Interventions addressing the adolescent HIV continuum of care in South Africa: a systematic review and modified Delphi analysis

Abstract

IntroductionCompared with adults, adolescents in South Africa have larger gaps at each step of the HIV continuum of care resulting in low levels of viral suppression.MethodsWe conducted a systematic review and modified Delphi analysis of interventions addressing the HIV continuum of care for adolescents in South Africa. We searched PubMed, Science Direct, and Google Scholar and online conference proceedings from the International AIDS Society, the International AIDS Conference, and the Conference on Retrovirology and Opportunistic Infections from 1 January 2010 to 30 September 2020. We then conducted a modified Delphi analysis with 29 researchers involved in the National Institutes of Health’s Fogarty International-supported Adolescent HIV Implementation Science Alliance–South Africa to evaluate interventions for efficacy, feasibility and potential for scale-up.ResultsWe identified nine initial published articles containing interventions addressing the adolescent HIV continuum of care in South Africa, including five interventions focused on HIV diagnosis, two on antiretroviral therapy adherence and two on retention in care. No studies addressed linkage to care or transition from paediatric to adult care. Two studies discussed intervention costs. In-home and HIV self-testing, community-based adherence support, and provision of adolescent-friendly services were the most impactful and scalable interventions addressing the adolescent HIV continuum of care.ConclusionFuture interventions should work comprehensively across the adolescent HIV continuum of care and be tailored to the specific needs of adolescents.