Peer-Led Models for Improving HIV Treatment and Care Outcomes Among Adolescents and Young People Living with HIV in Eastern and Southern Africa: A Rapid Review.

Résumé

Adolescents and Young People Living with HIV have poor levels of adherence to treatment and retention in care. Previous reviews highlighted the need for high-quality evidence on peer-led interventions for improving HIV treatment outcomes among Adolescents and Young People Living with HIV aged 10-24 years. We conducted a rapid review of such interventions in Eastern and Southern Africa, searching Google Scholar, PubMed, Scopus, and ProQuest for articles published between January 2017 and December 2024. The search yielded 1,642 articles; 13 met the inclusion criteria. Studies were conducted in nine countries (Ethiopia, Kenya, Lesotho, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe). Interventions were primarily facility-based (7), with others being community-based (3), digital/remote (2), or hybrid (1). Four studies were randomized controlled trials, indicating stronger evaluation designs than previous reviews. Despite variations in design and outcomes, most studies demonstrated that peer-led models improved ART adherence, retention in care, and/or viral suppression. Most effective models focus on psychosocial support, frequent contact with adolescents, parenting/caregiver support, home visits, and supervision for peer supporters. Facility-based programs succeeded when offering fast-track services, weekend hours, youth-friendly approaches, and psychosocial support. While mobile health interventions showed initial promise, their long-term effectiveness remains unproven.