislopM, NguyenH, et al.Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in southern Africa. J Acquir Immune Defic Syndr, 2009; 51(1):65–71.
6.
JobanputraK, ParkerLA, AzihC, et al.Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. PLoS One, 2015; 10(2):e0116144.
7.
FokamJ, SossoSM, YagaiB, et al.Viral suppression in adults, adolescents and children receiving antiretroviral therapy in Cameroon: Adolescents at high risk of virological failure in the era of “test and treat.”. AIDS Res Ther, 2019; 16(1):36.
8.
ZanoniBC, ArcharyM, BuchanS, et al.Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: The Cresting Wave. BMJ Glob Health, 2016; 1(3):e000004.
9.
AhonkhaiAA, BanigbeB, AdeolaJ, et al.Age matters: Increased risk of inconsistent HIV care and viremia among adolescents and young adults on antiretroviral therapy in Nigeria. J Adolesc Health, 2016; 59(3):298–304.
10.
LambMR, FayorseyR, Nuwagaba-BiribonwohaH, et al.High attrition before and after ART initiation among youth (15–24 years of age) enrolled in HIV care. AIDS, 2014; 28(4):559–568.
11.
KranzerK, BradleyJ, MusaaziJ, et al.Loss to follow-up among children and adolescents growing up with HIV infection: Age really matters. J Int AIDS Soc, 2017; 20(1):21737–21737.
12.
JereneD, AbebeW, TayeK, et al.Adolescents living with HIV are at higher risk of death and loss to follow up from care: Analysis of cohort data from eight health facilities in Ethiopia. PLoS One, 2019; 14(10):e0223655.
13.
UNICEF. Adolescent HIV Prevention; 2021. Available from: https://data.unicef.org/topic/hivaids/adolescents-young-people/ [Last accessed: October25, 2021].
14.
AmmonN, MasonS, CorkeryJM. Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: A systematic review. Public Health, 2018; 157:20–31.
15.
MacDonellK, Naar-KingS, HusztiH, et al. Barriers to medication adherence in behaviorally and perinatally infected youth living with HIV. AIDS Behav, 2013; 17(1):86–93.
16.
CluverL, MeinckF, ToskaE, et al.Multitype violence exposures and adolescent antiretroviral nonadherence in South Africa. AIDS, 2018; 32(8):975–983.
17.
AbebeH, ShumetS, NassirZ, et al.Prevalence of depressive symptoms and associated factors among HIV-positive youth attending ART follow-up in Addis Ababa, Ethiopia. AIDS Res Treat, 2019; 2019:4610458.
18.
DowDE, TurnerEL, ShayoAM, MmbagaB, et al.Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania. AIDS Care, 2016; 28(7):825–833.
19.
KimMH, MazengaAC, DevandraA, et al.Prevalence of depression and validation of the Beck Depression Inventory-II and the Children's Depression Inventory-Short amongst HIV-positive adolescents in Malawi. J Int AIDS Soc, 2014; 17(1):18965.
20.
KemigishaE, ZanoniB, BruceK, et al.Prevalence of depressive symptoms and associated factors among adolescents living with HIV/AIDS in South Western Uganda. AIDS Care, 2019; 31(10):1297–1303.
21.
PantelicM, BoyesM, CluverL, et al.HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV. J Int AIDS Soc, 2017; 20(1):21771.
22.
PantelicM, CasaleM, CluverL, et al.Multiple forms of discrimination and internalized stigma compromise retention in HIV care among adolescents: Findings from a South African cohort. J Int AIDS Soc, 2020; 23(5):e25488.
23.
AyanoG, DemelashS, AbrahaM, et al.The prevalence of depression among adolescent with HIV/AIDS: a systematic review and meta-analysis. AIDS Res Ther, 2021; 18(1):23.
24.
KimeraE, VindevogelS, ReynaertD, et al.Experiences and effects of HIV-related stigma among youth living with HIV/AIDS in Western Uganda: A photovoice study. PLoS One, 2020; 15(4):e0232359–e0232359.
25.
WoollettN, CluverL, BandeiraM, et al.Identifying risks for mental health problems in HIV positive adolescents accessing HIV treatment in Johannesburg. J Child Adolesc Ment Health, 2017; 29(1):11–26.
26.
