Psychosocial Support Interventions for Improved Adherence and Retention in ART care for Young People Living with HIV (10-24 years): A Scoping Review

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Mukumbang, Zaida Orth, Shelley A. Vickerman-Delport, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-26301/v4 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Dec, 2020 Read the published version in BMC Public Health → Version 4 posted 4 You are reading this latest preprint version Show more versions Abstract Background : Mental health disorders such as high levels of anxiety, isolation, depression and suicide ideation reported among young people living with HIV (10-24 years; YPLWH) contribute significantly to poor medication adherence and retention in care. While there is evidence supporting the role of psychosocial support interventions in promoting adherence and retention in antiretroviral treatment (ART) among adults living with HIV, there is little evidence on the role of psychosocial support on medication adherence among YPLWH. This scoping review was designed to identify and classify the types and effects of psychosocial support interventions designed to improve adherence and retention in ART among adolescents and young people living with HIV globally. Method : We searched six electronic databases (i.e., Scopus, Pubmed and EBSCOHost (Academic Search Premier, CINAHL, Psycarticles and Medline). Six relevant articles published between 2011 and 2019 met our inclusion criteria. We extracted information relevant to the nature and outcomes of the reported interventions using thematic content analysis informed by the Population, Intervention, comparison, outcome, and time (PICOT) framework. Results : Four distinctive treatment modalities that focused on improving ART adherence and retention in care were identified: individual counselling, support groups, family-centered services, and treatment supporters. Conclusion: There is a dearth of psychosocial support interventions to improve adherence and retention in ART amongst adolescents and young adults living with HIV. Future research and programming should seek to address psychosocial support interventions or approaches specifically designed to address the needs of adolescents and young adults living with HIV. PROSPERO: Registration CRD42018105057 Health Economics & Outcomes Research Infectious Diseases Health Policy Adolescents psychosocial support interventions HIV and AIDS adherence and retention Figures Figure 1 Background Since the introduction of antiretroviral therapy (ART), significant gains have been made in mitigating the impact of the HIV/AIDS pandemic [1]. The increasing effectiveness of and access to ART, along with increasing innovations in ART service delivery have redefined the HIV epidemic from a deadly infectious disease to a chronic, manageable disease [1–3]. However, poor adherence to treatment and suboptimal retention in care continue to present significant challenges to ending AIDS by 2030 [4]. In 2018, UNAIDS estimated that 1.6 million young people aged 10–24 years were living with HIV [5, 6]. Therefore, young people living with HIV (YPLHIV) constitute a growing and key sub-population of people living with HIV globally. The increasing availability and effectiveness of ART worldwide, has resulted in more children and adolescents living longer with HIV [7, 8]. However, it is well-documented that adolescents struggle to initiate, remain engaged, and consistently adhere to ART [9, 10]. While most of the individual, social and health systems barriers associated with ART adherence and retention in care affecting the general population also apply to YPLWH, the latter face greater risks of mental and behavioural health problems, which constitute additional barriers [7, 11, 12]. Psychological risk factors such as depressive disorders result from the chronicity of HIV infection, being orphaned, changes of guardianship, and the nature of parental and other adult support [11, 13, 14]. Due to the high levels of anxiety, isolation, depression and suicide reported among YPLWH, studies have recommended psychosocial support for YPLWH in addition to standard ART services to help them adapt and cope with the chronicity and stigma associated with HIV [3, 11, 12, 15–17]. Psychosocial support interventions are interpersonal or informational activities, strategies or techniques that can target biological, behavioural, cognitive, emotional, interpersonal, social or environmental factors with the aim of improving an individual’s health functioning and mental well-being [18]. To promote ART adherence and retention in care among YPLWH, a comprehensive psychosocial intervention is needed. Such psychosocial support interventions should promote HIV disclosure and communication, support adherence to medication, address feelings of isolation and other emotional-related distress, and the needs associated with emerging sexuality [19, 20]. Interventions such as counselling, cognitive behavioural therapy, and peer support have been applied to improve the mental health and overall well-being of people living with HIV over 18 years with success [21], supporting the role of psychosocial support interventions in promoting adherence and retention in ART care among adults living with HIV [22]. Nevertheless, there is little evidence on the nature and role of psychosocial support for YPLHIV [23]. To this end, in this review, we sought to identify, classify and assess the types and effects of psychosocial support interventions focused on improving adherence and retention in care among YPLHIV on ART in the current existing literature. Method Our scoping review was conducted in line with the guidelines proposed by Khan et al. [24] i.e. (1) Framing the question; (2) Identifying relevant publications; (3) Assessing study quality; (4) Summarising the evidence; and (5) Interpreting the findings. Based on the literature, we developed Boolean phrases that were tested using PubMed. The first literature search was conducted between March and October 2018. Due to unforeseen delays, an updated search using the same Boolean phrases and databases was conducted between October 2019 to March 2020. We searched multiple electronic databases – Scopus, PubMed and EBSCOHost (Academic Search Premier, CINAHL, Psycarticles and Medline) using a standard Boolean combination: “((adolescen* OR teenage* OR young people OR youth) [AND] (psychosocial intervention) [AND] (adherence in antiretroviral therapy OR retention in care))”. In addition, we hand-searched grey literature on mental health among YPLWH and transitioning YPLWH from paediatric to adult care. All titles and abstracts (including conference abstracts) were independently screened by SAV and ZO using the PICOT (Participants, Interventions, Comparisons, Outcomes and Time) mnemonics criteria described in Table 1. Discrepancies were resolved via discussions with a third researcher (FCM). Full texts of potentially relevant articles were retrieved and independently examined by the authors. The reference lists of considered relevant articles were also hand searched to identify further potentially relevant studies. Summaries of the interventions described in each article were retrieved using a standardized form, and key information such as study purpose, nature of intervention described, outcome of intervention and conclusions of each study were extracted. The acronym PICOT informed the eligibility criteria for inclusion in the scoping review: the population (participants) of focus, types of interventions (and comparisons), and the outcomes of interest. The time relates to the period within which the studies were published [see Table 1 below]. Table 1:PICOT based inclusion criteria Patient population Adolescents or young adults (10-24 years) living with HIV Intervention of Interest Psychosocial support Comparison interventions None Outcomes Primary outcomes (1) Adherence to antiretroviral treatment (viral load); (2) Retention in care Secondary outcomes (1) Quality of life and wellbeing; (2) Stigma and discrimination; (3) Disclosure Time 2005–2020 Other considerations Language English Studies were considered eligible for inclusion in this scoping review if they met the following criteria: (i) Evaluated the effects of or associations between psychosocial support intervention and adherence ART or retention in care or related biomedical outcomes e.g., viral suppression (primary outcomes). (ii) Reported quantitative measures of the primary outcomes. (iii) Targeted or included samples of adolescents (10–19 years) and/or youth (15–24 years) living with HIV in a mixed sample. (iv) Was published between January 1, 2005 and March 31, 2020. Only articles published in English were considered. There was no restriction by geographical location. Studies were excluded if they met the following criteria: (i) Adopted a qualitative research design (ii) Were a study protocol, or any form of review or conference abstracts not developed into full manuscripts. (iii) The population deviated from the age range specified. (iv) The intervention did not target the psychosocial needs of the study population. (v) The intervention focused on HIV prevention. The quality of the included articles was rated as either “poor”, “fair” or “good” by three independent researchers (EO, SAV and ZO), and EO made the final adjudication in cases of non-agreement. The rating of the articles was based on the criteria provided by the NIH-NHLBI Quality Assessment of Systematic Reviews and Meta-Analyses assessment tool [25]. Data Extraction The data were extracted using an excel spreadsheet under the following headings: study setting, sample characteristics, intervention objectives, study design and methods, outcome measures and results [Additional file 1]. Data Analysis We employed a thematic content analysis approach to distil information from the selected articles [26]. The extracted information was coded into two broad categories: Intervention components and outcomes measured as informed by the study aim. The intervention components were coded/classified along the following categories: (1) How the interventions were administered; (2) who delivered the intervention; (3) Point of intervention delivery; and (4) components of the intervention. The outcomes were coded according to the reported primary and secondary outcomes of the study. Results Figure 1 shows the PRISMA diagram illustrating the selection process of the included studies. The literature search resulted in 5,244 citations [ Figure 1 ], which were imported into a reference manager. Electronic (31) and manual (28) deduplication identified 59 duplicates. After screening for potentially relevant titles and abstracts 5,162 articles were excluded. After screening full-texts, 17 papers were further excluded because they did not report on the effects of a psychosocial support intervention on adherence and retention in ART for YPLWH. Subsequently, six papers were included in the review of having good quantitative standards. Five studies were considered to be of good methodological quality [27–31] and one of a fair quality [32]. Characteristics of included Studies The characteristics of the studies included in the review are summarised in Table 2 . Table 2:Characteristics of Included Studies (N=6) Characteristics Count References Year of Publication 2011 – 2015 2016 – 2020 3 3 [27] [28] [30] [29][31][32] Country United States of America Kenya Uganda South Africa Zimbabwe 2 1 1 1 1 [28][30] [29] [32] [27] [31] Study design (sample size) Pre and post intervention studies (61; 952) Randomized controlled trial (4,504; 66; 94) Retrospective cohort (174) 2 3 1 [29][30] [27][31][32] [28] The six papers were disseminated between 2011 and 2019. Two of the studies were conducted in United States of America [28, 30] and four in Southern and Eastern Africa (Uganda, Kenya, South Africa and Zimbabwe) [27, 29, 31, 32]. Two of the papers were pre- and post-intervention studies (n=1,113) [29, 30], three randomized control trials (RCT) [27, 31, 32] (n=4,664), and one retrospective cohort study (n=174) [28]. Intervention duration The duration of study was between 3 months and 10 years [Table 3]. Table 3: Intervention/study location and duration of intervention Article Country (location) Duration of intervention Wohl et al. [30] USA (Los Angeles) 2 years Davila et al. [28] USA (Texas) Decentralised era: 2 years Centralised area: 3 years Enhanced youth services: 10 years Ruria et al. [29] Kenya (Homa Bay) 6 months Graves et al. [32] Uganda 6 months Bhana et al. [27] South Africa (KwaZulu-Natal) 3 months Willis et al. [31] Zimbabwe (Gokwe south district) 12 months Six studies evaluated psychosocial support interventions, namely: psychosocial education, group adherence counselling, individual counselling and peer-support groups and peer counselling. Two studies evaluated the impact of a family-centred appointment scheduling and health education on patient retention and adherence to monthly appointment scheduling [27, 32]. Three studies evaluated a youth centred management model that combined psychosocial case management, treatment education/adherence support and HIV risk reduction counselling to provide a client-centred intervention through which care was coordinated [28, 30, 31]. Three studies [29, 30, 32] evaluated interventions that included fast-track service deliveries to streamline medication pick-up. Table 4 illustrates the nature and characteristics of the interventions identified. Health and psychosocial education delivered in the form of educational activities and workshops to provide information on HIV and other relevant topics formed an integral part of all six interventions [27–32]. Health education was delivered using posters and cartoons in a structured manner that provided participants with real life situations on navigating through being orphaned by AIDS; moving in with relatives; learning about own HIV diagnosis and treatment needs, while coping with family loss, stigma, peer relationships, identity, and family functioning [27–32]. Furthermore, trained staff who were equipped with the tools to care for and skilled in treating adolescents were employed in six of the interventions e.g. adolescent care providers, youth-focused social workers and psychologist [27–32]. Table 4: The nature and characteristics of the interventions Type of intervention N References Psychosocial education Teaching/education 6 [27][28][29][30][31][32] Educational workshops 3 [28][29][32] Adherence counselling Group counselling/ support groups 5 [27][28][29][31][32] Individual counselling 5 [27][29[30]][31][32] Family