Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence

Abstract

Introduction Adolescents and young adults (AYA) remain vulnerable to HIV‐infection and significant co‐morbid mental health challenges that are barriers to treatment and prevention efforts. Globally millions of AYA are living with HIV (AYALH) and/or have been affected by HIV in their families (AYAAH), with studies highlighting the need for mental health programmes. With no current guidelines for delivering mental health interventions for AYALH or AYAAH, a scoping review was undertaken to explore current evidence‐based mental health interventions for AYALH and AYAAH to inform future work. Methods The review, targeting work between 2014 and 2020, initially included studies of evidence‐based mental health interventions for AYALH and AYAAH, ages 10 to 24 years, that used traditional mental health treatments. Given the few studies identified, we expanded our search to include psychosocial interventions that had mental health study outcomes. Results and discussion We identified 13 studies, seven focused on AYALH, five on AYAAH, and one on both. Most studies took place in sub‐Saharan Africa. Depression was targeted in eight studies with the remainder focused on a range of emotional and behavioural symptoms. Few studies used evidence‐based approaches such as Cognitive Behaviour Therapy; psychosocial approaches included mental health treatments, group‐based and family strengthening interventions, economic empowerment combined with family strengthening, group‐based mindfulness and community interventions. Eleven studies were randomized control trials with four pilot studies. There was variation in sample size, treatment delivery mode (individual focus, group‐based, family focus), and measures of effectiveness across studies. Most used trained lay counsellors as facilitators, with few using trained mental health professionals. Eleven studies reported positive intervention effects on mental health. Conclusions Despite the need for mental health interventions for AYALH and AYAAH, we know surprisingly little about mental health treatment for this vulnerable population. There are some promising approaches, but more work is needed to identify evidence‐based approaches and corresponding mechanisms of change. Given limited resources, integrating mental health treatment into healthcare settings and using digital health approaches may support more standardized and scalable treatments. Greater emphasis on implementation science frameworks is needed to create sustainable mental health treatment for AYALH and AYAAH globally.

Predictors of Attempted Suicide Among Youth Living With Perinatal HIV Infection and Perinatal HIV-Exposed Uninfected Counterparts

“…Yet few evidence-based interventions exist to address general AYAL-PHIV mental health, and no interventions, to our knowledge, specifically address suicidality among young people affected by HIV. 64,65 Our findings suggest an urgent need to tailor suicide prevention interventions to the unique context and challenges of early adulthood for AYALPHIV. [66][67][68][69] Potential interventions could consider approaches to support AYAL-PHIV as they transition to adulthood.…”

Adolescent Health Series: The status of adolescent mental health research, practice and policy in sub‐Saharan Africa: A narrative review

“…Interventions to address AMH problems at the individual level were studied within anti-retroviral treatment facilities, school, family or community settings and typically delivered by non-specialist providers (20). Noteworthy studies listed in Table 2 are At the family and community level, the results of intervention programs such as the VUKA family program in South Africa and the Families Matter!…”

“…Interventions to address AMH problems at the individual level were studied within anti‐retroviral treatment facilities, school, family or community settings and typically delivered by non‐specialist providers [24]. Noteworthy studies listed in Table 2 are described below.…”

Conceptualisation and psychometric evaluation of positive psychological outcome measures used in adolescents and young adults living with HIV: a mixed scoping and systematic review protocol

“… 1 2 6 Also, with the increased availability and uptake of highly effective antiretroviral therapy, HIV has evolved into a long-term condition with a concomitant surge in comorbid non-communicable diseases. 5 7 For example, common mental disorders, including anxiety and depression, are prevalent in AYALHIV, with a pooled prevalence of 26.1% (95% CI 18.9 to 34.8). 2 However, there is a dearth of integrated programmes combining HIV and mental healthcare.…”