LewisJV, AbramowitzS, KoenigLJ, et al.Negative life events and depression in adolescents with HIV: A stress and coping analysis. AIDS Care, 2015; 27(10):1265–1274.
27.
WillisN, MavhuW, WogrinC, et al.Understanding the experience and manifestation of depression in adolescents living with HIV in Harare, Zimbabwe. PLoS One, 2018; 13(1):e0190423.
28.
VreemanRC, McCoyBM, LeeS. Mental health challenges among adolescents living with HIV. J Int AIDS Soc, 2017; 20(Suppl 3):21497.
29.
OlashoreAA, ParukS, AkanniOO, et al.Psychiatric disorders in adolescents living with HIV and association with antiretroviral therapy adherence in Sub-Saharan Africa: A systematic review and meta-analysis. AIDS Behav, 2021; 25(6):1711–1728.
30.
Smith FawziMC, NgL, KanyanganziF, et al.Mental health and antiretroviral adherence among youth living with HIV in Rwanda. Pediatrics, 2016; 138(4):e2053235.
31.
OkawaS, Mwanza KabagheS, MwiyaM, et al.Psychological well-being and adherence to antiretroviral therapy among adolescents living with HIV in Zambia. AIDS Care, 2018; 30(5):634–642.
32.
OkonjiEF, MukumbangFC, OrthZ, et al.Psychosocial support interventions for improved adherence and retention in ART care for young people living with HIV (10–24 years): A scoping review. BMC Public Health, 2020; 20(1):1841.
33.
Rooks-PeckCR, AdegbiteAH, WichserME, et al.Mental health and retention in HIV care: A systematic review and meta-analysis. Health Psychol, 2018; 37(6):574–585.
34.
CasaleM, BoyesM, PantelicM, et al.Suicidal thoughts and behaviour among South African adolescents living with HIV: Can social support buffer the impact of stigma?. J Affect Disord, 2019; 245:82–90.
35.
EnriquezM, ConnVS. Peers as facilitators of medication adherence interventions: A review. J Prim Care Community Health, 2016; 7(1):44–55.
36.
MarkD, HrapcakS, AmeyanW, et al.Peer support within a health care context: a concept analysis. Int J Nurs Stud, 2003; 40(3):321–332.
37.
AhmedCV, WeissingerG, TeitelmanA, et al.Expert client service delivery practices among adolescents living with HIV in Eswatini: A thematic analysis. Child Youth Serv Rev, 2022; 132:106309.
38.
WillisN, MilanziA, MawodzekeM, et al.Effectiveness of community adolescent treatment supporters (CATS) interventions in improving linkage and retention in care, adherence to ART and psychosocial well-being: A randomised trial among adolescents living with HIV in rural Zimbabwe. BMC Public Health, 2019; 19(1):117–117.
39.
GrimsrudAT, PikeC, BekkerL-G. The power of peers and community in the continuum of HIV care. Lancet Glob Health, 2020; 8(2):e167–e168.
40.
BergRC, PageS, Øgård-RepålA. The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis. PLoS One, 2021; 16(6):e0252623.
41.
LaurenziCA, du ToitS, AmeyanW, et al.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. J Int AIDS Soc, 2021; 24(8):e25741.
42.
CasaleM, CarlqvistA, CluverL. Recent interventions to improve retention in HIV care and adherence to antiretroviral treatment among adolescents and youth: A systematic review. AIDS Patient Care STDS, 2019; 33(6):237–252.
43.
AlconS, AhmedB, SloaneD, et al.Interventions to improve medication adherence in adolescents with HIV: A systematic review and meta-analysis. J Investig Med, 2020; 68(7):1217.
44.
RidgewayK, DulliLS, MurrayKR, et al.Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature. PLoS One, 2018; 13(1):e0189770.
45.
MurrayKR, DulliLS, RidgewayK, et al.Improving retention in HIV care among adolescents and adults in low- and middle-income countries: A systematic review of the literature. PLoS One, 2017; 12(9):e0184879.
46.
MacPhersonP, MunthaliC, FergusonJ, et al.Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care. Trop Med Int Health, 2015; 20(8):1015–1032.
47.
CrowleyT, RohwerA. Self-management interventions for adolescents living with HIV: A systematic review. BMC Infect Dis, 2021; 21(1):431.
48.
