Self-management interventions for adolescents living with HIV: a systematic review
Open Access
- 7 May 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 21 (1), 1-29
- https://doi.org/10.1186/s12879-021-06072-0
Abstract
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 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. We 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. We 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. Existing 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. PROSPERO CRD42019126313.This publication has 59 references indexed in Scilit:
- Multisystemic therapy for poorly adherent youth with HIV: Results from a pilot randomized controlled trialAIDS Care, 2012
- GRADE guidelines: 3. Rating the quality of evidenceJournal of Clinical Epidemiology, 2011
- GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tablesJournal of Clinical Epidemiology, 2011
- Improving Health Outcomes for Youth Living With the Human Immunodeficiency VirusArchives of Pediatrics & Adolescent Medicine, 2009
- The Individual and Family Self-Management Theory: Background and perspectives on context, process, and outcomesNursing Outlook, 2009
- A New Self-Report Measure of Self-Management of Type 1 Diabetes for AdolescentsNursing Research, 2009
- Healthy Choices: Motivational Enhancement Therapy for Health Risk Behaviors In HIV-Positive YouthAIDS Education and Prevention, 2006
- Grading quality of evidence and strength of recommendationsBMJ, 2004
- Interventions to Improve Chronic Illness Care: Evaluating Their EffectivenessDisease Management, 2003
- Unending Work and Care: Managing Chronic Illness at Home.Contemporary Sociology: A Journal of Reviews, 1989