centered Family based psychosocial intervention 2 [27][32] Fast track/fast lane services Priority clinic scheduling 3 [29][30][32] Use of reminder cards/sms Reminder cards/sms 1 [32] Intervention agent Social worker 2 [30][28] Adolescent care provider 3 [29][31][32] Clinical psychologist/Bachelor-level counsellor 2 [27][30] General practitioner/Nurse 3 [27][29][32] Peer counsellor 4 [28][29][31][32] Lay counsellor/CHW 2 [27][32] Point of intervention delivery Facility-based 6 [27][28][29][30][31][32] Community-based 2 [28][31] School-based 1 [29] Components of intervention Knowledge/education on HIV/AIDS 6 [27][28][29][30][31][32] Adherence to treatment and retention in care 6 [27][28][29][30][31][32] Family-focused programme 2 [27][32] Scheduled visits 3 [29][30] [32] Emotional/Affective support 4 [27][30][31][32] Structural support (youth clinic) 4 [28][29][31][32] Sexual and reproductive health 5 [27][28][29][30][31] Disclosure, stigma and discrimination 5 [27][28][29][31][32] Health promotion 1 [32] AIDS related loss and bereavement care 1 [27] Six studies evaluated interventions that involved individual and peer counselling as part of the interventions [27–32]. The counselling sessions were facilitated by trained community adolescent treatment supporters (CATS), social workers, lay health workers, trained health professionals, or research teams, and aimed to increase HIV knowledge and address adherence and retention barriers [27-32]. These individual counselling methods used a client-centred approach [27, 30–32], or motivational interviewing [28] or peer counselling [29]. Group counselling or support groups were found in five articles as a means of psychosocial support [27-29, 31, 32]. Youth specific support groups addressed issues such as emotional needs; developing self-management skills; capacity building; sexual health; and the stigma related to HIV [28, 31, 32]. One study implemented a school-based programme to create a supportive environment for adherence for YPLWH [29]. The programme offered counselling at schools on sexual and reproductive health and encouraged adolescents to establish health clubs among themselves [29]. In addition, the intervention provided HIV medication on the school premises to enhance adherence and linkage to care, as well supporting participating learners in disclosure [29]. Two of the interventions had family-centred services [27, 32]; with one intervention implementing a family clinic day (FCD) [32]. FCD applied to paediatric and adolescents living with HIV and their immediate family who received priority HIV-care and counselling on a day allocated specifically to them [32]. Another component of FCD was the use of reminder cards and calendars for scheduling appointments. Health education workshops were held, which were led by peers equipped in leading discussions around HIV, sexual and reproductive health, adherence, disclosure, puberty and life skills [27-29, 32]. In addition, the Vuka family programme [27] another family-centred intervention conducted 10 health education workshop sessions that covered subject areas addressing mental and depressive disorders experienced by adolescents living with HIV. These sessions included AIDS-related loss and bereavement, HIV transmission and treatment knowledge; disclosure of HIV status to others; youth identity, acceptance, and coping with HIV; adherence to medical treatment; stigma and discrimination; caregiver child communication, particularly on sensitive topics such as puberty and HIV. The Vuka family programme also identified and developed strategies to keep children safe in high-risk situations where sexual behaviour and drug use are common [27]. Furthermore, integrated group sessions were held that were comprised of HIV-infected youth and their caregiver/s, as well as separate group activities for caregivers and preadolescents. In the case of the Red-Carpet Intervention, adolescents were given VIP express cards- a card offering adolescents fast-track counselling and HIV treatment [29]. One of the interventions also offered adolescents the opportunity to schedule their appointments [32]. Moreover, adolescent waiting areas were implemented to create an adolescent-friendly environment aimed at improving retention to ART services at facilities [28, 32]. Although referral systems were used in two of the programmes, the programmes lacked the services needed by participants, like individual counselling [27]; and support groups for substance abusers; and housing or nutrition services. Reminders cards and sms were used in one of the studies [32]. Participants were scheduled to attend their next appointment visit using reminder cards and reminded to take their medications by sending SMS messages at regular intervals. Outcomes measured The primary outcomes of interest were adherence to ART and retention in care. The measures of psychosocial support outcomes reported were: (i) self-management (self-efficacy and self-esteem), which is associated with improved self-concept and future orientation [27, 28, 31, 32]; (ii) reduction of stigma and discrimination [27, 31]; (iii) disclosure and communication [27, 31, 32]; and (iv) perceived support in the form of social support, instrumental support, family and/or peer support and informational support [28-32]. Our findings showed that five of the studies [28-32] reported on both the primary and secondary intended outcomes [Table 5]. Table 5: Reporting of primary and secondary intervention outcomes Reference 28 only reported outcomes of retention in care and adherence to medication and no other psychosocial outcome. Nevertheless, the reference was included because its intervention included educational activities and support groups offered by social services staff trained in the use of motivational interviewing Retention in care was investigated in five of the six studies [28-32]. Three studies found retention in care at 24 months [28], 12 months [31], and 6 months [30] to be significantly higher following exposure to the psychosocial interventions. Wohl et al. [30], found that participants’ HIV clinic visits significantly increased between baseline and at six months following the youth case management intervention (p < 0.0001). Davila et al. [28] found that the centralisation of youth services, which was composed of multifaceted psychosocial intervention components, improved the retention in care of YPLWH (p < 0.01) at 12 months. However, there were no significant differences observed in baseline viral load by service era (p = 0.91) [28] Similarly, Ruria et al. [29] conducted a pre- and post-intervention to measure retention of YPLWH in ART care. The findings indicated that after one month, 90% of patients were linked to care in the pre-intervention cohort compared to 85.7% in the post-intervention cohort. The high rate of linkage to care in the pre-intervention phase was attributed to the national policy on Adolescent Reproductive Health and development [29]. However, the results show that following the implementation of the peer counselling and psychosocial support intervention, a significant increase from 66% to 90%; and 54.4% to 98.6% were observed at three months and six months respectively. While there is a high rate of YPLWH linking to care within the first month of ART initiation, these numbers drop with time, and that the intervention is more successful in linking YPLWH to ART over time. Results from the Family Clinic Day (FCD) intervention showed a significant increase in patient adherence to clinic appointment schedules, that is 65% (p < 0.01) of adolescent participants were adherent to their appointment schedules compared to 53% participants in the control facilities). However, no effect on retention in care between the control group and the intervention group (p = 0.94) was observed [39]. Adherence to medication was reported as a significant outcome in three studies [27, 31, 32]. According to Bhana et al. [27], a self-reported scale on how often medication was missed over the past six months by participants in the VUKA intervention reported significantly greater adherence to treatment than those in the control group (p < 0.05) [27]. Willis et al. [31] found that the intervention group were 3.9 times more likely to adhere to treatment compared to the control group. Four of the studies reported on secondary outcomes [27, 30-32]. The study conducted by Wohl et al. [30], showed that personalised case management interventions provided instrumental support for participants (tangible help provided by others). For example, support in the form of referrals for housing, mental health services, risk reduction education and transportation assistance within the first six months post the intervention [30]. Similarly, qualitative findings from the FCD intervention conducted by Graves et al., suggests that the family groups component of the intervention provided participants with increased instrumental, family, peer, and informational support [32]. The findings from the VUKA pilot programme reported significant increases in individual self-concept and future orientation, improved parent-child communication, improved social support and informational support [27]. Furthermore, caregivers reported improved family support, and a decrease in the experience of stigma [27]. One study investigated the effects of community adolescent treatment supporters on psychosocial wellbeing [31]. Willis et al. [31] found a statistical significant increase in confidence, self-esteem and self-worth ( p < 0.001). In addition, the intervention group reported a statistically significant improvement in the quality of life, while the control group reported a significant decline in the quality of life ( p = 0.028) [31]. Discussion Our review revealed that individual and peer counselling was a distinctive treatment modality when focusing on improving ART adherence, linkage to care and/or retention in care [27-32]. While in two instances, individual counselling was carried out using client-centred theory [30] and motivational interviewing [28], one study employed trained community adolescent treatment supporters (CATS) to provide peer to peer support to YPLWH [31]. These techniques have proved to improve adherence and retention in care among YPLWH [22, 31] . Motivational interviewing is confirmed to help people adopt better health behaviours such as helping young people to use condoms more often, and also to reduce viral load [34]. Individual counselling interventions have also been identified as resource-intensive approaches [16] as they are applied at an individual level. Although it may be challenging to implement in low and middle-income countries (LMICs), however equipping low cadre health care workers such as peer lay counsellors or CATS with the necessary skills could prove effective in providing ART care and support tailored to adolescent’s particular needs [35]. Support groups were used in five of the interventions [27-29, 31, 32] that created a space for participants to share knowledge, build social capital and expand their support systems. This method of delivering psychosocial support has been found to improve adherence, linkage to care and quality of life, while being a viable treatment option in LMIC where healthcare staff and resources are limited [28]. Peer support has been reported as a major source of social support and information among adolescents in relation to living with HIV [29, 31]. Furthermore, centralising health services for youth have the propensity to reduce barriers to retention and adherence to ART care by providing medical and social services at one central location and reducing the need for navigating complex healthcare systems and improving coordination of services. The enhanced centralised youth service programme attempted to reduce negative health beliefs and misinformation about HIV by supporting patient’s emotional needs and providing youth friendly HIV education to address misconceptions about living with HIV [28, 30, 31]. Youth specific support groups and educational activities offer opportunities for youth to develop support systems, knowledge, and self-management skills. Family/household-centred services were found in two articles [27, 32], which enhanced family cohesion and communication in both cases. The family/household-centred care approach argues that the family shares the responsibility of caring for the YPLWH [38]. A recent review conducted to explore the availability and effectiveness of family/household-focused interventions to improve ART adherence and retention in care found that some of the HIV-related interventions with a household focus were focused on YPLWH, and incorporated aspects of information sharing on HIV; improving communication; stimulating social support and promoting mental health [39]. Furthermore, studies have shown that integrating paediatric and adult services has positive outcomes in adherence and retention in care [40]. Additionally, the VUKA family programme addressed sensitive topics relating to HIV by using a culturally tailored cartoon [27]; such interactive modes of delivering interventions have been found to enable parent-child communication [41]. Appointment cards were used in one of the interventions where calendars and reminder cards helped schedule eligible patients to attend their next appointment on a family clinic day [32]. There are growing evidence from published literature that mHealth as a means of active client follow-up could improve the retention of patients in care through sending of SMS reminders of their appointment dates [33, 42]. The World Health Organization recommend utilising mobile phone reminders to improve adherence, bearing in mind that the process should be carefully monitored when aimed at adolescents for effective implementation [43]. In addition, it has been argued that adherence interventions adopting a single approach, such as phone call reminders, are less effective compared to multicomponent interventions that mobilise several support strategies and delivery modalities [44], specifically due to lower cell phone network coverage in rural and remote areas in LMICs [45]. Our scoping review identified six studies that reported on the effects of psychosocial interventions on adolescent adherence to ART and retention in care. Despite the growing recognition of the burden of HIV and psychosocial challenges faced by YPLWH, this review indicates that there is a dearth of evidence on psychosocial support interventions aimed at YPLWH. Other authors have shared the same sentiments [46, 47]. Strasser et al. [46] state that evidence-based psychosocial