Psychosocial support for young people with HIV: does it work?

A review of trial findings from around the world that offered psychosocial support to young people with HIV suggests they were effective at improving young people's adherence to antiretroviral treatment (ART) and viral load but had less impact in other key areas, such as sexual risk taking.

Psychosocial support focuses on people’s psychology, behaviour and social structures.

The evidence review looked at 30 randomised controlled trials that tested various forms of psychological support, including motivational interviewing, cognitive-behavioural therapy, economic empowerment, peer support and mindfulness.

The trials took place between 2000 and 2020 with a total of 4,055 adolescents and young people with HIV (ages 10-24). Most of the trials (60%) took place in the United States. The others took place in Nigeria, South Africa, Uganda, Zambia, Zimbabwe and Thailand.

Around one third of trials provided some support or information via phone, SMS or online platforms. Most used health providers but some used peers mentors and lay counsellors.

Trial participants who received psychosocial support were more likely to adhere to ART and experience reductions in their viral load than young people in the control groups.

But psychosocial support did not have a significant impact on young people’s sexual risk behaviours and knowledge, link to or retention in HIV care, or becoming virally suppressed. But it is possible that the trials did not follow young people for long enough to properly assess these outcomes.

To achieve these outcomes, psychosocial support may need to be provided with other forms of support.

More research is needed on psychosocial interventions designed to reduce young people’s sexual risk behaviours and strengthen their engagement in HIV care. No trials looked at psychosocial support in the context of moving from child to adult HIV care. This area also needs investigation.

Young people supported the design and/or implementation of 53% of the trials. This happened through things such as workshops and youth advisory groups. This approach is vital for ensuring psychosocial support meets young people's needs.

Most of the trials in this review took place in the United States. But there is a need for more research on what works for young people in low- and middle-income countries with high HIV prevalence, including an assessment of cost-effectiveness.

Using lay health counsellors and peer mentors are low-cost approaches that have been effective. Digital interventions have also shown promise, and may be particularly useful to meet the challenges arising from COVID-19.