Background
Framework | Self-management abilities or processes | Self-management behaviours |
---|---|---|
Corbin & Strauss (1988) [14] Sattoe et al. (2015) [9] | • Medical management • Behavioural management • Emotional management | Not described |
Lorig & Holman (2004) [15] | • Problem solving • Decision making • Utilising resources • Partnering with healthcare providers • Taking action and improving self-efficacy | Not described |
Ryan & Sawin (2009) [16] Sawin (2017) [11] | • Enhancing knowledge and beliefs (self-efficacy, outcome expectancy, goal congruence) • Regulating skills and abilities (goal-setting, self-monitoring, reflective thinking, decision making, planning, action, self-evaluation, emotional control) • Social facilitation (influence, support, collaboration) | • Engaging in treatment / treatment adherence • Symptom monitoring |
Schilling et al. (2009) [17] | • Collaborating with parents – frequency of parental involvement • Problem solving – adjusting regimen themselves and knowing blood values • Goals – endorsing potential goals | • Performing key care activities • Communicating with parents, healthcare workers, friends |
Modi et al. (2012) [10] | • Determining healthcare needs • Seeking disease and treatment related information • Communicating with the medical team | • Taking medication • Attending appointments • Self-monitoring symptoms • Lifestyle modifications • Behavioural compliance with parental instructions • Self-care |
Bernardin et al. (2013) [18] | • Self-care skills • Interpersonal skills (communication, relationships, safer sex practices, disclosure) • Technical knowledge (HIV and ART) • Cognitive skills (goal setting, problem solving, decision making, coping skills) • Positive attitudes (self-efficacy, positivity, etc.) • Planning for future roles | • Health and illness management • Use of health services |
Grey et al. (2014) [19] | • Illness needs (learning, taking ownership of health needs, performing health promotion activities) • Activating resources (health care, psychological, spiritual, social, community) • Living with a chronic illness (processing emotions, adjusting, integrating illness into daily life, meaning making) | • Acquiring information, monitoring and managing symptoms, taking action to prevent complications, goal setting, decision making, problem solving, planning, evaluating, etc. • Communicating effectively, making decisions collaboratively, seeking support of family and friends, etc. • Dealing with shock and blame, making sense of illness, dealing with stigma, creating a sense of purpose, etc. |
Mehraeen et al. (2018) [20] | • Self-management skills not explicitly described | • Medication regimen adherence • Safe sexual behaviour • Physical activity improvement • Symptom management • Attending appointments • Communication with healthcare providers |
Objectives
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Assess the effectiveness of self-management interventions on improving health-related outcomes of ALHIV on ART.
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Describe various self-management interventions and their components.
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Determine which interventions may be relevant in low-resource settings with high HIV burden.
Methods
Study design
Eligibility criteria
Types of studies
Types of participants
Types of interventions
Types of outcomes
Information sources and search strategy
Selection of studies and data extraction
Data analysis and synthesis
Certainty of the evidence
Ethical considerations
Results
Characteristics of included studies
ID | Name of intervention | Design | Participant characteristics | Sample size | Participants on ART? | Perinatal or sexual transmission | Country & Setting | Outcomes |
---|---|---|---|---|---|---|---|---|
Cell Phone Support | RCTa – parallel group | Age 15–24 History of non-adherence (< 90%) 62.2% Male 70.27% Non-Hispanic/ Black/African American | n = 37 Intervention = 19 Control (usual care) = 18 | Yes | Both - 54% behaviourally infected and 46% perinatally infected | USA High income Urban Community/home | Confidence - self-efficacy for adherence Adherence Self-care abilities - substance use Viral suppression Mental health - depression Emotional health - stress Psychological health - problem solving / distraction Healthcare utilisation | |
Bhana et al. 2014) [42] | Vuka Family Programme | RCT – parallel group | Age 10–14 Child and caregiver 51% Female Black South Africans, Zulu Receiving childcare grant: n = 45 (82%) | n = 65 Intervention = 33 Control (wait list) = 32 | Yes | Perinatal | South Africa Middle-income Urban Health facility | Knowledge - HIV treatment knowledge Confidence - self-identity, self-satisfaction, self-esteem Social support - youth and caregiver communication and comfort Adherence Mental health - strengths and difficulties, child depression |
Mental Health Intervention Sauti ya Vijana (SYV; The Voice of Youth) | RCT – parallel group | Age 12–24 50.5% Female | n = 93 Intervention = 55 Control (usual care) = 38 | Yes | Both (84% perinatal) | Tanzania Low-income Urban Health facility | Internal stigmab Adherence Viral suppression Mental health - strengths and difficulties, post traumatic stress, depression | |
Peer-led TI-CBT | RCT – parallel group | Age 14–21 | n = 356 Intervention = 178 Control (other intervention with no SM components) = 178 | Yes | Unclear | Rwanda Low income Urban Health facility | Adherence Health/risk behaviour - sexual behaviour and drug use Healthcare utilisation | |