support services for children are currently under-developed and under-resourced, and argue that the current state of affairs need to be addressed and improved. Petersen et al. [47] also identified the need for targeted efficacy-based mental health promotion interventions for children and adolescent HIV populations in South Africa. Five studies in this review reported increased retention and adherence to ART among adolescents and young people following the administration of an intervention with psychosocial components [27, 28, 30-32]. A study evaluating the effects of a psychosocial intervention among PLHIV attending clinical care in Estonia reported that the intervention increased the proportion of patients that were optimally adherent [48]. Similarly, a study conducted by Tominari et al. [49] reported that the implementation of mental health services demonstrated a significant increase in retention in care among PLHIV. Evidence suggests that ART adherence interventions need to adopt long-term and flexible approaches to effectively support adherence behaviour [44]. The study conducted by Wohl et al. [30] reported that a significant dose response trend was observed between retention in care and increasing number of hours in the intervention and increasing number of intervention appointments. Furthermore, Wohl et al. [30] found that a time-intensive intervention delivered by a non-judgemental and culturally competent peer is effective in engaging participant in consistent ART care. These findings are supported by previous studies, which suggest that intensive interventions are required to produce effective adherence outcomes, while one-time interventions without ongoing educational support may prove inefficient [50]. According to Edwards and Barker [51], developing frameworks for understanding and describing contexts, which incorporate an adaptive approach for intervention implementation and scale-up are necessary to advance HIV/AIDS implementation research and to ensure the effectiveness of an intervention. We learnt from the scoping review that psychosocial support interventions for YPLWH are feasible and acceptable to participants and healthcare workers. However, more empirical evidence is needed to understand the mechanisms which allow these interventions to work, to improve the availability of services and care for YPLWH. Limited information exists regarding the effectiveness of adherence interventions for YPLWH in LMICs [1]. The findings from the CATS and VUKA programme indicate that psychosocial interventions may be successfully implemented to improve YPLWH adherence to ART in resource limited settings. These findings are supported in a recent study reporting on the effectiveness of teen adherence clubs in Zimbabwe and South Africa [52]. Limitations and strengths of the review A strength of this scoping review is our extensive and comprehensive database search that encompasses global peer reviewed papers with a narrative reporting approach. All questions related to inclusion/exclusion of a study were discussed with the investigating team. We observed significant heterogeneity in measurements and definition of optimal adherence and inclusion criteria for participants in the different studies. The limitation of this scoping review and inference of results is limited by the quality of the individual papers underlying the process. For example, many of the papers included had small sample size. Further limitation to this scoping review is the exclusion of interventions that may have been evaluated using qualitative methods such as those conducted by Dorothy et al. [53], Donenberg et al. [54] and Mahvu et al. [55]. In addition, we only focused on English publications and those published before 2005 introducing the potential to have excluded studies that might have otherwise met these inclusion criteria. Our focus in the last 15 years was meant to capture the most recent evidence because so much has changed in the HIV/AIDS treatment and care protocol since its inception. Capturing the last 15 years would provide more relevant evidence regarding the most recent treatment care protocols. Furthermore, self-reported measures are fraught with bias compared to more objective measures of adherence such as viral load, antiretroviral drug levels and pill counts. Lastly, in this review we did not differentiate the impact of behavioural patterns as a result of the intervention offered. For example, exploring the behavioural patterns between newly acquired HIV vs perinatal HIV. As well as, the different age groups 10-19 years and 20-24 years as these age groups’ psychosocial needs are different. Conclusion Individual and group counselling including family-centered group counselling and the use of adolescent peer support were distinctive treatment modalities when focusing on improving ART adherence, linkage to care and/or retention in care. However, this review found only six studies that evaluated psychosocial support interventions suggesting that there is dearth of evidence on psychosocial support interventions to improve adherence and retention in ART care amongst young people living with HIV. Where studies exist; methodological quality, target population, and sample size are limited. Future research and programming should seek to address psychosocial support interventions or approaches specifically designed to address the needs of adolescents and young adults living with HIV. Appraisal of the study quality Methodological appraisal of study quality or risk of bias of the included articles, was based on the criteria provided by the NIH-NHLBI Quality Assessment of Systematic Reviews and Meta-Analyses assessment tool. Reporting The scoping review was reported following the PRISMA guidelines to enhance transparency in reporting. List Of Abbreviations ART - Antiretroviral therapy HIV - Human Immunodeficiency-Virus A&YPLHIV - Adolescents and young people living with HIV OLHIV - Older adults living with HIV PICOT - Population, Intervention, Comparison, Outcome and Time PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials Because the study was a scoping review of published studies, the full references of these studies have been provided in the reference list. Competing interests The authors declare no competing interests Funding No funding was received for this study. Authors' contributions EO, FCM, and BVW designed the study and selected the search terms. SV and ZO screened titles and abstracts using the identified inclusion and exclusion criteria. The data were analysed by SV, ZO, EO and FCM. EO, SV and ZO drafted the first manuscript with editorial and content input from BVW and FCM. All authors read and approved the final manuscript. Acknowledgements Not applicable because all contributors to this paper met the authorship criteria. Authors’ information The main author Emeka Okonji (EO) holds a master’s degree in Demography and Population studies. He is currently working as senior monitoring and evaluation manager for an NGO that provides treatment care and support to people living with HIV and AIDS in South Africa. Furthermore, the author is currently doing his PhD in the field of Public Health. This paper is part of his PhD programme and aim to make a case for a psychosocial intervention specifically designed to improve adherence and retention amongst adolescents living with HIV and AIDS. Footnotes Not applicable. References Hudelson C, Cluver L. Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: A systematic review. AIDS Care. 2015;27:805–816. http://dx.doi.org/10.1080/09540121.2015.1011073. Mukumbang FC, Van Belle S, Marchal B, Van Wyk B. Exploring “generative mechanisms” of the antiretroviral adherence club intervention using the realist approach: A scoping review of research-based antiretroviral treatment adherence theories. BMC Public Health. 2017;17:1–14. http://dx.doi.org/10.1186/s12889-017-4322-8. Mutumba M, Musiime V, Lepkwoski JM, Harper GW, Snow RC, Resnicow K, et al. 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AIDS Care. 2016;28:825–33. http://dx.doi.org/10.1080/09540121.2016.1139043. Sam-Agudu NA, Pharr JR, Bruno T, Cross CL, Cornelius LJ, Okonkwo P, et al. Adolescent Coordinated Transition (ACT) to improve health outcomes among young people living with HIV in Nigeria: Study protocol for a randomized controlled trial. Trials. 2017;18:1–12. http://dx.doi.org/10.1186/s13063-017-2347-z. Aderemi, T. J., Mac-seing, M., Woreta, S. A., & Agbemavi, K. Predictors of voluntary HIV counselling and testing services utilization among people with disabilities in Addis Ababa, Ethiopia. AIDS Care, 2014; doi:10.1080/09540121.2014.923811. Sibhatu B., Amare D., Amberbir A., Kebede D. Barriers and facilitators to antiretroviral medication adherence among HIV-infected paediatric patients in Ethiopia : A qualitative study. SAHARA-J: Journal of Social Aspects of HIV/AIDS 2009; doi: 10.1080/17290376.2009.9724943 . Accessed 15 Jun 2018. Vreeman RC, McCoy BM, Lee S. 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SAHARA J. 2011;8:33-41. http://dx.doi.org/10.1080/17290376.2011.9724982. MacPherson P, Munthali C, Ferguson J, Armstrong A, Kranzer K, Ferrand RA, et al. Service delivery interventions to improve adolescents’ linkage, retention and adherence to antiretroviral therapy and HIV care. Trop Med Int Heal. 2015;8:1015-1032. http://dx.doi.org/10.1111/tmi.12517. Sanchez-Sosa JJ. Treatment adherence: The role of behavioral mechanisms and some implications for health care interventions. Rev Mex Psicol. http://www.healthnet.unam.mx 2002;19:85–92. Accessed 16 Jun 2018. England MJ, Butler AS, Gonzalez ML Committee on Developing Evidence-Based Standards for Psychosocial Interventions for Mental Disorders Board on Health Sciences Policy. Schotanus-dijkstra M, Drossaert CHC, Pieterse ME, Boon B, Walburg JA, Bohlmeijer ET. An early intervention to promote well-being and flourishing and reduce anxiety and depression : A randomized controlled trial. 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Khan KS, Kunz R, Kleijnen J, Antes G. Five steps to conducting a systematic review. J R Soc Med. 2003; 96:118-121.. NIH-NHLBI Quality Assessment of Systematic Reviews and Meta-Analyses assessment tool: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools . Accessed 10 Aug 2018. Snilstveit B, Oliver S, Vojtkova M. Narrative approaches to systematic review and synthesis of evidence for international development policy and practice. J Dev Eff. 2012;4:409–29. https://doi.org/10.1080/19439342.2012.710641 . Bhana A, Mellins CA, Petersen I, Alicea S, Myeza N, Holst H, et al. The VUKA family program: Piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa. AIDS Care. 2014;26:1–11. https://doi.org/10.1080/09540121.2013.806770. Davila JA, Miertschin N, Sansgiry S, Schwarzwald H, Henley C, Giordano TP. Centralization of HIV services in HIV-positive African-American and Hispanic youth improves retention in care. AIDS Care. England; 2013;25:202–6. https://doi.org/10.1080/09540121.2012.689811 Ruria EC, Masaba R, Kose J, Woelk G, Mwangi E, Matu L, et al. Optimizing linkage to care and initiation and retention on treatment of adolescents with newly diagnosed HIV infection. AIDS. 2017;31:S253–60. https://doi.org/10.1097/QAD.0000000000001538 Wohl AR, Garland WH, Wu J, Au CW, Boger A, Dierst-Davies R, et al. A youth-focused case management intervention to engage and retain young gay men of color in HIV care. AIDS Care. 2011;23:988–97. https://doi.org/10.1080/09540121.2010.542125. Willis N, Milanzi A, Mawodzeke M, Dziwa C, Armstrong A, Yekeye I, Mtshali P, James V (2019) Effectiveness of community adolescent treatment supporters (CATS) interventions in improving linkage and retention in care, adherence to ART and psychosocial well-being: A randomised trial among adolescents living with HIV in rural Zimbabwe. BMC Public Health 19:1–9 Graves JC, Elyanu P, Schellack CJ, Asire B, Prust ML, Prescott MR, et al. Impact of a family clinic day intervention on paediatric and adolescent appointment adherence and retention in antiretroviral therapy: A cluster randomized controlled trial in Uganda. PLoS One. 2018;13:1–18. https://doi.org/10.1371/journal.pone.0192068 Puccio JA, Belzer M, Olson J, Martinez M, Salata C, Tucker D, et al. The Use of Cell Phone Reminder Calls for Assisting HIV-Infected Adolescents and Young Adults to Adhere to Highly Active Antiretroviral Therapy: A Pilot Study. AIDS Patient Care STDS. 2006;20:438–44. https://doi.org/ 10.1089/apc.2006.20.438 . Mbuagbaw L, Ye C, Thabane L. Motivational interviewing for improving outcomes in youth living with HIV. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD009748. doi: 10.1002/14651858.CD009748.pub2 Mary Fabri, Charles Ingabire, Mardge Cohen, Geri Donenberg, Sabin Nsanzimana. The mental health of HIV-positive adolescents. 2015; https://doi.org/10.1016/S2215-0366(15)00291-6. Bateganya M, Amanyeiwe U, Dong M. The impact of support groups for people living with HIV on clinical outcomes: A systematic review of the literature. J Acquir Immune Defic Syndr. 2016;68:S368-S374. https://doi.org/ 10.1097/QAI.0000000000000519 . Robbins RN, Spector AY, Mellins CA, Remien RH. Optimizing ART Adherence : Update for HIV Treatment and Prevention. Curr HIV/AIDS Rep. 2014;423–33. https://doi.org/1 0.1007/s11904-014-0229-5 . Belsey MA. AIDS and the family: Policy options for a crisis in family capital. UNAIDS. 2005. https://www.un.org/esa/socdev/family/Publications/aidsandthefamily.pdf . Accessed 18 Mar 2018. Mukumbang, F.C., Knight, L., Masquillier, C. et al. Household-focused interventions to enhance the treatment and management of HIV in low- and middle-income countries: a scoping review. BMC Public Health 19, 1682 (2019). https://doi.org/10.1186/s12889-019-8020-6 Leeper SC, Montague BT, Friedman JF, Flanigan TP. Lessons learned from family-centred models of treatment for children living with HIV: current approaches and future directions. J Int AIDS Soc. 2010;13(Suppl 2):S3. https://doi.org/ 10.1186/1758-2652-13-S2-S3 . Bastien S, Kajula LJ, Muhwezi WW. A review of studies of parent-child communication about sexuality and HIV/AIDS in sub-Saharan Africa. Reprod Health. 2011;8:25. https://doi.org/ 10.1186/1742-4755-8-25 . Haberer JE et al. Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendationsJournal of the International AIDS Society 2017, 20:21371 http://www.jiasociety.org/index.php/jias/article/view/21371/ http://dx.doi.org/10.7448/IAS.20.1.21371 World Health Organization. HIV and Adolescents: Guidance for HIV Testing and Counselling and Care for Adolescents Living with HIV. Recommendations for a Public Health Approach and Considerations for Policy-Makers and Managers. WHO Publ. 2013;100. https://apps.who.int/iris/handle/10665/94334 . Accessed 20 Mar 2018. Simoni JM, Amico KR, Smith L, Nelson K. Antiretroviral adherence interventions: Translating findings to the real world clinic. Curr HIV/AIDS Rep. 2010;7:44–51. https://doi.org/10.1007/s11904-009-0037-5. Marisa Casale, Anna Carlqvist, and Lucie Cluver. Recent interventions to improve retention in HIV care and adherence to antiretroviral treatment among adolescents and youth: A systematic review. AIDS patient care and STDs 2019; 33: 6. doi: 10.1089/apc.2018.0320. Strasser S, Gibbons S. The development of HIV-related mental health and psychosocial services for children and adolescents in Zambia: The case for learning by doing. Child Youth Serv Rev. 2014;45:150–7. http://dx.doi.org/10.1016/j.childyouth.2014.03.032 Petersen I, Bhana A, Myeza N, Alicea S, John S, Holst H, Mckay M, Mellins C Psychosocial challenges and protective influences for socio- emotional coping of HIV+ adolescents in South Africa. A qualitative investigation. doi: 10.1080/09540121003623693 Uusküla A, Laisaar K-T, Raag M, Lemsalu L, Lõhmus L, Rüütel K, et al. Effects of Counselling on Adherence to Antiretroviral Treatment Among People with HIV in Estonia: A Randomized Controlled Trial. AIDS Behav. 2018;22:224–33. https://doi.org/10.1007/s10461-017-1859-6. Tominari S, Nakakura T, Yasuo T, Yamanaka K, Takahashi Y, Shirasaka T, et al. Implementation of mental health service has an impact on retention in HIV care: a nested case-control study in a japanese HIV care facility. PLoS One. 2013;8:e69603. https://doi.org/10.1371/journal.pone.0069603 Simoni JM, Amico KR, Pearson CR, Malow R. Strategies for promoting adherence to antiretroviral therapy: a review of the literature. Curr Infect Dis Rep. 2008;10:515–21. https://doi.org/ 10.1007/s11908-008-0083-y . Edwards N, Barker PM. The Importance of Context in Implementation Research. J Acquir Immune Defic Syndr. 2014;67(Suppl 2):S157–62. https://doi.org/10.1097/QAI.0000000000000322. MacKenzie RK, van Lettow M, Gondwe C, Nyirongo J, Singano V, Banda V, et al. Greater retention in care among adolescents on antiretroviral treatment accessing “Teen Club” an adolescent-centred differentiated care model compared with standard of care: a nested case-control study at a tertiary referral hospital in Malawi. J Int AIDS Soc. 2017;20. https://doi.org/10.1002/jia2.25028. Dorothy E. Dow, Blandina T. Mmbaga, Elizabeth L. Turner, John A. Gallis, Zachary J. Tabb, Coleen K. Cunningham & Karen E. O’Donnell (2018) Building resilience: a mental health intervention for Tanzanian youth living with HIV, AIDS Care, 30:sup4, 12-20, DOI: 10.1080/09540121.2018.1527008 Donenberg GR, Cohen MH, Ingabire C, et al. Applying the Exploration Preparation Implementation Sustainment (EPIS) Framework to the Kigali Imbereheza Project for Rwandan Adolescents Living With HIV. J Acquir Immune Defic Syndr. 2019;82 Suppl 3(Suppl 3):S289-S298. doi:10.1097/QAI.0000000000002204 Mavhu W, Willis N, Mufuka J, et al. Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial. Lancet Glob Health . 2020;8(2):e264-e275. doi:10.1016/S2214-109X(19)30526-1 Supplementary Files Additionalfile1.pdf Cite Share Download PDF Status: Published Journal Publication published 01 Dec, 2020 Read the published version in BMC Public Health → Version 4 posted Editorial decision: Accept 15 Oct, 2020 Editor assigned by journal 14 Oct, 2020 Submission checks completed at journal 13 Oct, 2020 Editor invited by journal 13 Oct, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-26301","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":3490474,"identity":"f860ca15-1fea-497a-be3d-1135edfa04c9","order_by":0,"name":"Emeka Francis Okonji","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYHACZgaGAwwMjM3MQJJBQoYULWwJIC08xGthYOAxAJME1fOLHT5s8OGMTR5zO8/nVzdqLHgY2A8f3YBPi+TstOTEGTfSihmbebdZ5xwDOownLe0GPi0Gt3OMD/N8OJzYCNRinMMG1CLBY4ZXi/3t/M9QLTzPjHP+EaHFQDqHOZnnBlgL8+PcNiK0SNxOMzaccSYNqIXNjDm3T4KHjZBf+GcnP5b4cMwmcWP/4cefc77VyfGzHz6GVwscGDYwsEmAGGxEKQcBeWCcfiBa9SgYBaNgFIwoAAByBUjg06PG+QAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-3499-6948","institution":"University of the Western Cape","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Emeka","middleName":"Francis","lastName":"Okonji","suffix":""},{"id":3490475,"identity":"dbda8625-4579-40f5-9250-d8bcb6f59f47","order_by":1,"name":"Ferdinand C. 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The increasing effectiveness of and access to ART, along with increasing innovations in ART service delivery have redefined the HIV epidemic from a deadly infectious disease to a chronic, manageable disease [1\u0026ndash;3]. However, poor adherence to treatment and suboptimal retention in care continue to present significant challenges to ending AIDS by 2030 [4].\u003c/p\u003e\n\u003cp\u003eIn 2018, UNAIDS estimated that 1.6 million young people aged 10\u0026ndash;24 years were living with HIV [5, 6]. Therefore, young people living with HIV (YPLHIV) constitute a growing and key sub-population of people living with HIV globally. The increasing availability and effectiveness of ART worldwide, has resulted in more children and adolescents living longer with HIV [7, 8]. However, it is well-documented that adolescents struggle to initiate, remain engaged, and consistently adhere to ART [9, 10]. While most of the individual, social and health systems barriers associated with ART adherence and retention in care affecting the general population also apply to YPLWH, the latter face greater risks of mental and behavioural health problems, which constitute additional barriers [7, 11, 12]. Psychological risk factors such as depressive disorders result from the chronicity of HIV infection, being orphaned, changes of guardianship, and the nature of parental and other adult support [11, 13, 14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDue to the high levels of anxiety, isolation, depression and suicide reported among YPLWH, studies have recommended psychosocial support for YPLWH in addition to standard ART services to help them adapt and cope with the chronicity and stigma associated with HIV [3, 11, 12, 15\u0026ndash;17]. Psychosocial support interventions are interpersonal or informational activities, strategies or techniques that can target biological, behavioural, cognitive, emotional, interpersonal, social or environmental factors with the aim of improving an individual\u0026rsquo;s health functioning and mental well-being [18]. To promote ART adherence and retention in care among YPLWH, a comprehensive psychosocial intervention is needed. Such psychosocial support interventions should promote HIV disclosure and communication, support adherence to medication, address feelings of isolation and other emotional-related distress, and the needs associated with emerging sexuality [19, 20].\u003c/p\u003e\n\u003cp\u003eInterventions such as counselling, cognitive behavioural therapy, and peer support have been applied to improve the mental health and overall well-being of\u0026nbsp; people living with HIV over 18 years with success [21], supporting the role of psychosocial support interventions in promoting adherence and retention in ART care among adults living with HIV [22]. \u0026nbsp;Nevertheless, there is little evidence on the nature and role of psychosocial support for YPLHIV [23]. To this end, in this review, we sought to identify, classify and assess the types and effects of psychosocial support interventions focused on improving adherence and retention in care among YPLHIV on ART in the current existing literature.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eOur scoping review was conducted in line with the guidelines proposed by Khan et al. [24] i.e. (1) Framing the question; (2) Identifying relevant publications; (3) Assessing study quality; (4) Summarising the evidence; and (5) Interpreting the findings.\u003c/p\u003e\n\u003cp\u003eBased on the literature, we developed Boolean phrases that were tested using PubMed. The first literature search was conducted between March and October 2018. Due to unforeseen delays, an updated search using the same Boolean phrases and databases was conducted between October 2019 to March 2020. We searched multiple electronic databases \u0026ndash; Scopus, PubMed and EBSCOHost (Academic Search Premier, CINAHL, Psycarticles and Medline) using a standard Boolean combination: \u0026ldquo;((adolescen* OR teenage* OR young people OR youth) [AND] (psychosocial intervention) [AND] (adherence in antiretroviral therapy OR retention in care))\u0026rdquo;. In addition, we hand-searched grey literature on mental health among YPLWH and transitioning YPLWH from paediatric to adult care. All titles and abstracts (including conference abstracts) were independently screened by SAV and ZO using the PICOT (Participants, Interventions, Comparisons, Outcomes and Time) mnemonics criteria described in Table 1. Discrepancies were resolved via discussions with a third researcher (FCM). Full texts of potentially relevant articles were retrieved and independently examined by the authors. The reference lists of considered relevant articles were also hand searched to identify further potentially relevant studies. Summaries of the interventions described in each article were retrieved using a standardized form, and key information such as study purpose, nature of intervention described, outcome of intervention and conclusions of each study were extracted.\u003c/p\u003e\n\u003cp\u003eThe acronym PICOT informed the eligibility criteria for inclusion in the scoping review: the population (participants) of focus, types of interventions (and comparisons), and the outcomes of interest. The time relates to the period within which the studies were published [see Table 1 below].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1:PICOT based inclusion criteria\u003c/p\u003e\n\u003ctable border=\"1\" width=\"605\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatient population\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"406\"\u003e\n\u003cp\u003e\u003cstrong\u003eAdolescents or young adults (10-24 years) living with HIV \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003eIntervention of Interest\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"406\"\u003e\n\u003cp\u003ePsychosocial support\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003eComparison interventions\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"406\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"406\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Primary outcomes\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"406\"\u003e\n\u003cp\u003e(1)\u0026nbsp;\u0026nbsp; Adherence to antiretroviral treatment (viral load);\u003c/p\u003e\n\u003cp\u003e(2)\u0026nbsp;\u0026nbsp; Retention in care\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Secondary outcomes\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"406\"\u003e\n\u003cp\u003e(1) Quality of life and wellbeing;\u003c/p\u003e\n\u003cp\u003e(2) Stigma and discrimination;\u003c/p\u003e\n\u003cp\u003e(3) Disclosure\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"198\"\u003e\n\u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"406\"\u003e\n\u003cp\u003e2005\u0026ndash;2020\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"198\"\u003e\n\u003cp\u003e\u003cstrong\u003eOther considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u0026nbsp; Language\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"406\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"406\"\u003e\n\u003cp\u003eEnglish\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eStudies were considered eligible for inclusion in this scoping review if they met the following criteria: (i) Evaluated the effects of or associations between psychosocial support intervention and adherence ART or retention in care or related biomedical outcomes e.g., viral suppression (primary outcomes). (ii) Reported quantitative measures of the primary outcomes. (iii) Targeted or included samples of adolescents (10\u0026ndash;19 years) and/or youth (15\u0026ndash;24 years) living with HIV in a mixed sample. (iv) Was published between January 1, 2005 and March 31, 2020. Only articles published in English were considered. There was no restriction by geographical location.\u003c/p\u003e\n\u003cp\u003eStudies were excluded if they met the following criteria: (i) Adopted a qualitative research design (ii) Were a study protocol, or any form of review or conference abstracts not developed into full manuscripts. (iii) The population deviated from the age range specified. (iv) The intervention did not target the psychosocial needs of the study population. (v) The intervention focused on HIV prevention.\u003c/p\u003e\n\u003cp\u003eThe quality of the included articles was rated as either \u0026ldquo;poor\u0026rdquo;, \u0026ldquo;fair\u0026rdquo; or \u0026ldquo;good\u0026rdquo; by three independent researchers (EO, SAV and ZO), and EO made the final adjudication in cases of non-agreement. The rating of the articles was based on the criteria provided by the NIH-NHLBI Quality Assessment of Systematic Reviews and Meta-Analyses assessment tool [25].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData Extraction \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were extracted using an excel spreadsheet under the following headings: study setting, sample characteristics, intervention objectives, study design and methods, outcome measures and results [Additional file 1].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData Analysis\u0026nbsp; \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe employed a thematic content analysis approach to distil information from the selected articles [26]. The extracted information was coded into two broad categories: Intervention components and outcomes measured as informed by the study aim. The intervention components were coded/classified along the following categories: (1) How the interventions were administered; (2) who delivered the intervention; (3) Point of intervention delivery; and (4) components of the intervention. The outcomes were coded according to the reported primary and secondary outcomes of the study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFigure 1 shows the PRISMA diagram illustrating the selection process of the included studies. The literature search resulted in 5,244 citations [\u003cstrong\u003eFigure 1\u003c/strong\u003e], which were imported into a reference manager. Electronic (31) and manual (28) deduplication identified 59 duplicates. After screening for potentially relevant titles and abstracts 5,162 articles were excluded. After screening full-texts, 17 papers were further excluded because they did not report on the effects of a psychosocial support intervention on adherence and retention in ART for YPLWH. Subsequently, six papers were included in the review of having good quantitative standards.