Community-based HIV/AIDS interventions to promote psychosocial well-being among people living with HIV/AIDS: a literature review

Figures & data

Table 1. Key characteristics of HIV/AIDS interventions from 22 quantitative studies (organized by study design).

Author/date	Study location/age range	Sample	Intervention strategy	Outcome measurements	Main findings
Panel A: Focusing on adult PLWHA only (eight quantitative studies)
Pre/post one group study (two studies)
Allen et al. (2009)	Australia; adult mean age 40	N = 41	Community-based mental health drug and alcohol nurse role with 6–8 week FU	Depression; quality of life; health	Improvement in impairment and social problems
	No effect on depression or quality of life
Operario et al. (2010)	Oakland, CA; adult mean age 46.5	N = 36	The Bruthas project: information- and motivation–behavioral skills model of HIV preventive behavior change and the AIDS risk reduction model	Social support; self-esteem; loneliness	Increased social support, self-esteem at FU
	Reduced loneliness at FU
Cluster RCT (one study)
Apinundecha et al. (2007)	Thailand; adult mean age 44.8	Intv: n = 32, Cntl: n = 34	Community participation intervention of HIV knowledge and stigma reduction education	Five stigma indices	Reduction in HIV/AIDS stigma
RCT at the individual level (three studies)
Munoz et al. (2010)	Peru; adults mean age 32	Intv: n = 60; Cntl: n = 60	Cntl: controls from a neighboring district; Intl: community-based CASA	Depression; stigma; social support; quality of life; self-efficacy	Improvements in all five outcome indices
Sacks et al. (2011)	Philadelphia; adult mean age 39.8	Intv: n = 42; Cntl: n = 34	The MTC-A program	Depression; mental health component	MTC-A clients with greater psychological functioning and stable physical health at baseline had greater improvement overall than counterparts in the comparison group
Weiss et al. (2011)	Florida, New York, New Jersey in the USA; adult aged 18+	SWPI: RCT; Intv: n = 212; Cntl: n = 239	Cntl: the SMART/EST women's program (SWP)	Distress; social support; self-efficacy; coping skills; quality of life	Improved social support, self-efficacy, coping skills, and quality of life
	SWPII: RCT; total n = 482	Intv: cognitive-behavioral stress management/expressive-supportive therapy	Reduced distress
Post-intervention cross-sectional survey (one study)
Ramirez-Valles et al. (2005)	New York city and Washington, DC; adult mean age 40	N = 155	Community participation in AIDS and gay-related organizations (volunteerism and activism)	Self-esteem; depression; loneliness	It compensated for the association between stigma, depression, and loneliness
	It buffered the negative association between stigma and self-esteem
Quasi-experimental design with a comparison group (one study)
Heckman et al. (2006)	Four sites in the USA (Ohio, Pennsylvania, Arizona, New York); older adults 50+	Immediate trt: n = 44; Delayed trt: n = 46	Twelve-session telephone-delivered coping improvement group intervention with 3 mth FU	Psychological symptoms; life stressor burden, coping self-efficacy, avoidance coping	Higher coping self-efficacy
	Fewer psychological symptoms
	Lower levels of life stressor burden
	Less frequent use of avoidance coping
Panel B: Focusing on OVCY, adolescents, and/or their adult caregivers (14 quantitative studies)
Cluster RCT (one study)
Kumakech et al. (2009)	Uganda; AIDS orphans aged 10–15	Total orphans: n = 326; Intv: n = 159; Cntl: n = 167	School-based peer-group support intervention	Self-concept; anxiety; depression; anger	Improvement in depression, anger and anxiety; no effect on self-concept
RCT at the individual level (two studies)
Lee et al. (2007)	New York city; adolescent mean age 14.7, parent mean age 38	Parents: Intv: n = 153; Cntl: n = 154; adolescents: Intv: n = 206; Cntl: n = 207	Cntl: standard care group; Intv: coping skills interventions with 2-yr FU	Depression	Lower levels of depression
Rotheram-Borus et al. (2006)	New York city; adolescents mean age 14.77	Intv: n = 153; Cntl: n = 135	Project TALC; Cntl: standard care condition; Intv: coping skills intervention	Emotional distress; positive expectations	Reduced emotional distress at 3 yrs and increased positive future expectations at 6 yrs
Post-intervention cross-sectional survey (six studies)
Horizons (2007)	Rwanda; youth aged ≤24	Baseline: n = 692; FU: n = 593	Adult mentoring program for YHHs	Perception of adult support; grief; marginalization; maltreatment; depression	A decrease in feelings of marginalization, depressive symptoms, and feelings of grief
