The ‘4th 90’ target as a strategy to improve health‐related quality of life of people living with HIV in sub‐Saharan Africa

Abstract

Objectives: Next to monitoring the clinical health of people living with HIV through the triple 90 targets, a 4th 90 target was proposed in 2016 to improve HIV healthrelated quality of life (HrQoL) by addressing comorbidities and other psychosocial challenges. This scoping review aimed at understanding related psychosocial determinants, including strategies to improve HrQoL for people living with HIV in sub-Saharan Africa (SSA), as an initiative to ameliorate the continuum of care. Methods: This scoping review followed PRISMA guidelines. We searched PubMed and Wiley databases from 01 January 2011 to 19 April 2021 for articles on HrQoL, including determinants and related interventions in SSA. We also conducted a manual search to retrieve grey literature on the '4th 90' target. The six domains of HrQoL defined in the most widely used instrument (i.e., WHOQOL-HIV-BREF tool) served as a guiding framework. Results: Thirty-three articles were included for analysis. Seven articles illustrated the ongoing debate on the 4th 90 target, highlighting challenges with measuring indicators. Nine articles discussed HrQoL domains, reporting the highest scores in the spirituality and physical domains and lowest scores in the social and environmental domains. The presence of stigma and depressive symptoms was associated with low HrQoL. Seventeen articles discussed HrQoL interventions, highlighting that improved HrQoL enhanced health-seeking behaviour. Only two interventions addressed the environmental domain highlighting the fact that selection of intervention aims were not evidence led. Conclusion: Introducing the 4th 90 target in SSA as a strategy to enhance HrQoL amongst people living with HIV could improve the HIV continuum of care; however, efforts are required to effectively address environmental and structural determinants. K E Y W O R D S health related quality of life, HIV, scoping review, sub-Saharan Africa

The Effect of Stigma and Social Networks on Role Expectations among African Immigrants Living with HIV

“…Within these cultures, HIV is framed by four predominant discourses: mortality , which sees HIV as a “death sentence”; immorality , which associates HIV with (sexual) promiscuity and deviance; retribution , which deems HIV as punishment for the contravention of religious edicts; and the discourse of invisibility , reflected in the generalized silence and discomfort about HIV as a taboo subject, often referenced with third-person pronouns such as “it”, “thing”, “this”, or “the disease” [ 49 , 50 , 51 ]. Despite increased HIV knowledge and progress with stigma reduction programs in sub-Saharan Africa, these discourses continue to fuel negative attitudes towards HIV and PLWHA [ 52 , 53 ] in the region, survive through migration, and are reinforced through continuing contact by African immigrants with their countries of origin [ 48 , 54 ].…”