ReifLK, AbramsEJ, ArpadiS, et al.Interventions to improve antiretroviral therapy adherence among adolescents and youth in low- and middle-income countries: A systematic review 2015–2019. AIDS Behav, 2020; 24(10):2797–2810.
49.
KewKM, CarrR, CrossinghamI. Lay-led and peer support interventions for adolescents with asthma. Cochrane Database Syst Rev, 2017; 4(4):CD012331.
50.
Rose-ClarkeK, BentleyA, MarstonC, et al.Peer-facilitated community-based interventions for adolescent health in low- and middle-income countries: A systematic review. PLoS One, 2019; 14(1):e0210468–e0210468.
51.
AhmedC, WeissingerG, TeitelmanA, et al.Roles and responsibilities of expert clients in adolescent HIV service delivery in Eswatini: A conventional content analysis. Afr J AIDS Res, 2023; 22(1):27–34.
52.
TaperaT, WillisN, MadzekeK, et al.Effects of a peer-led intervention on HIV care continuum outcomes among contacts of children, adolescents, and young adults living with HIV in Zimbabwe. Glob Health Sci Pract, 2019; 7(4):575.
53.
KarwaR, MainaM, MercerT, et al.Leveraging peer-based support to facilitate HIV care in Kenya. PLoS Med, 2017; 14(7):e1002355.
54.
AremH, NakyanjoN, KagaayiJ, et al.Peer health workers and AIDS care in Rakai, Uganda: A mixed methods operations research evaluation of a cluster-randomized trial. AIDS Patient Care STDS, 2011; 25(12):719–724.
55.
El-SadrWM, HolmesCB, MugyenyiP, et al.Scale-up of HIV treatment through PEPFAR: A historic public health achievement. J Acquir Immune Defic Syndr, 2012; 60(Suppl 3):S96–S104.
56.
SawyerSM, AzzopardiPS, WickremarathneD, et al.The age of adolescence. Lancet Child Adolesc Health, 2018; 2(3):223–228.
DulliL, RidgewayK, PackerC, et al.A social media-based support group for youth living with HIV in Nigeria (SMART Connections): Randomized controlled trial. J Med Internet Res, 2020; 22(6):e18343.
59.
DenisonJA, BurkeVM, MitiS, et al.Project YES! Youth Engaging for Success: A randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15–24 years) in Ndola, Zambia. PLoS One, 2020; 15(4):e0230703.
60.
DowDE, MmbagaBT, GallisJA, et al.A group-based mental health intervention for young people living with HIV in Tanzania: Results of a pilot individually randomized group treatment trial. BMC Public Health, 2020; 20(1):1358.
61.
GalárragaO, EnimilA, BosomtweD, et al.Group-based economic incentives to improve adherence to antiretroviral therapy among youth living with HIV: Safety and preliminary efficacy from a pilot trial. Vulnerable Child Youth Stud, 2020; 15(3):257–268.
62.
GravesJC, ElyanuP, SchellackCJ, et al.Impact of a Family Clinic Day intervention on paediatric and adolescent appointment adherence and retention in antiretroviral therapy: A cluster randomized controlled trial in Uganda. PLoS One, 2018; 13(3):e0192068.
63.
GrimsrudA, LesoskyM, KalomboC, et al.Implementation and operational research: Community-based adherence clubs for the management of stable antiretroviral therapy patients in Cape Town, South Africa: A cohort study. J Acquir Immune Defic Syndr, 2016; 71(1):e16–e23.
64.
MacKenzieRK, van LettowM, GondweC, et al.Greater retention in care among adolescents on antiretroviral treatment accessing “Teen Club” an adolescent-centred differentiated care model compared with standard of care: A nested case-control study at a tertiary referral hospital in Malawi. J Int AIDS Soc, 2017; 20(3):e25028.
65.
MavhuW, WillisN, MufukaJ, et al.Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): A cluster-randomised controlled trial. Lancet Glob Health, 2020; 8(2):e264–e275.
66.
MunyayiFK, van WykB. The effects of Teen Clubs on retention in HIV care among adolescents in Windhoek, Namibia. South Afr J HIV Med, 2020; 21(1):1031.
67.
MunyayiFK, van WykBE. The comparison of Teen Clubs vs. standard care on treatment outcomes for adolescents on antiretroviral therapy in Windhoek, Namibia. AIDS Res Treat, 2020; 2020:8604276.