Horizons (2006)	Zimbabwe; youth aged 14–20	N = 1258	STRIVE/community-level efforts project. – PSS – Residential camps	Psychosocial well-being; psychosocial distress; lingering grief	A greater improvement in self-confidence, especially among males
	Limited association between intervention and hopefulness, self-efficacy, and ability to hope
Thurman et al. (2006)	Rwanda; youth aged 12–24	N = 692	Trained adult volunteers from the community provide mentoring to YHHs	Depression; grief; marginalization	An improvement in overall psychosocial outcomes
MEASURE (2009a)	Mbeya, Tanzania; OVC aged 8–14; caregivers mean age 41.4	OVC: n = 564; caregivers: n = 488	The Mama Mkubwa community-centered psychosocial support program implemented by TSA program staff – Volunteer home visits – Kids club participation	Self-esteem; psychosocial outcomes (positive, negative, marginalization, community stigma)	Home visit were positively associated with OVC's global self-esteem, and made caregivers have better emotional health, feel less marginalized
	Kids club: no effect
MEASURE (2009b)	Kilifi, Kenya; OVC aged 8–14; guardians mean age 41.6	OVC: n = 1036; guardians: n = 771	Kilifi OVC project: – Volunteer CHWs – Guardian support groups	Self-esteem; pro-social behavior; total difficulties; social isolation; perceived stigma	OVC: increased pro-social behavior, reduced behavioral problem, lower social isolation, and perceived negative attitudes. No effect on self-esteem
	Caregivers: lower marginalization and perceived negative attitudes
MEASURE (2009c)	Thika, Kenya; OVC aged 8–14; guardians: aged 18+	OVC: N = 3423; guardians: n = 2487	The IAP – Home visit – School-based HIV education – OVC care and support community sensitization meeting	Child protection; child social isolation; extended family support; in-kind transfer	OVC: reduced social isolation, more family support, and in-kind transfers from the community
	Caregivers: reduced stigma
Quasi-experimental design with a comparison group (five studies)
Clacherty and Donald (2006)	Kagera, Tanzania; older child group 13–18; younger child group 9–12	Older group: Intv: n = 78, Cntl: n = 78; younger group: Intv: n = 60, Cntl: n = 60	VSI project: child-led organizations providing HIV counseling	Emotional stress; social networks	A significant lower level of emotional stress, more emotional and practical support from adults, a greater variety of strategies for solving their problems, and a stronger internal locus of control
Lavin et al. (2010)	Rwanda; OVCY aged 10–17	Intv: n = 95; Cntl: n = 83	COSMO program	Marginalization; adult support; peer relationship; authority assistance; CES-D score	Less frequently experienced people speaking badly of them or their families or making fun of them. More frequently reported having a reliable adult in their life, stronger peer relationship, jealousy, experienced certain psychological symptoms at very high levels
MEASURE (2009d)	Iringa, Tanzania; OVC aged 8–14; caregivers mean age 44.1	Caregivers: total n = 845; OVC: Intv: n = 552, Contl: n = 552	Allamano/Tumaini HBC program – Home visit by volunteers – Kids club – Link community to the Allamano health clinic – Ensuring possession of basic school materials	Self-esteem (two measures); psychosocial outcomes (positive, negative, marginalization, perceived community sigma)	Home visits: better psychosocial outcomes for caregivers; no effect on OVC's global self-esteem or family related self-esteem
	Kids club: reduced emotional problems and improved social behavior
	Link to health clinic: no effect
	School supplies: better psychosocial outcomes
MEASURE (2009e)	Kagera, Tanzania; MVC aged 7–15; caregivers mean age 43.4	Caregivers (766): Intv: 335, Cntl: 431; OVC (895): Intv: n = 434, Cntl: n = 461	The SAWAKA Jali Watoto program – HIV/AIDS prevention, care and support activities – Direct support to MVC and caregivers	Self-esteem (two measures); psychosocial outcomes (positive, negative, marginalization, stigma)	OVC: better global self-esteem, more positive feelings about life, feeling more community jealousy and resentments
	Caregivers: More positive feelings about life, feeling more jealousy and more negative community attitudes toward HIV-affected families
Mueller et al. (2011)	South Africa; OVC aged 8–18	Intv: n = 177, Cntl: n = 120	MAD about ART program	Self-esteem; depression; self-efficacy; emotional problems	Increase self-efficacy
	No effect on self-esteem, depression, or emotional problems