\u0026nbsp; Five studies were considered to be of good methodological quality [27\u0026ndash;31] and one of a fair quality [32].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics of included Studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe characteristics of the studies included in the review are summarised in \u003cstrong\u003eTable 2\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eTable 2:Characteristics of Included Studies (N=6)\u003c/p\u003e\n\u003ctable border=\"1\" width=\"100%\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 10%;\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 70%;\"\u003e\n\u003cp\u003e\u003cstrong\u003eCount\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 19%;\"\u003e\n\u003cp\u003e\u003cstrong\u003eReferences \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 10%;\"\u003e\n\u003cp\u003e\u003cstrong\u003eYear of Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2011 \u0026ndash; 2015\u003c/p\u003e\n\u003cp\u003e2016 \u0026ndash; 2020\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 70%;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 19%;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[27] [28] [30]\u003c/p\u003e\n\u003cp\u003e[29][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 10%;\"\u003e\n\u003cp\u003e\u003cstrong\u003eCountry\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnited States of America\u003c/p\u003e\n\u003cp\u003eKenya\u003c/p\u003e\n\u003cp\u003eUganda\u003c/p\u003e\n\u003cp\u003eSouth Africa\u003c/p\u003e\n\u003cp\u003eZimbabwe\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 70%;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 19%;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[28][30]\u003c/p\u003e\n\u003cp\u003e[29]\u003c/p\u003e\n\u003cp\u003e[32]\u003c/p\u003e\n\u003cp\u003e[27]\u003c/p\u003e\n\u003cp\u003e[31]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 10%;\"\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design (sample size)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePre and post intervention studies (61; 952)\u003c/p\u003e\n\u003cp\u003eRandomized controlled trial (4,504; 66; 94)\u003c/p\u003e\n\u003cp\u003eRetrospective cohort (174)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 70%;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 19%;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[29][30]\u003c/p\u003e\n\u003cp\u003e[27][31][32]\u003c/p\u003e\n\u003cp\u003e[28]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe six papers were disseminated between 2011 and 2019. Two of the studies were conducted in United States of America [28, 30] and four in Southern and Eastern Africa (Uganda, Kenya, South Africa and Zimbabwe) [27, 29, 31, 32]. Two of the papers were pre- and post-intervention studies (n=1,113) [29, 30], three randomized control trials (RCT) [27, 31, 32] (n=4,664), and one retrospective cohort study (n=174) [28].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention duration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe duration of study was between 3 months and 10 years [Table 3].\u003c/p\u003e\n\u003cp\u003eTable 3: Intervention/study location and duration of intervention\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u003cstrong\u003eArticle \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003e\u003cstrong\u003eCountry (location)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"242\"\u003e\n\u003cp\u003e\u003cstrong\u003eDuration of intervention \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eWohl et al. [30]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eUSA (Los Angeles)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"242\"\u003e\n\u003cp\u003e2 years\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eDavila et al. [28]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eUSA (Texas)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"242\"\u003e\n\u003cp\u003eDecentralised era: 2 years\u003c/p\u003e\n\u003cp\u003eCentralised area: 3 years\u003c/p\u003e\n\u003cp\u003eEnhanced youth services: 10 years\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eRuria et al. [29]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eKenya (Homa Bay)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"242\"\u003e\n\u003cp\u003e6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eGraves et al. [32]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eUganda\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"242\"\u003e\n\u003cp\u003e6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eBhana et al. [27]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eSouth Africa (KwaZulu-Natal)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"242\"\u003e\n\u003cp\u003e3 months\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eWillis et al. [31]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"217\"\u003e\n\u003cp\u003eZimbabwe (Gokwe south district)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"242\"\u003e\n\u003cp\u003e12 months\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSix studies evaluated psychosocial support interventions, namely: psychosocial education, group adherence counselling, individual counselling and peer-support groups and peer counselling. Two studies evaluated the impact of a family-centred appointment scheduling and health education on patient retention and adherence to monthly appointment scheduling [27, 32]. Three studies evaluated a youth centred management model that combined psychosocial case management, treatment education/adherence support and HIV risk reduction counselling to provide a client-centred intervention through which care was coordinated [28, 30, 31]. Three studies [29, 30, 32] evaluated interventions that included fast-track service deliveries to streamline medication pick-up. Table 4 illustrates the nature and characteristics of the interventions identified.\u003c/p\u003e\n\u003cp\u003eHealth and psychosocial education delivered in the form of educational activities and workshops to provide information on HIV and other relevant topics formed an integral part of all six interventions [27\u0026ndash;32]. Health education was delivered using posters and cartoons in a structured manner that provided participants with real life situations on navigating through being orphaned by AIDS; moving in with relatives; learning about own HIV diagnosis and treatment needs, while coping with family loss, stigma, peer relationships, identity, and family functioning [27\u0026ndash;32]. Furthermore, trained staff who were equipped with the tools to care for and skilled in treating adolescents were employed in six of the interventions e.g. adolescent care providers, youth-focused social workers and psychologist [27\u0026ndash;32].\u003c/p\u003e\n\u003cp\u003eTable 4: The nature and characteristics of the interventions\u003c/p\u003e\n\u003ctable border=\"1\" width=\"652\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003e\u003cstrong\u003eType of intervention\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e\u003cstrong\u003eReferences\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003e\u003cstrong\u003ePsychosocial education\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTeaching/education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][28][29][30][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eEducational workshops\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[28][29][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003e\u003cstrong\u003eAdherence counselling \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eGroup counselling/ support groups\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][28][29][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eIndividual counselling\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][29[30]][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003e\u003cstrong\u003eFamily centered\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eFamily based psychosocial intervention\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003e\u003cstrong\u003eFast track/fast lane services\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003ePriority clinic scheduling\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[29][30][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003e\u003cstrong\u003eUse of reminder cards/sms\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eReminder cards/sms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"652\"\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention agent\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eSocial worker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[30][28]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eAdolescent care provider\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[29][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eClinical psychologist/Bachelor-level counsellor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][30]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eGeneral practitioner/Nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][29][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003ePeer counsellor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[28][29][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eLay counsellor/CHW\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"652\"\u003e\n\u003cp\u003e\u003cstrong\u003ePoint of intervention delivery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eFacility-based\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][28][29][30][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eCommunity-based\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[28][31]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eSchool-based\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[29]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"652\"\u003e\n\u003cp\u003e\u003cstrong\u003eComponents of intervention\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eKnowledge/education on HIV/AIDS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][28][29][30][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eAdherence to treatment and retention in care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][28][29][30][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eFamily-focused programme\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eScheduled visits\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[29][30] [32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eEmotional/Affective support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][30][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eStructural support (youth clinic)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[28][29][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eSexual and reproductive health\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][28][29][30][31]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eDisclosure, stigma and discrimination\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27][28][29][31][32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eHealth promotion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[32]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"405\"\u003e\n\u003cp\u003eAIDS related loss and bereavement care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"163\"\u003e\n\u003cp\u003e[27]\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSix studies evaluated interventions that involved individual and peer counselling as part of the interventions [27\u0026ndash;32]. The counselling sessions were facilitated by trained community adolescent treatment supporters (CATS), social workers, lay health workers, trained health professionals, or research teams, and aimed to increase HIV knowledge and address adherence and retention barriers [27-32]. These individual counselling methods used a client-centred approach [27, 30\u0026ndash;32], or motivational interviewing [28] or peer counselling [29]. \u0026nbsp;Group counselling or support groups were found in five articles as a means of psychosocial support [27-29, 31, 32]. Youth specific support groups addressed issues such as emotional needs; developing self-management skills; capacity building; sexual health; and the stigma related to HIV [28, 31, 32].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne study implemented a school-based programme to create a supportive environment for adherence for YPLWH [29]. The programme offered counselling at schools on sexual and reproductive health and encouraged adolescents to establish health clubs among themselves [29]. In addition, the intervention provided HIV medication on the school premises to enhance adherence and linkage to care, as well supporting participating learners in disclosure [29].\u003c/p\u003e\n\u003cp\u003eTwo of the interventions had family-centred services [27, 32]; with one intervention implementing a family clinic day (FCD) [32]. FCD applied to paediatric and adolescents living with HIV and their immediate family who received priority HIV-care and counselling on a day allocated specifically to them [32]. Another component of FCD was the use of reminder cards and calendars for scheduling appointments. Health education workshops were held, which were led by peers equipped in leading discussions around HIV, sexual and reproductive health, adherence, disclosure, puberty and life skills [27-29, 32]. In addition, the Vuka family programme [27] another family-centred intervention conducted 10 health education workshop sessions that covered subject areas addressing mental and depressive disorders experienced by adolescents living with HIV. These sessions included AIDS-related loss and bereavement, HIV transmission and treatment knowledge; disclosure of HIV status to others; youth identity, acceptance, and coping with HIV; adherence to medical treatment; stigma and discrimination; caregiver child communication, particularly on sensitive topics such as puberty and HIV. The Vuka family programme also identified and developed strategies to keep children safe in high-risk situations where sexual behaviour and drug use are common [27]. Furthermore, integrated group sessions were held that were comprised of HIV-infected youth and their caregiver/s, as well as separate group activities for caregivers and preadolescents.