Abstract
BackgroundSelf-management interventions aim to enable people living with chronic conditions to increase control over their condition in order to achieve optimal health and may be pertinent for young people with chronic illnesses such as HIV. Our aim was to evaluate the effectiveness of self-management interventions for improving health-related outcomes of adolescents living with HIV (ALHIV) and identify the components that are most effective, particularly in low-resource settings with a high HIV burden.MethodsWe considered randomised controlled trials (RCTs), cluster RCTs, non-randomised controlled trials (non-RCTs) and controlled before-after (CBA) studies. We did a comprehensive search up to 1 August 2019. Two authors independently screened titles, abstracts and full texts, extracted data and assessed the risk of bias. We synthesised results in a meta-analysis where studies were sufficiently homogenous. In case of substantial heterogeneity, we synthesised results narratively. We assessed the certainty of evidence using GRADE and presented our findings as summaries in tabulated form.ResultsWe included 14 studies, comprising 12 RCTs and two non-RCTs. Most studies were conducted in the United States, one in Thailand and four in Africa. Interventions were diverse, addressing a variety of self-management domains and including a combination of individual, group, face-to-face, cell phone or information communication technology mediated approaches. Delivery agents varied from trained counsellors to healthcare workers and peers. Self-management interventions compared to usual care for ALHIV made little to no difference to most health-related outcomes, but the evidence is very uncertain. Self-management interventions may increase adherence and decrease HIV viral load, but the evidence is very uncertain. We could not identify any particular components of interventions that were more effective for improving certain outcomes.ConclusionExisting evidence on the effectiveness of self-management interventions for improving health-related outcomes of ALHIV is very uncertain. Self-management interventions for ALHIV should take into account the individual, social and health system contexts. Intervention components need to be aligned to the desired outcomes.Systematic review registrationPROSPERO CRD42019126313.
Highlights
Introductionadolescents living with Human Immunodeficiency Virus (HIV) (ALHIV) are faced with the dual challenge of having to live with a life-long chronic condition and adhere to treatment, while being confronted with developmental challenges and HIV-related stigma [6]
Self-management interventions aim to enable people living with chronic conditions to increase control over their condition in order to achieve optimal health and may be pertinent for young people with chronic illnesses such as Human Immunodeficiency Virus (HIV)
Study design We conducted a systematic review of self-management interventions for adolescents living with HIV (ALHIV) on Antiretroviral treatment (ART) and reported it according to the PRISMA reporting guidelines [31] (See Additional file 1)
Summary
ALHIV are faced with the dual challenge of having to live with a life-long chronic condition and adhere to treatment, while being confronted with developmental challenges and HIV-related stigma [6]. Supporting them through this vulnerable phase to ensure they make a safe and productive transition to adulthood requires a differentiated care approach – a type of patient-centred approach where HIV care and services are adapted to suit the needs of certain groups [7]. The participative approach to care is likely to appeal to them [9]
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