Note: mth, month; yr, year; trt, treatment; FU, follow-up; INTV, intervention group; CNTL, control group; RCT, randomized controlled trial; OVC, orphans and vulnerable children; PWH, parents with HIV; PLWHA, people living with HIV or AIDS; VCT, voluntary counseling and testing; MVC, most vulnerable children; OVCY, vulnerable children and youth; MTC-R, modified therapeutic community residential treatment; MTC-A, modified therapeutic community aftercare program; SMART/EST, the stress management and relaxation training/expressive–supportive therapy; CES-D, Center for Epidemiologic Studies Depression Scale.

Table 2. Key characteristics of HIV/AIDS community interventions from six qualitative studies (adults only).

Author/date	Study location/age range	Sample	Intervention strategy	Study design	Outcome measurements	Main findings
Airhihenbuwa et al. (2009)	South Africa; adults with wide age range	N = 453	The PEN-3 cultural model: – Cultural identify – Relationships and expectations – Cultural empowerment	Focus group, informant interviews	Stigma	A community dialogue was one strategy used to reduce stigmatization of PLWHA in South Africa
Hyde et al. (2005)	Los Angeles, CA; adult mean age 35	N = 35	GLIs – Educational forums – Multi-session small-group workshop	Semi-structured interviews	Social isolation; depression	Benefited from social support networks with a reduction in feelings of social isolation and depression
Kaleeba et al. (1997)	Uganda; adult mean age 32.3	Clients: n = 324; caregivers: n = 232	TASO model: – An NGO-supported clinical service – Providing counseling, medical and social supports to PWAs	A participatory approach	Coping skills; plan for future	High level of acceptance in families and communities, high percentage of making plan for the future, and high coping of clients and families
Maman et al. (2009)	Four sites in Africa, one in Thailand; adult aged 18–32	Total n = 655	A multi-site community randomized trial of community-based HIV VCT	Semi-structured interviews	Stigma	Lower HIV stigma
Ramirez-Valles and Brown (2003)	Chicago, USA; adult volunteers	Total Org n = 62; total men: n = 13	Community involvements in volunteerism and activism	In-depth interviews	Self-esteem; sense of empowerment	Increased self-esteem and sense of empowerment
Waterman et al. (2007)	Kenya; adult health professionals	N = 27	HBC professionals	A PAR study	Stigma	Reducing stigmatizing behavior in the context of delivering and coordinating HIV HBC

Note: NGO, non-governmental organization; VCT, voluntary counseling and testing; PWA, people living with HIV/AIDS; Org, organizations; HBC, home-based care; PAR, participatory action research.

Table

(a) The union of the following terms using the ‘or’ function

AID

HIV

STI

Acquired immunodeficiency syndrome

Sexual transmitted infections

(b) Community

Community-based

(c) Intervention

Participation

Prevention

Evaluation

(d) Psychosocial

Psychological

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