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

Christina A. Laurenzi, G. J. Melendez-Torres, Daniel T. Page, Lodewyk Steyn Vogel, Tashmira Kara, Nadia A. Sam-Agudu, Nicola Willis, Wole Ameyan, Elona Toska, David Anthony Ross, Sarah Skeen

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


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 intervention 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 mechanisms 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.

Original languageEnglish (US)
Pages (from-to)254-269
Number of pages16
JournalJournal of Adolescent Health
Issue number3
StatePublished - Sep 2022
Externally publishedYes

Bibliographical note

Funding Information:
This work was funded by the World Health Organization .

Publisher Copyright:
© 2022


  • Adolescents and young people living with HIV
  • Antiretroviral adherence
  • Psychosocial interventions
  • Realist review

PubMed: MeSH publication types

  • Journal Article
  • Review
  • Systematic Review
  • Research Support, Non-U.S. Gov't


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