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the case of the Red-Carpet Intervention, adolescents were given VIP express cards- a card offering adolescents fast-track counselling and HIV treatment [29]. One of the interventions also offered adolescents the opportunity to schedule their appointments [32]. Moreover, adolescent waiting areas were implemented to create an adolescent-friendly environment aimed at improving retention to ART services at facilities [28, 32]. Although referral systems were used in two of the programmes, the programmes lacked the services needed by participants, like individual counselling [27]; and support groups for substance abusers; and housing or nutrition services.\u003c/p\u003e\n\u003cp\u003eReminders cards and sms were used in one of the studies [32]. Participants were scheduled to attend their next appointment visit using reminder cards and reminded to take their medications by sending SMS messages at regular intervals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes\u003c/strong\u003e \u003cstrong\u003emeasured\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcomes of interest were adherence to ART and retention in care. The measures of psychosocial support outcomes reported were: (i) self-management (self-efficacy and self-esteem), which is associated with improved self-concept and future orientation [27, 28, 31, 32]; (ii) reduction of stigma and discrimination [27, 31]; (iii) disclosure and communication [27, 31, 32]; and (iv) perceived support in the form of social support, instrumental support, family and/or peer support and informational support [28-32]. Our findings showed that five of the studies [28-32] reported on both the primary and secondary intended outcomes [Table 5].\u003c/p\u003e\n\u003cp\u003eTable 5: Reporting of primary and secondary intervention outcomes\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" alt=\"\" /\u003e\u003c/p\u003e\n\u003cp\u003eReference 28 only reported outcomes of retention in care and adherence to medication and no other psychosocial outcome. Nevertheless, the reference was included because its intervention included educational activities and support groups offered by social services staff trained in the use of motivational interviewing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRetention in care was investigated in five of the six studies [28-32]. Three studies found retention in care at 24 months [28], 12 months [31], and 6 months [30] to be significantly higher following exposure to the psychosocial interventions. Wohl et al. [30], found that participants\u0026rsquo; HIV clinic visits significantly increased between baseline and at six months following the youth case management intervention (p \u0026lt; 0.0001). Davila et al. [28] found that the centralisation of youth services, which was composed of multifaceted psychosocial intervention components, improved the retention in care of YPLWH (p \u0026lt; 0.01) at 12 months. However, there were no significant differences observed in baseline viral load by service era (p = 0.91) [28]\u003c/p\u003e\n\u003cp\u003eSimilarly, Ruria et al. [29] conducted a pre- and post-intervention to measure retention of YPLWH in ART care. The findings indicated that after one month, 90% of patients were linked to care in the pre-intervention cohort compared to 85.7% in the post-intervention cohort. The high rate of linkage to care in the pre-intervention phase was attributed to the national policy on Adolescent Reproductive Health and development [29]. However, the results show that following the implementation of the peer counselling and psychosocial support intervention, a significant increase from 66% to 90%; and 54.4% to 98.6% were observed at three months and six months respectively.\u0026nbsp; While there is a high rate of YPLWH linking to care within the first month of ART initiation, these numbers drop with time, and that the intervention is more successful in linking YPLWH to ART over time.\u003c/p\u003e\n\u003cp\u003eResults from the Family Clinic Day (FCD) intervention showed a significant increase in patient adherence to clinic appointment schedules, that is 65% (p \u0026lt; 0.01) of adolescent participants were adherent to their appointment schedules compared to 53% participants in the control facilities). However, no effect on retention in care between the control group and the intervention group (p = 0.94) was observed [39]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdherence to medication was reported as a significant outcome in three studies [27, 31, 32]. According to Bhana et al. [27], a self-reported scale on how often medication was missed over the past six months by participants in the VUKA intervention reported significantly greater adherence to treatment than those in the control group (p \u0026lt; 0.05) [27]. Willis et al. [31] found that the intervention group were 3.9 times more likely to adhere to treatment compared to the control group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFour of the studies reported on secondary outcomes [27, 30-32]. The study conducted by Wohl et al. [30], showed that personalised case management interventions provided instrumental support for participants (tangible help provided by others). For example, support in the form of referrals for housing, mental health services, risk reduction education and transportation assistance within the first six months post the intervention [30]. Similarly, qualitative findings from the FCD intervention conducted by Graves et al., suggests that the family groups component of the intervention provided participants with increased instrumental, family, peer, and informational support [32]. The findings from the VUKA pilot programme reported significant increases in individual self-concept and future orientation, improved parent-child communication, improved social support and informational support [27]. Furthermore, caregivers reported improved family support, and a decrease in the experience of stigma [27]. One study investigated the effects of community adolescent treatment supporters on psychosocial wellbeing [31]. Willis et al. [31] found a statistical significant increase in confidence, self-esteem and self-worth (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, the intervention group reported a statistically significant improvement in the quality of life, while the control group reported a significant decline in the quality of life (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.028) [31].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur review revealed that individual and peer counselling was a distinctive treatment modality when focusing on improving ART adherence, linkage to care and/or retention in care [27-32]. While in two instances, individual counselling was carried out using client-centred theory [30] and motivational interviewing [28], one study employed trained community adolescent treatment supporters (CATS) to provide peer to peer support to YPLWH [31]. These techniques have proved to improve adherence and retention in care among YPLWH [22, 31] . Motivational interviewing is confirmed to help people adopt better health behaviours such as helping young people to use condoms more often, and also to reduce viral load [34]. Individual counselling interventions have also been identified as resource-intensive approaches [16] as they are applied at an individual level. Although it may be challenging to implement in low and middle-income countries (LMICs), however equipping low cadre health care workers such as peer lay counsellors or CATS with the necessary skills could prove effective in providing ART care and support tailored to adolescent\u0026rsquo;s particular needs [35].\u003c/p\u003e\n\u003cp\u003eSupport groups were used in five of the interventions [27-29, 31, 32] that created a space for participants to share knowledge, build social capital and expand their support systems. This method of delivering psychosocial support has been found to improve adherence, linkage to care and quality of life, while being a viable treatment option in LMIC where healthcare staff and resources are limited [28]. Peer support has been reported as a major source of social support and information among adolescents in relation to living with HIV [29, 31]. Furthermore, centralising health services for youth have the propensity to reduce barriers to retention and adherence to ART care by providing medical and social services at one central location and reducing the need for navigating complex healthcare systems and improving coordination of services. The enhanced centralised youth service programme attempted to reduce negative health beliefs and misinformation about HIV by supporting patient\u0026rsquo;s emotional needs and providing youth friendly HIV education to address misconceptions about living with HIV [28, 30, 31]. Youth specific support groups and educational activities offer opportunities for youth to develop support systems, knowledge, and self-management skills.\u003c/p\u003e\n\u003cp\u003eFamily/household-centred services were found in two articles [27, 32], which enhanced family cohesion and communication in both cases. The family/household-centred care approach argues that the family shares the responsibility of caring for the YPLWH [38]. A recent review conducted to explore the availability and effectiveness of family/household-focused interventions to improve ART adherence and retention in care found that some of the HIV-related interventions with a household focus were focused on YPLWH, and incorporated aspects of information sharing on HIV; improving communication; stimulating social support and promoting mental health [39]. Furthermore, studies have shown that integrating paediatric and adult services has positive outcomes in adherence and retention in care [40]. Additionally, the VUKA family programme addressed sensitive topics relating to HIV by using a culturally tailored cartoon [27]; such interactive modes of delivering interventions have been found to enable parent-child communication [41].\u003c/p\u003e\n\u003cp\u003eAppointment cards \u0026nbsp;were used in one of the interventions where calendars and reminder cards helped schedule eligible patients to attend their next appointment on a family clinic day \u0026nbsp;[32]. There are growing evidence from published literature that mHealth as a means of active client follow-up could improve the retention of patients in care through sending of SMS reminders of their appointment dates [33, 42]. The World Health Organization recommend utilising mobile phone reminders to improve adherence, bearing in mind that the process should be carefully monitored when aimed at adolescents for effective implementation [43]. In addition, it has been argued that adherence interventions adopting a single approach, such as phone call reminders, are less effective compared to multicomponent interventions that mobilise several support strategies and delivery modalities [44], specifically due to lower cell phone network coverage in rural and remote areas in LMICs [45].\u003c/p\u003e\n\u003cp\u003eOur scoping review identified six studies that reported on the effects of psychosocial interventions on adolescent adherence to ART and retention in care. Despite the growing recognition of the burden of HIV and psychosocial challenges faced by YPLWH, this review indicates that there is a dearth of evidence on psychosocial support interventions aimed at YPLWH. Other authors have shared the same sentiments [46, 47]. Strasser et al. [46] state that evidence-based psychosocial support services for children are currently under-developed and under-resourced, and argue that the current state of affairs need to be addressed and improved. Petersen et al. [47] also identified the need for targeted efficacy-based mental health promotion interventions for children and adolescent HIV populations in South Africa.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFive studies in this review reported increased retention and adherence to ART among adolescents and young people following the administration of an intervention with psychosocial components [27, 28, 30-32]. A study evaluating the effects of a psychosocial intervention among PLHIV attending clinical care in Estonia reported that the intervention increased the proportion of patients that were optimally adherent [48]. Similarly, a study conducted by Tominari et al. [49] reported that the implementation of mental health services demonstrated a significant increase in retention in care among PLHIV.\u003c/p\u003e\n\u003cp\u003eEvidence suggests that ART adherence interventions need to adopt long-term and flexible approaches to effectively support adherence behaviour [44]. The study conducted by Wohl et al. [30] reported that a significant dose response trend was observed between retention in care and increasing number of hours in the intervention and increasing number of intervention appointments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, Wohl et al. [30] found that a time-intensive intervention delivered by a non-judgemental and culturally competent peer is effective in engaging participant in consistent ART care. These findings are supported by previous studies, which suggest that intensive interventions are required to produce effective adherence outcomes, while one-time interventions without ongoing educational support may prove inefficient [50]. According to Edwards and Barker [51], developing frameworks for understanding and describing contexts, which incorporate an adaptive approach for intervention implementation and scale-up are necessary to advance HIV/AIDS implementation research and to ensure the effectiveness of an intervention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe learnt from the scoping review that psychosocial support interventions for YPLWH are feasible and acceptable to participants and healthcare workers. However, more empirical evidence is needed to understand the mechanisms which allow these interventions to work, to improve the availability of services and care for YPLWH. Limited information exists regarding the effectiveness of adherence interventions for YPLWH in LMICs [1]. The findings from the CATS and VUKA programme indicate that psychosocial interventions may be successfully implemented to improve YPLWH adherence to ART in resource limited settings. These findings are supported in a recent study reporting on the effectiveness of teen adherence clubs in Zimbabwe and South Africa [52].