Adolescents living with HIV face substantial difficulties in
accessing HIV care services and have worse treatment outcomes than other age
groups. The objective of this review was to evaluate the effectiveness of
service delivery interventions to improve adolescents’ linkage from HIV
diagnosis to antiretroviral therapy (ART) initiation, retention in HIV care and
adherence to ART.
We systematically searched the Medline, SCOPUS and Web of
Sciences databases and conference abstracts from the International AIDS
Conference and International Conference on AIDS and STIs in Africa (ICASA).
Studies published in English between 1st January 2001 and 9th June 2014 were
included. Two authors independently evaluated reports for eligibility,
extracted data and assessed methodological quality using the Cochrane risk of
bias tool and Newcastle–Ottawa Scale.
Eleven studies from nine countries were eligible for review.
Three studies were randomised controlled trials. Interventions assessed
included individual and group counselling and education; peer support; directly
observed therapy; financial incentives; and interventions to improve the
adolescent-friendliness of clinics. Most studies were of low to moderate
methodological quality.
This review identified limited evidence on the effectiveness
of service delivery interventions to support adolescents’ linkage from HIV
diagnosis to ART initiation, retention on ART and adherence to ART. Although
recommendations are qualified because of the small numbers of studies and
limited methodological quality, offering individual and group education and
counselling, financial incentives, increasing clinic accessibility and
provision of specific adolescent-tailored services appear promising
interventions and warrant further investigation.
Below: The adolescent-focused HIV care pathway. Based on a figure by Kranzer and colleagues [79] (adapted).
Below: Typography of interventions to improve adolescents’ linkage, retention and adherence to ART. Where studies evaluated interventions consisting of more than one component, or complex multifaceted interventions, they are listed more than once in the figure.
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