Interventions targeting sexual and reproductive health and rights outcomes of young people living with HIV: a comprehensive review of current interventions from sub-Saharan Africa

Figures & data

Fig. 1 Sexual and reproductive health needs of young people and young people living with HIV.

Fig. 2 Search string.

Fig. 3 Flowchart of the process of study selection.

Table 1 Intervention description of interventions for young people living with HIV

	Country	Theoretical approach	Intervention type and duration	Target group and transmission type (vertical/horizontal)
Mixed methods
Snyder et al. (2014) (Hlanganani)	South Africa	Cognitive behavioural therapy (CBT), Bandura's social cognitive theory of self-efficacy	Support groups 3 sessions over 11 months 120 min per session	16–24 years Diagnosis up to 12 months prior Unknown
Bhana et al. (2014) (VUKA)	South Africa	Psychosocial support	Family-based programme with caregiver 10 sessions over 3 months	10–14 years Enrolled at HIV care at hospital Aware of his/her HIV status Vertically acquired HIV
Quantitative
Lightfoot et al. (2007)	Uganda	CBT	One-on-one with nurses 18 sessions	14–21 years Unknown
Senyonyi et al. (2012)	Uganda	CBT	Group counselling Recurring weekly sessions 80 min per session	12–18 years Vertically acquired HIV
Qualitative
Mupambireyi et al. (2014)	Zimbabwe	Psychosocial support	Support groups Meet once a week	11–13 years Knowledge of HIV status for at least 6 months prior Vertically acquired HIV
Parker et al. (2013)	DRC	Psychosocial support	Support group with trusted person 6 sessions over a period of 6 weeks 90 min per session	15–24 Aware of his/her HIV status Agree to Focus Group Discussions following session 2 and 6 Agree to attending the entire intervention Unknown

Table 2 Outcomes and results of interventions for young people living with HIV

	Study type, sample size, and intervention recruitment and retention	Follow-up time for evaluation	SRHR outcomes	Results
Mixed methods
Snyder et al. (2014) (Hlanganani)	Randomised control trial (RCT) Intervention: 109 74 (68%) returning for all three sessions Control: 222 Male=5 (5%) Female=104 (95%)	Start of session 1 (baseline) to end of session 3 (follow-up)	1) Mental health 2) Sex life	1) Improvement in attitude towards HIV as a manageable chronic disease – 9% increase, p=0.07. Increase in coping – 6.6% (p=0.2) declared increased feelings of support. 2) Disclosure: Improvement – six people disclosed during intervention with a mean number of people that participants disclosed to rose from 2 to 4. Condom use: In last 3 weeks, they had talked to their partners about condoms, rose 69 to 83% (p=0.035) and condom use increased by 12% (p=0.49).
			3) Treatment and side effects	3) ART attendance: Significantly higher proportion of intervention arm participants attended for their first ART visit (100%) vs. comparison arm, 58.06% (p<0.001, CI–0.66, −0.33).
				Qualitative findings Information on positive prevention and STIs were two of the most popular educational items: ‘About CD4 counts and ARVs – that you must know your viral load and CD4 count. After going to Hlanganani I went for a CD4 count test, and they found that I had a very low CD4 count, so they told me I should go on ARV treatment, so now I am starting treatment soon’. In learning about living positively with HIV, there was a trend towards significant improvement in managing HIV as a chronic disease. ‘Do people with HIV still live long and productive lives?’ There was a 9% increase in ‘Yes’ answers from intervention group (p=0.07).
Bhana et al. (2014) (VUKA)	RCT 74 families (caregiver plus child) enrolled in programme 65 participated in study Intervention: 33 Control: 32 59 (91%) completed post-test Females=33 Males=32	Two weeks after last intervention session	1) Treatment and side effects	1) Significantly greater improvements in reported adherence (β=1.5, p<0.05) There was also an improvement in treatment knowledge (β=0.27, p<0.08). Qualitative findings This article only reports qualitative findings for the caregivers of the young people.
Quantitative
Lightfoot et al. (2007)	RCT Intervention: 50 Control: 50 Female=72% Male=28%	Assessed at baseline and 3 months	1) Sex Life	1) Intervention (34%) and control (46%) recently sexually active; remained similar in follow-up (35 and 44%). No change on number of sexual acts. Sexual partners: decrease in the log number of sexual partners (F1,19=4.68, p=0.04); Consistent condom use: Consistent condom use increased to 93% in intervention (p<0.01) from 10%, control did not significantly change, from 15 to 12%. Over half intervention and control highly protected (74 and 65%) (abstinence/consistent condom use), significantly rose to 98% intervention (p<0.01), no change in control.
Senyonyi et al. (2012)	RCT 328 contacted to participate via phone or face-to-face 171 were selected to take part in the intervention, 115 attended at least three sessions, completed one or more of assessments/instruments Female=54 (53%)	No information	1) Sex life 2) Mental health	1) No significant group differences on sexual behaviour when compared to control (p=0.876). 2) Depression: No significant differences in depression variable (p=0.700). Anxiety: Mean scores in group showed significant decrease in anxiety (p=0.006).
Qualitative
Mupambireyi et al. (2014)	Purposive sampling Part of a bigger clinical ART RCT Caregivers also interviewed Phase 1=26 Phase 2 and 3=15 Phase 4=12 Females=14 Males=12	At various stages of intervention (data collected over 15 months)	1) Treatment and side effects 2) Mental health	1) Key message of support groups is to adhere for life, participants found it portrayed in a more understandable and in a helpful way than at clinics and home. ‘I would say you must attend support groups so that you are taught on taking medication well without missing because if you do not take medication well, you will die’. Still had adherence challenges, they felt that if they did not adhere, they were considered ‘bad’ and would not attend as a result. Children felt that the support groups were a good source of HIV information, thought when tested, they still had suboptimal knowledge of HIV and ARVs. 2) Easier to socialise and play, considered ‘normal’, ‘fit in’. Acceptance and self-acceptance, gained confidence, realised there were others like them. Felt role models/older children inspiring and transformative.
			3) Sex life	3) Deterred by support groups for fear of accidental disclosure to non-HIV peers. Forced disclosure as intro to group.
Parker et al. (2013)	Not specified 191 were eligible, part of programme FGD=13	FGD after session 2 and after session 6	1) Sex life	1) Improving condom use skills, improving ability to deal with unsafe sex, increasing capacity to assess level of risk of different behaviours. Improved ability to negotiate safer sex behaviour and openness to discuss sexual behaviour with caregiver.
			2) Mental health	2) Improving ability to deal with triggers of high-risk behaviour. Young people living with HIV reported improving problem-solving skills Increased decision-making autonomy, Improved ability to develop potential future goals.