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and strengths of the review\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA strength of this scoping review is our extensive and comprehensive database search that encompasses global peer reviewed papers with a narrative reporting approach. All questions related to inclusion/exclusion of a study were discussed with the investigating team. We observed significant heterogeneity in measurements and definition of optimal adherence and inclusion criteria for participants in the different studies.\u003c/p\u003e\n\u003cp\u003eThe limitation of this scoping review and inference of results is limited by the quality of the individual papers underlying the process. For example, many of the papers included had small sample size. Further limitation to this scoping review is the exclusion of interventions that may have been evaluated using qualitative methods such as those conducted by Dorothy et al. \u0026nbsp;[53], Donenberg et al. [54] and Mahvu et al. [55]. In addition, we only focused on English publications and those published before 2005 introducing the potential to have excluded studies that might have otherwise met these inclusion criteria. Our focus in the last 15 years was meant to capture the most recent evidence because so much has changed in the HIV/AIDS treatment and care protocol since its inception. Capturing the last 15 years would provide more relevant evidence regarding the most recent treatment care protocols. \u0026nbsp;Furthermore, self-reported measures are fraught with bias compared to more objective measures of adherence such as viral load, antiretroviral drug levels and pill counts. \u0026nbsp;Lastly, in this review we did not differentiate the impact of behavioural patterns as a result of the intervention offered. For example, exploring the behavioural patterns between newly acquired HIV vs perinatal HIV. As well as, the different age groups 10-19 years and 20-24 years as these age groups\u0026rsquo; psychosocial needs are different.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIndividual and group counselling including family-centered group counselling and the use of adolescent peer support were distinctive treatment modalities when focusing on improving ART adherence, linkage to care and/or retention in care. However, this review found only six studies that evaluated psychosocial support interventions suggesting that there is dearth of evidence on psychosocial support interventions to improve adherence and retention in ART care amongst young people living with HIV. Where studies exist; methodological quality, target population, and sample size are limited. Future research and programming should seek to address psychosocial support interventions or approaches specifically designed to address the needs of adolescents and young adults living with HIV.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAppraisal of the study quality \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMethodological appraisal of study quality or risk of bias of the included articles, was based on the criteria provided by the NIH-NHLBI Quality Assessment of Systematic Reviews and Meta-Analyses assessment tool.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReporting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe scoping review was reported following the PRISMA guidelines to enhance transparency in reporting.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003eART\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; - \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Antiretroviral therapy\u003c/p\u003e\n\u003cp\u003eHIV \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; - \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Human Immunodeficiency-Virus\u003c/p\u003e\n\u003cp\u003eA\u0026amp;YPLHIV\u0026nbsp;\u0026nbsp; -\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Adolescents and young people living with HIV\u003c/p\u003e\n\u003cp\u003eOLHIV\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; -\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Older adults living with HIV\u003c/p\u003e\n\u003cp\u003ePICOT\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; -\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Population, Intervention, Comparison, Outcome and Time\u003c/p\u003e\n\u003cp\u003ePRISMA\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; -\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Preferred Reporting Items for Systematic Reviews and Meta-Analyses\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBecause the study was a scoping review of published studies, the full references of these studies have been provided in the reference list.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEO, FCM, and BVW designed the study and selected the search terms. SV and ZO screened titles and abstracts using the identified inclusion and exclusion criteria. The data were analysed by SV, ZO, EO and FCM. EO, SV and ZO drafted the first manuscript with editorial and content input from BVW and FCM. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable because all contributors to this paper met the authorship criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; information\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main author Emeka Okonji (EO) holds a master\u0026rsquo;s degree in Demography and Population studies.\u0026nbsp;\u0026nbsp; He is currently working as senior monitoring and evaluation manager for an NGO that provides treatment care and support to people living with HIV and AIDS in South Africa. Furthermore, the author is currently doing his PhD in the field of Public Health.\u0026nbsp;\u0026nbsp; This paper is part of his PhD programme\u0026nbsp;\u0026nbsp; and aim to make a case for a psychosocial intervention specifically designed to improve adherence and retention amongst adolescents living with HIV and AIDS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFootnotes \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eHudelson C, Cluver L. Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: A systematic review. AIDS Care. 2015;27:805\u0026ndash;816. http://dx.doi.org/10.1080/09540121.2015.1011073.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eMukumbang FC, Van Belle S, Marchal B, Van Wyk B. 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Accessed 18 Mar 2018.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eMukumbang, F.C., Knight, L., Masquillier, C.\u0026nbsp;\u003cem\u003eet al.\u003c/em\u003eHousehold-focused interventions to enhance the treatment and management of HIV in low- and middle-income countries: a scoping review.\u0026nbsp;\u003cem\u003eBMC Public Health\u003c/em\u003e\u0026nbsp;19,\u0026nbsp;1682 (2019). https://doi.org/10.1186/s12889-019-8020-6\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eLeeper SC, Montague BT, Friedman JF, Flanigan TP. Lessons learned from family-centred models of treatment for children living with HIV: current\u0026nbsp; approaches and future directions. J Int AIDS Soc. 2010;13(Suppl 2):S3. https://doi.org/\u003ca style=\"color: #000000;\" href=\"https://dx.doi.org/10.1186%2F1758-2652-13-S2-S3\"\u003e10.1186/1758-2652-13-S2-S3\u003c/a\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eBastien S, Kajula LJ, Muhwezi WW. A review of studies of parent-child communication about sexuality and HIV/AIDS in sub-Saharan Africa. Reprod Health. 2011;8:25. https://doi.org/\u003ca style=\"color: #000000;\" href=\"https://dx.doi.org/10.1186%2F1742-4755-8-25\"\u003e10.1186/1742-4755-8-25\u003c/a\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eHaberer JE et al. Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendationsJournal of the International AIDS Society 2017, 20:21371\u003ca style=\"color: #000000;\" href=\"http://www.jiasociety.org/index.php/jias/article/view/21371/\"\u003ehttp://www.jiasociety.org/index.php/jias/article/view/21371/\u003c/a\u003ehttp://dx.doi.org/10.7448/IAS.20.1.21371\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eWorld Health Organization. HIV and Adolescents: Guidance for HIV Testing and Counselling and Care for Adolescents Living with HIV. Recommendations for a Public Health Approach and Considerations for Policy-Makers and Managers. WHO Publ. 2013;100. \u003ca style=\"color: #000000;\" href=\"https://apps.who.int/iris/handle/10665/94334\"\u003ehttps://apps.who.int/iris/handle/10665/94334\u003c/a\u003e. Accessed 20 Mar 2018.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eSimoni JM, Amico KR, Smith L, Nelson K. Antiretroviral adherence interventions: Translating findings to the real world clinic. Curr HIV/AIDS Rep. 2010;7:44\u0026ndash;51. https://doi.org/10.1007/s11904-009-0037-5.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eMarisa Casale, Anna Carlqvist, and Lucie Cluver. Recent interventions to improve retention in HIV care and adherence to antiretroviral treatment among adolescents and youth: A systematic review. AIDS patient care and STDs 2019; 33: 6.\u0026nbsp; doi: 10.1089/apc.2018.0320.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eStrasser S, Gibbons S. The development of HIV-related mental health and psychosocial services for children and adolescents in Zambia: The case for learning by doing. Child Youth Serv Rev. 2014;45:150\u0026ndash;7. http://dx.doi.org/10.1016/j.childyouth.2014.03.032\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003ePetersen I, Bhana A, Myeza N, Alicea S, John S, Holst H, Mckay M, Mellins C Psychosocial challenges and protective influences for socio- emotional coping of HIV+ adolescents in South Africa. A qualitative investigation. doi: 10.1080/09540121003623693\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eUusk\u0026uuml;la A, Laisaar K-T, Raag M, Lemsalu L, L\u0026otilde;hmus L, R\u0026uuml;\u0026uuml;tel K, et al. Effects of Counselling on Adherence to Antiretroviral Treatment Among People with HIV in Estonia: A Randomized Controlled Trial. AIDS Behav. 2018;22:224\u0026ndash;33. https://doi.org/10.1007/s10461-017-1859-6.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eTominari S, Nakakura T, Yasuo T, Yamanaka K, Takahashi Y, Shirasaka T, et al. Implementation of mental health service has an impact on retention in HIV care: a nested case-control study in a japanese HIV care facility. PLoS One. 2013;8:e69603. https://doi.org/10.1371/journal.pone.0069603\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eSimoni JM, Amico KR, Pearson CR, Malow R. Strategies for promoting adherence to antiretroviral therapy: a review of the literature. Curr Infect Dis Rep. 2008;10:515\u0026ndash;21. https://doi.org/\u003ca style=\"color: #000000;\" href=\"https://dx.doi.org/10.1007%2Fs11908-008-0083-y\"\u003e10.1007/s11908-008-0083-y\u003c/a\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eEdwards N, Barker PM. The Importance of Context in Implementation Research. J Acquir Immune Defic Syndr. 2014;67(Suppl 2):S157\u0026ndash;62. https://doi.org/10.1097/QAI.0000000000000322.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eMacKenzie RK, van Lettow M, Gondwe C, Nyirongo J, Singano V, Banda V, et al. Greater retention in care among adolescents on antiretroviral treatment accessing \u0026ldquo;Teen Club\u0026rdquo; an adolescent-centred differentiated care model compared with standard of care: a nested case-control study at a tertiary referral hospital in Malawi. J Int AIDS Soc. 2017;20. https://doi.org/10.1002/jia2.25028.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eDorothy E. Dow, Blandina T. Mmbaga, Elizabeth L. Turner, John A. Gallis, Zachary J. Tabb, Coleen K. Cunningham \u0026amp; Karen E. O\u0026rsquo;Donnell (2018) Building resilience: a mental health intervention for Tanzanian youth living with HIV, AIDS Care, 30:sup4, 12-20, DOI: 10.1080/09540121.2018.1527008\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eDonenberg GR, Cohen MH, Ingabire C, et al. Applying the Exploration Preparation Implementation Sustainment (EPIS) Framework to the Kigali Imbereheza Project for Rwandan Adolescents Living With HIV. J Acquir Immune Defic Syndr. 2019;82 Suppl 3(Suppl 3):S289-S298. doi:10.1097/QAI.0000000000002204\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003e\u003cspan style=\"color: #000000;\"\u003eMavhu W, Willis N, Mufuka J, et al. Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial.\u0026nbsp;\u003cem\u003eLancet Glob Health\u003c/em\u003e. 2020;8(2):e264-e275. doi:10.1016/S2214-109X(19)30526-1\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adolescents, psychosocial support, interventions, HIV and AIDS, adherence and retention","lastPublishedDoi":"10.21203/rs.3.rs-26301/v4","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-26301/v4","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Mental health disorders such as high levels of anxiety, isolation, depression and suicide ideation reported among young people living with HIV (10-24 years; YPLWH) contribute significantly to poor medication adherence and retention in care. While there is evidence supporting the role of psychosocial support interventions in promoting adherence and retention in antiretroviral treatment (ART) among adults living with HIV, there is little evidence on the role of psychosocial support on medication adherence among YPLWH. This scoping review was designed to identify and classify the types and effects of psychosocial support interventions designed to improve adherence and retention in ART among adolescents and young people living with HIV globally.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: We searched six electronic databases (i.e., Scopus, Pubmed and EBSCOHost (Academic Search Premier, CINAHL, Psycarticles and Medline). Six relevant articles published between 2011 and 2019 met our inclusion criteria. We extracted information relevant to the nature and outcomes of the reported interventions using thematic content analysis informed by the Population, Intervention, comparison, outcome, and time (PICOT) framework.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Four distinctive treatment modalities that focused on improving ART adherence and retention in care were identified: individual counselling, support groups, family-centered services, and treatment supporters.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e There is a dearth of psychosocial support interventions to improve adherence and retention in ART amongst adolescents and young adults living with HIV. Future research and programming should seek to address psychosocial support interventions or approaches specifically designed to address the needs of adolescents and young adults living with HIV.