How Do Psychosocial Interventions for Adolescents and Young People Living With HIV Improve Adherence and Viral Load? A Realist Review

Purpose: Psychosocial interventions have the potential to support adolescents and young people living with HIV (AYPLHIV) to achieve better HIV outcomes. However, more evidence is needed to understand which interventions are most effective, and the mechanisms driving how they work in practice.Methods: We used realist methodologies to generate statements based on evidence from inter-vention studies and linked evidence included in a systematic review of psychosocial interventions for AYPLHIV. Key data were extracted from available sources to generate cases, including context -mechanism-outcome pathways. Higher level themes were refined iteratively to create a mid-range theory of how these interventions may work.Results: From 26 resulting cases, 8 statements were crafted, grouped into 3 overarching categories, to describe how these interventions worked. Interventions were overall found to set off mecha-nisms to improve adherence when (1) responding to individual-level factors to support AYPLHIV (via incorporating agency and empowerment, personalized and/or contextualized approaches, and self-care skills); (2) tailoring delivery strategies to address specific needs (via diverse strategies, longer duration, and digital delivery); and (3) providing supportive resources (via peer and broader support, and structural support and integration into existing services). Discussion: A collection of diverse mechanisms may individually or collectively drive improved outcomes for AYPLHIV engaged in psychosocial interventions. Recommendations for integrating our findings into practice are discussed.(c) 2022 Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.

Automated summary

This study used realist methodologies to investigate the effects and mechanisms of psychosocial interventions on AYPLHIV. The findings revealed that these interventions improved participants' adherence and HIV outcomes through responding to individual-level factors, tailoring delivery strategies, and providing supportive resources.