68.
NasuunaE, KigoziJ, BabiryeL, et al.Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda. BMC Public Health, 2018; 18(1):1048.
69.
NdhlovuCE, KouamouV, NyamayaroP, et al.The transient effect of a peer support intervention to improve adherence among adolescents and young adults failing antiretroviral therapy in Harare, Zimbabwe: A randomized control trial. AIDS Res Ther, 2021; 18(1):32.
70.
RuriaEC, MasabaR, KoseJ, et al.Optimizing linkage to care and initiation and retention on treatment of adolescents with newly diagnosed HIV infection. AIDS, 2017; 31(Suppl 3):S253–s260.
71.
StanglAL, MwaleM, SebanyM, et al.Feasibility, acceptability and preliminary efficacy of Tikambisane (‘Let's Talk to Each Other’): A pilot support group intervention for adolescent girls living with HIV in Zambia. J Int Assoc Provid AIDS Care, 2021; 20:2325958221124772.
72.
TaiwoBO, KutiKM, KuhnsLM, et al.Effect of text messaging plus peer navigation on viral suppression among youth with HIV in the iCARE Nigeria pilot study. J Acquir Immune Defic Syndr, 2021; 87(4):1086–1092.
73.
TeasdaleCA, AlwarT, ChegeD, et al.Impact of youth and adolescent friendly services on retention of 10-24-year-olds in HIV care and treatment programs in Nyanza, Kenya. J Acquir Immune Defic Syndr, 2016; 71(2):e56–e59.
74.
VuL, Burnett-ZiemanB, BanuraC, et al.Increasing uptake of HIV, sexually transmitted infection, and family planning services, and reducing HIV-related risk behaviors among youth living with HIV in Uganda. J Adolesc Health, 2017; 60:S22–S28.
75.
ZanoniBC, SibayaT, CairnsC, et al.Higher retention and viral suppression with adolescent-focused HIV clinic in South Africa. PLoS One, 2017; 12(12):e0190260.
76.
DonenbergGR, FittsJ, IngabireC, et al.Results of the Kigali Imbereheza Project: A 2-arm individually randomized trial of TI-CBT enhanced to address ART adherence and mental health for Rwandan youth living with HIV. J Acquir Immune Defic Syndr, 2022; 90(1):69–78.
77.
KasimonjeB, ShamuT, MudzvitiT, et al.Group counselling for adherence support among young people failing first-line antiretroviral therapy in Zimbabwe. South Afr J HIV Med, 2021; 22(1):1292.
78.
BarkerD, EnimilA, GalárragaO, et al.In-clinic adolescent peer group support for engagement in sub-Saharan Africa: A feasibility and acceptability trial. J Int Assoc Provid AIDS Care, 2019; 18:2325958219835786.
79.
NessTE, AgrawalV, GuffeyD, et al.Impact of using creative arts programming to support HIV treatment in adolescents and young adults in Eswatini. AIDS Res Ther, 2021; 18(1):100.
80.
MadibaS, MohlabaneN. Attendance of psychosocial teen clubs and self-reported antiretroviral medication adherence: A cross section study of adolescents with perinatal HIV in the Kingdom of Lesotho. AIMS Public Health, 2021; 8(3):541–552.
81.
ChoryA, CallenG, NyandikoW, et al.A pilot study of a mobile intervention to support mental health and adherence among adolescents living with HIV in Western Kenya. AIDS Behav, 2022; 26(1):232–242.
82.
IvanovaO, WambuaS, MwaisakaJ, et al.Evaluation of the ELIMIKA pilot project: Improving ART adherence among HIV positive youth using an eHealth intervention in Mombasa, Kenya. Afr J Reprod Health, 2019; 23(1):100–110.
83.
YatorO, John-StewartG, KhasakhalaL, et al.Preliminary effectiveness of group interpersonal psychotherapy for young Kenyan mothers with HIV and depression: A pilot trial. Am J Psychother, 2022; 75(2):89–96.
84.
BergerBE, FerransCE, LashleyFR. Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Res Nurs Health, 2001; 24(6):518–529.
85.
StewardWT, AgnewE, de KadtJ, et al.Impact of SMS and peer navigation on retention in HIV care among adults in South Africa: Results of a three-arm cluster randomized controlled trial. J Int AIDS Soc, 2021; 24(8):e25774.
