Designing HIV prevention interventions that are acceptable to young adults in sub-Saharan Africa: Insights from a mapping review and inductive thematic analysis

Abstract

RationaleUnderstanding what young adults and other key stakeholders find acceptable for HIV prevention interventions and reasons explaining acceptability or lack thereof is crucial for intervention developers and implementers in sub-Saharan Africa (SSA). Higher acceptability of health and social interventions can improve intervention uptake and effectiveness. ObjectivesThis paper aims to aggregate and synthesise the evidence on the acceptability of HIV prevention interventions for young adults in SSA, published over the past twelve years. MethodsIn line with PRISMA guidelines, we conducted a systematic mapping review to identify studies assessing the acceptability of HIV prevention interventions with young adults aged 10–24 in SSA, published between 2010 and 2022. We employed descriptive syntheses to aggregate and present study characteristics, methodologies, and findings on overall intervention acceptability. An inductive thematic analysis of quantitative and qualitative findings across studies was then conducted to highlight reasons for the acceptability or unacceptability of interventions among young adults and other stakeholders. ResultsThe review identified 32 studies assessing young adults’ acceptability of HIV prevention interventions. Fourteen studies also explored the acceptability of other stakeholders, such as caregivers, teachers, and healthcare workers. Overall reported acceptability was high. Of the 18 studies that provided a quantitative assessment based on the proportion of participants that found the intervention acceptable, only one study reported acceptability below 50%. The findings of the thematic analysis identified the following seven key factors shaping acceptability: ease of use; intervention understanding; intervention costs; perceived positive effects; perceived negative effects; relevance to young adults’ needs and context; and social factors shaping acceptability. ConclusionThe review highlights the importance of collecting and aggregating information on the acceptability of HIV prevention interventions in Africa to inform future intervention development. It also points to factors developers and implementers of HIV prevention services and programmes should consider. However, our review also exposes gaps in the literature. More research is needed to investigate the acceptability of different stakeholders beyond end-users, the acceptability of integrated interventions, and the development of more robust theoretical frameworks and measurement tools. Understanding what influences the acceptability of interventions among young people and other key individuals will better equip researchers and practitioners to meet their needs and improve opportunities for the transition to adulthood.