Health‐related needs reported by adolescents living with HIV and receiving antiretroviral therapy in sub‐Saharan Africa: a systematic literature review

Abstract

Introduction Adolescents living with HIV (ALHIV) on antiretroviral therapy (ART) have specific health needs that can be challenging to deliver. Sub‐Saharan Africa (SSA) is home to 84% of the global population of ALHIV, of whom about 59% receive ART. Several studies in SSA have demonstrated health service gaps due to lack of synchronized healthcare for ALHIV receiving ART. We conducted a systematic review of health‐related needs among ALHIV on ART in SSA to inform decisions and policies on care. Methods We searched MEDLINE, Web of Science, EMBASE, PsycINFO, Cochrane library and grey literature for studies reporting health‐related needs among ALHIV receiving ART in SSA, between January 2003 and May 2020. Results and discussion Of the 2333 potentially eligible articles identified, 32 were eligible. Eligible studies were published between 2008 and 2019, in 11 countries: Zambia (7), Uganda (6), Tanzania (4), South Africa (4), Kenya (3), Ghana (2), Zimbabwe (2), Rwanda (1), Malawi (1), Botswana (1) and Democratic Republic of Congo (1). Seven categories of health needs among ALHIV were identified. In descending order of occurrence, these were: psychosocial needs (stigma reduction, disclosure and privacy support, and difficulty accepting diagnosis); dependency of care (need for family and provider support, and desire for autonomy); self‐management needs (desire for better coping strategies, medication adherence support and reduced ART side effects); non‐responsive health services (non‐adolescent friendly facility services and non‐compatible school system); need for food, financial and material support; inadequate information about HIV (desire for more knowledge to fight misinformation and misconception); and developmental and growth needs (desire to experience sex, parenthood and love). Ecological analysis identified different priority needs between ALHIV, their caregivers and healthcare providers, including psychosocial needs, financial challenges and non‐responsive health services, respectively. Conclusions To respond effectively to the health needs of ALHIV and improve ART adherence, interventions should focus on stigma reduction, disclosure challenges and innovative coping mechanisms for ART. Interventions that address the health needs of ALHIV from the perspective of carers and providers, such as financial support schemes and adolescent‐friendly healthcare strategies, should supplement efforts to improve adolescent ART adherence outcomes.

“I am still human and worth a life:” a qualitative study of the impacts of a community based, peer-led, treatment support model for young adults living with HIV in Zimbabwe

“…However, given the risk of punishment or retaliation for parents who might fault the child for their diagnosis ( 38 ), CATs carefully support participants to navigate disclosure. Our findings suggest that the most effective strategy for the child’s wellbeing and health is to respect his or her wishes and find enabling ways to sustain adherence, rather than promoting disclosure against her wishes, which could lead to non-adherence and poor mental health ( 23 , 36 , 39 ). This type of consideration and nuance in deciding who to tell and providing post-disclosure counseling and support proved a critical element of peer navigation services for youth, and aligns with findings from other research in the region around effective disclosure strategies for youth ( 6 , 35 , 40 ).…”

“We can tell a good teacher who cares, understands, and can be confidential about it”: youth and caregiver experiences with HIV disclosure to schools in Kenya

“…Although theoretically, schools may be an ideal venue to offer support to YLH, they often lack structured support systems for disclosure of HIV status and medication adherence ( 10 , 16 , 22 , 23 ). For example, providing detailed and correct information about HIV has been shown to reduce stigma in community settings and could be adapted for school settings ( 24 , 25 ). In a recent boarding school-based intervention (Red Carpet Program) implemented in some boarding schools in Kenya, school-wide HIV education followed by disclosure education for focal persons on the school health committee or who serve as Adolescent Health advocates resulted in better linkage to care ( 26 ).…”

A qualitative analysis of self-management needs of adolescents and young adults living with perinatally acquired HIV in rural, southwestern Uganda

“…Further, many HIV care facilities focus primarily on access to antiretroviral therapy, with little or no focus on attending to the psychological, social and behavioral aspects of the illness, such that many AYLPHIV age into adulthood without the skills necessary to manage the illness on their own [34,35]. These skills are particularly vital for AYLPHIV in rural areas, where they often struggle with poverty, food insecurity, and limited educational opportunities in addition to managing a chronic stigmatized condition [17,33,[36][37][38].…”