86.
AmaniB, MerzaD, SavoyC, et al.Peer-delivered cognitive-behavioral therapy for postpartum depression: A randomized controlled trial. J Clin Psychiatry, 2021; 83(1):21m13928.
87.
FuhrDC, SalisburyTT, De SilvaMJ, et al.Effectiveness of peer-delivered interventions for severe mental illness and depression on clinical and psychosocial outcomes: A systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol, 2014; 49(11):1691–1702.
88.
BhanaA, MellinsCA, PetersenI, et al.The VUKA family program: piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa. AIDS Care, 2014; 26(1):1–11.
89.
Di GennaroF, MarottaC, RamirezL, et al.High prevalence of mental health disorders in adolescents and youth living with HIV: An observational study from eight health services in Sofala Province, Mozambique. AIDS Patient Care STDS, 2022; 36(4):123–129.
90.
DessauvagieAS, Jörns-PresentatiA, NappAK, et al.The prevalence of mental health problems in sub-Saharan adolescents living with HIV: A systematic review. Glob Ment Health (Camb), 2020; 7:e29.
91.
SafrenSA, O'CleirighC, AndersenLS, et al.Treating depression and improving adherence in HIV care with task-shared cognitive behavioural therapy in Khayelitsha, South Africa: a randomized controlled trial. J Int AIDS Soc, 2021; 24(10):e25823.
92.
Van TamV, LarssonM, PharrisA, et al.Peer support and improved quality of life among persons living with HIV on antiretroviral treatment: A randomised controlled trial from north-eastern Vietnam. Health Qual Life Outcomes, 2012; 10(1):53.
93.
AcriM, ZhangS, AdlerJG, et al.Peer-delivered models for caregivers of children and adults with health conditions: A review. J Child Fam Stud, 2017; 25(2):337–344.
94.
SsewamalaFM, DvalishviliD, MellinsCA, et al.The long-term effects of a family based economic empowerment intervention (Suubi+Adherence) on suppression of HIV viral loads among adolescents living with HIV in southern Uganda: Findings from 5-year cluster randomized trial. PLoS One, 2020; 15(2):e0228370.
95.
TozanY, CapassoA, SunS, et al.The efficacy and cost-effectiveness of a family-based economic empowerment intervention (Suubi + Adherence) on suppression of HIV viral loads among adolescents living with HIV: Results from a Cluster Randomized Controlled Trial in southern Uganda. J Int AIDS Soc, 2021; 24(6):e25752.
96.
BermudezLG, JenningsL, SsewamalaFM, et al.Equity in adherence to antiretroviral therapy among economically vulnerable adolescents living with HIV in Uganda. AIDS Care, 2016; 28(Suppl 2):83–91.
97.
Cavazos-RehgP, ByansiW, XuC, et al.The impact of a family-based economic intervention on the mental health of HIV-infected adolescents in Uganda: Results from Suubi+Adherence. J Adolesc Health, 2021; 68(4):742–749.
98.
GuinartD, KaneJM. Use of behavioral economics to improve medication adherence in severe mental illness. Psychiatr Serv, 2019; 70(10):955–957.
99.
LinnemayrS, StecherC, MukasaB. Behavioral economic incentives to improve adherence to antiretroviral medication. AIDS, 2017; 31(5):719–726.
100.
VlaevI, KingD, DarziA, et al.Changing health behaviors using financial incentives: A review from behavioral economics. BMC Public Health, 2019; 19(1):1059.
101.
StevensJ. Topical review: Behavioral economics as a promising framework for promoting treatment adherence to pediatric regimens. J Pediatr Psychol, 2014; 39(10):1097–1103.
102.
HartzJC, de FerrantiSD. The Use of Mobile Health Technology and Behavioral Economics to Encourage Adherence in Adolescents [ClinicalTrials.gov]; 2020. Available from: https://clinicaltrials.gov/ct2/show/NCT04458766 [Last accessed: May 2022].
103.
MacCarthyS, WagnerZ, Mendoza-GrafA, et al.A randomized controlled trial study of the acceptability, feasibility, and preliminary impact of SITA (SMS as an Incentive To Adhere): A mobile technology-based intervention informed by behavioral economics to improve ART adherence among youth in Uganda. BMC Infect Dis, 2020; 20(1):173–173.
