Mental health interventions for adolescents living with HIV or affected by HIV in low- and middle-income countries: systematic review

Abstract

Background Mental health difficulties and mental disorders are common in adolescents living with HIV or who are affected by HIV because of living in HIV-affected households in low- and middle-income (LMICs) countries, but little is known about the interventions that target these individuals and whether they are effective. Aims This systematic review aims to address these gaps by examining what has worked and what has not worked to support the mental health of adolescents living with HIV or affected by HIV in low- and middle-income contexts (PROSPERO Number: CRD42018103269). Method A systematic literature review of online databases from the year 2000 to 2018, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, included English-language publications of quantitative evaluations of psychosocial interventions aiming to improve mental health among adolescents living with HIV and adolescents from HIV-affected households (aged 10–24 years) in LMICs. Results Out of 2956 articles, 16 studies from 8 LMICs met the inclusion criteria. Thirteen studies focused on adolescents affected by HIV and only three studies on adolescents living with HIV. Only five studies included were from Sub-Saharan Africa. Interventions most often used a family-strengthening approach strengthening caregiver–adolescent relationships and communication and some problem-solving in groups or individually. Five studies reported statistically significant changes in adolescent and caregiver mental health or mental well-being, five among adolescents only and two among caregivers only. Conclusions Research on what works to improve mental health in adolescents living with HIV in LMIC is in its nascent stages. Family-based interventions and economic strengthening show promise.

Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa

“…Results from our modification assessment suggest the association between physical or sexual violence and depressive symptoms is mitigated in individuals with higher social support or self‐esteem. Although a number of interventions aimed at improving social support or self‐esteem among South African YLWH have proven ineffective, interventions from similar settings have demonstrated success [78,79]. The Zvandiri programme, which began as a single support group in Zambia, aims to ensure the physical, social and mental well‐being of YLWH to improve HIV care outcomes.…”

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

“…Relatedly, multiple reviews have documented that even fewer trials have tested interventions which target the mental health needs AYALH or AYAAH, particularly in LMIC, with mixed findings [9,24,29,37,38]. Due to the lack of sufficient evidence, the World Health Organization guidelines on mental health treatment and prevention for adolescents (Helping Adolescents Thrive) concluded that despite the priority of delivering mental health interventions to AYALH, no recommendations could be made and highlighted a need for highquality research on psychosocial interventions promoting AYALH mental health [39]. A similar need has been advocated for AYAAH including uninfected AYA with PHEU given the high rates of mental health problems and potential risks of perinatal exposure to ART, as well as similar psychosocial and contextual risks as AYALH [40].…”

Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

“…One strategy to support adolescent-caregiver relationships are parenting and family strengthening programmes [ 53 – 55 ]. Several programmes have been developed or tailored for families with ALHIV [ 56 ] and adolescents affected by HIV [ 57 , 58 ]. For example, the Vuka programme [ 18 ] is a group-based intervention for adolescent-caregiver pairs that addresses adolescent-caregiver communication, strategies for adolescent safety in the community, and HIV knowledge and disclosure, among other topics.…”