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePROSPERO: Registration CRD42018105057\u003c/strong\u003e\u003c/p\u003e","manuscriptTitle":"Psychosocial Support Interventions for Improved Adherence and Retention in ART care for Young People Living with HIV (10-24 years): A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":4,"date":"2020-10-23 17:24:07","doi":"10.21203/rs.3.rs-26301/v4","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept","date":"2020-10-15T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-10-14T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-10-13T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-10-13T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":3,"date":"2020-10-14 18:26:03","doi":"10.21203/rs.3.rs-26301/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-10-08T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-10-01T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-09-30T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-09-30T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-08-08 13:56:28","doi":"10.21203/rs.3.rs-26301/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-09-24T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-09-09T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nThe authors have been very responsive to the comments.\n\nOne final and minor suggestion, at the end of the manuscript,\n\nYou refer to pill counts as both biased and objective……just put this in one place. I'm not sure how useful they are, but indeed pill counts are a more objective measure. Suggest the following:\n\nSelf-reported measures are fraught with bias compared to more objective measures of adherence such as viral load, antiretroviral drug levels and pill counts. See lines 407 to 409.\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-08-17T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-08-16T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nI am satisfied with the revision made on the manuscript. One more comment is \"Quality assessment for included studies is critical in a systematic review paper. Please add a table to present quality assessment for each domain of NHLBI for each study.\"* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-08-15T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-08-14T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-08-03T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-08-02T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-08-02T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-05-06 17:30:44","doi":"10.21203/rs.3.rs-26301/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-07-07T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-07-01T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nThis manuscript is a scoping review describing studies that utilize a psychosocial intervention to improve ART adherence and/or retention in care among young people living with HIV. The review is important and timely and for the most part well written. A few minor points are suggested to be addressed prior to publication. Not all references provided are mandatory for inclusion, but provided as examples for the authors to consider.\n\nComments\n\n1. Line 57, please check the references as UNICEF usually refers to adolescents 10-19 years old and UNAIDS young people 10-24 years old (youth 15-24 years old). I think you are citing Unicef here and should remove young people from the sentence for accuracy. Adolescents are technically nested within the definition of young people so A\u0026YLHIV doesn't really make sense. It is best to decide on the age group and use one of the above for terminology, example young people living with HIV (YPLWH) if you want 10-24 years of age.\n\n2. It might be helpful to know how you define a psychosocial intervention or what is the P psychosocial support in the screening process of the PICOT question. In the intro this is defined line 72-75 with reference 32. The Bhana intervention is clearly applicable, but based on the titles of the other 5 papers it is unclear what makes them a \"psychosocial intervention\". In Table 5 several papers included don't seem to include psychosocial outcomes? Perhaps this can be better described as to what made them fit your definition.\n\n3. Line 82, reference 34 suggests this paper is about YPLWH, but it seems it is really more about adults (inclusion criteria is \u003e=18 years) and only RCTs were included? I think the way you describe this review is a bit misleading. If you state it is in adults \u003e=18 years it makes your review stand out more (there is not another like it focused on YPLWH). I do think the Vreeman article, your reference 21 is probably better able to support that fact that psychosocial interventions are needed for YPLWH and you have a later ref in this paragraph as well.\n\n4. Methods: line 94/95 say search March -Oct 2018 and then again Oct 2019 to March 2020. Did new authors come on board. Was there consistency between the two searches? Why the time lag? A supplemental figure of the standardized form may be helpful for the reader if results were attempted to be duplicated. (In your repeat search, did you not find the Mavhu/Willis article from Lancet Global Health, Jan 2020?....mentioned in comment xx—line 163 says all included articles were published 2011-2019).\n\n5. Inclusion criteria in lines 115-122, should iv for QOL \u0026 well being and stigma/disclosure, etc be OR not AND. In Table 5 it seems several studies did not report on any of these secondary outcomes?\n\n6. Line 128….Six articles were included is typically considered a result, not methodology. Same with your decision on which were good or fair—would put this in results, but keep the description of rating in the methodology.\n\n7. Be consistent. As before, Line 132, the following sentence is really a result \"Five studies were considered to be of good methodological quality [38, 41, 42, 43 \u0026 45] and 133 one of a fair quality [39]\" and should be removed from the methods. Note this differs from that mentioned in your results that \", six papers were included in the review of having good qualitative standards.\" On line 154-155. It seems like this should be good QUANtitative not qualitative standards….was the standard on which the quality was based quantitative? Seems like it based on the inclusion criteria from your methods? Please resolve and be consistent (line 124 studies were excluded if they only had qualitative outcomes)?\n\n8. Line 217, The VUKA family program should be reference 43, Bhana, not reference 41.\n\n9. Line 282, it seems that ref 45, Willis and the CATS program reported on secondary outcomes? But that ref 39 was qualitative in nature, which I thought was exclusion criteria based on the methods?\n\n10. Line 300, here it seems Ref 41 reports on individual level counseling, but in the result on line 194 the text specifically says it does not (without Ref 41, but including Ref 42)? Perhaps this can be better clarified? \n\n11. For the discussion, the authors could consider mentioning other studies that use MI, but that did not measure adherence directly (sources include Haberer JE et al. Journal of the International AIDS Society 2017, 20:21371 http://www.jiasociety.org/index.php/jias/article/view/21371 http://dx.doi.org/10.7448/IAS.20.1.21371; Cochrane reviews --Mbuagbaw L, Ye C, Thabane L, Motivational interviewing for improving outcomes in youth living with HIV (Review) and Bain-Brickley D, Butler LM, Kennedy GE, Rutherford GW, Interventions to improve adherence to antiretroviral therapy in children with HIV infection (Review)\n\n12. Line 326 and 327, you could mention the Champs+ article (McKay PMID 20852676) from which VUKA (Ref 43) was adapted\n\n13. Line 327, studies Have (not has) shown\n\n14. Lines 337-338 seems like it could use a reference and the Haberer article mentioned in comment 11 would seem to support the statement. You could even use the primary literature from that review article to be more precise. A reference of some sort would be helpful.\n\n15. Paragraph lines 356-364 I found a bit distracting. You move to give a few examples from adult literature, but there are MANY more, Safren PMID 27658881 comes to mind as a major article in the field. Your point seems to be that addressing psychosocial issues improves adherence in adults, but this point is already made in the introduction. I'm not sure this paragraph adds much, but instead seems to distract from your focus on YPLWH?\n\n16. Line 398, by gay do you mean homosexual? Perhaps this could be stated in a clearer way with scientific language? However, I don't quite understand this statement in the context of your limitations?\n\n17. I would argue a few additional limitations\n\na. some interventions currently published must have been excluded due to only presenting qualitative data (a totally justified exclusion criteria), but examples include KIP from Rwanda (PMID: 26249308 \u0026 31764266)—for instance the Lancet Psychiatry paper here could be used to support your statement on line 307 to 309; SYV from Tanzania (PMID 30626197 and NCT02888288) -could support your statements in lines 315/316, and an upcoming trial on clinical trials.gov through the IMPAACT network (NCT04024488). Mentioning these newer trials may keep your article timely. The Zvandiri CATS program now has a more robust paper (PMID: 31924539) describing viral load as an adherence outcome that was published Jan 2020. I believe the Willis paper cited only self-reported adherence and not viral load. Did this pop up on your search?\nb. The Redcarpet intervention was for newly diagnosed ado/youth….more likely behavior acquired as compared to VUKA that was 10-14 y/o likely PHIV. Does mode of infection affect intervention targets and response? This review doesn't differentiate (which is ok, but perhaps a limitation). All YPLWH don't have the same needs and this could be better articulated. ….these are quite heterogenous populations and interventions.\nc. To your final sentence I would add the limitation that be them family or self-report these reports of fraught with bias and objective measures of adherence would strengthen the data (viral loads; clearer measures of drug levels, etc.)\nd. Only English articles were used…..were there others in other languages? Probably not a huge limitation, but worth mentioning\n\n18. References: please check the references follow journal guidelines. Example, the Willis reference has first last name; Reference 55 and 56 are the same reference.\n\n19. Table 2: it would be helpful to the reader to have an extra column to the right of count labeled associated reference to easily review the literature and categories described. You provide this in subsequent tables and it is helpful.\n\n20. Table 1 and 5: It seems only one study (Ref 41) provides viral load data. I think you need to change (viral load) from your primary outcome of adherence in table 1 if only 1/6 studies reported viral load? Similarly, this chart looks like Ref 41 only reported on retention and viral load….not on psychosocial outcomes? Why did the authors feel this was a psychosocial intervention? Perhaps a footnote in Table 5 to justify inclusion is warranted given your inclusion criteria in methods states that studies needed QUAL data on both adherence/retention in care and psychosocial outcome measures (criteria iv line 119).\n\n\n\n\n\n\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Unable to assess**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n"},{"type":"reviewerAgreed","content":"","date":"2020-06-01T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-05-24T12:00:00+00:00","index":1,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nThis scoping review was aimed to identify and classify the types and effects of psychosocial support interventions designed to improve adherence and retention in ART among adolescents and young people living with HIV. This paper is well written and organized. I read this paper with great interest. I hope the authors find the comments useful.\n\n1. How \"psychosocial support/intervention\" was defined in the present review?\n2. Regarding the search strategy:\n * For inclusion criteria (iv), did studies have to report these secondary outcomes?\n * For inclusion criteria (iii), did studies with mixed samples were included in the present review (e.g., 50% of the participants were adults younger than 24 years old, and 50% were older than 24)\n * For inclusion criteria on publication year (2005-2020) and language (English), is that possible to provide justifications on these restrictions or any potential limitations resulted from this search strategy?\n * For exclusion criteria (iv), what does it mean by \"the intervention did not hold a psychosocial focus /lacked psychosocial aspects\"? I would like to hear some examples.\n * For exclusion criteria (v), what does it mean by \"the intervention was preventative in nature\"?\n * Whether conference abstracts were screened?\n * I am also wondering whether the authors did some preliminary test(s) of their search strategy.\n3. Any psychological/behavioral theories involved in the interventions included in this review? It would be perfect to have a review and summary of this.\n4. Can the author clarify whether 1) abstract screening, 2) data extraction, 3) quality assessment were done by two independent researchers?\n5. The authors may like to provide more detail on the quality assessment for included studies, including what criteria have been used.\n6. The authors mentioned in the Limitation section that some populations group included in the review are gay (homosexual might be a better term). Can the authors provide some insight into how psychosocial support on ART adherence might be influenced by the participant's sexual orientation? BTW, I did not see this as a limitation.\n7. PICOT in Table 1 said, \"comparison interventions\" were not applicable. Are there any studies comparing psychosocial support interventions with other forms of interventions? If yes, are these studies ineligible?\n8. I would suggest the authors reformat Table 2, 4,5, to be consistent with Table 3.\n* Are the methods appropriate and well described?: **No**\n* Does the work include the necessary controls?: **No**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **Not relevant to this manuscript**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. 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