Holden et al. (2019) [47] | Stepping Stones | Non-RCT (Historical controls) | Age 5–14 Limited ART adherence/school attendance 53.7% > 10 years 52% Female | n = 177 Intervention = 86 Control (usual care) = 91 | Yes | Unclear sexual, mostly perinatal | Tanzania Low income Urban Community | Adherence CD4 |
Hosek et al. (2018) [48] | ACCEPT (Adolescents Coping, Connecting, Empowering, and Protecting Together) | RCT – parallel group | Age 16–24 Diagnosed with HIV for less than 15 months 68% Gay/lesbian 80.6% Male 51.5% Currently in school 83.5% African American | n = 103 Intervention = 57 Control (other intervention with SM components) = 46 | Unclear (71.8% taking ART) | Sexual | USA High income Urban Heath facility | Stigmac Social support Networks and communication - engagement with healthcare provider Adherence Viral suppression CD4 Health-related quality of life Mental Health - psychological distress Healthcare utilisation |
Jeffries et al. (2016) [49] | UCare4Life | RCT – parallel group | Age 15–24 Own a phone with text-messaging capability 85% Age 21–24 86% Male 76% Black or African American 68% Diagnosed less than 3 years ago | n = 136 Intervention = 91 Control (usual care) = 45 | Unclear | Unclear | USA High income Urban Home/ICT | Adherence Self-care abilities - binge drinking Viral suppression |
Letourneau et al. (2013) [50] | Multisystemic therapy | Non-RCT – parallel group | Age 9–17 Poor adherence/risky behaviour 65% Female 91% African American | n = 34 Intervention = 20 Control (other intervention with SM components) = 14 | Yes | Perinatal (33/34) | USA High income Urban Community/ICT | Adherence Viral suppression CD4 |
Mimiaga et al. (2019) [51] | Positive STEPS | RCT – parallel group | Age 16–24 Self-report adherence difficulty | n = 14 Intervention =7 Control (usual care) = 7 | Yes | Sexual (82% behaviourally infected) | USA High income Urban Community/ICT/ Health Facility | Confidence - adherence readiness, medication taking, self-efficacy Social support Interpersonal skills Adherence |
Naar-King et al. (2006) [52] | Healthy Choices | RCT – parallel group | Age 16–25 51% Male 88% African American 58% Heterosexual | n = 62 Intervention = 31 Control (wait list) = 33 | Unclear – 1/3 on ART | Sexual (91%) | USA High income Urban Health facility | Health/risk behaviour - sexual risk behaviour Self-care abilities - illicit drug and alcohol use Viral suppression |
Naar-King et al. (2009) [53] | Healthy Choices | RCT – parallel group | Age 16–24 At least 1 of 3 HIV risk behaviours 56.6% Heterosexual 52.7% Male 83.3% African American | n = 186 Intervention =94 Control (usual care) = 92 | Unclear – 34.4% on ART at baseline | Unclear | USA High income Urban Health facility | Viral suppression |
Rongkavilit et al. (2014) [54] | Healthy Choices | RCT – parallel group | Age 16–25 Mean age 21.7 80% Male 41.8% HIV diagnoses in last 6 months | n = 110 Intervention = 55 Control (other intervention with no SM components) = 55 | Unclear – 45.5% diagnosed in past 6 months | Yes, 70% MSM | Thailand Middle income Urban Health facility | Confidence - self-efficacy for health promotion and risk reduction Adherence Health/risk behaviour - Consistent condom use Self-care abilities - alcohol and substance use Viral suppression Mental health Emotional health - anxiety |
Webb et al. (2017) [55] | Mindfulness-based stress reduction (MBSR) | RCT – parallel group | Age 14–22 CD4 count > 200 Mean age 18.7 32.2% Female | n = 93 Intervention = 48 Control (Other intervention with no SM components) = 45 | Unclear | Unclear | USA High income Urban Health facility | Mindfulnessd Adherence Viral suppression CD4 s Health-related quality of life Mental health - coping Emotional health - perceived stress Psychological health – problem solving / distraction |
Whiteley et al. (2018) [56] | iPhone game (BattleViro) | RCT – parallel group | 14–26 Detectable viral load 74% Non-heterosexual Mean age 22.4 78.7% Male 96.7% Black, African American or Haitian | n = 61 Intervention = 32 Control (other intervention with no SM components) = 29 | Yes | Sexual | USA High income Urban Community/ICT/Home | Knowledge - HIV treatment, ART knowledge Confidence - motivation, self-efficacy Social support Adherence Health / risk behaviour - Sexual risk behaviour Viral suppression Mental health - psychological distress |
Summary of interventions
ID | Intervention name | Intervention type | Description of intervention | When and how much | Delivery method | Delivery agent |
---|---|---|---|---|---|---|
Completed studies | ||||||
Cell Phone Support | Individual | Standardised script: closed and open-ended questions regarding medication review, barriers to taking medication, problem-solving support, referrals and scheduling. | Telephone calls (3-5 min) once or twice a day for 24 weeks | Telephone/SMSa | Trained adherence counsellor/HCWb | |
Bhana et al. (2014) [42] | Vuka Family Programme (based on CHAMP) | Group | Culturally tailored cartoon storyline used to convey information, accommodate unique needs, family processes (communication, supervision, monitoring & support), mental health, risk behaviour & adherence. | Six sessions over a 3-month period (2 Saturdays a month) | Face-to-face | HCW (lay counsellor supervised by psychiatrist) |
Mental Health Intervention Sauti ya Vijana (SYV; The Voice of Youth) | Individual/Group | It incorporates principles of cognitive behavioural therapy, interpersonal psychotherapy, and motivational interviewing. Includes relaxation, coping with stress, relationships, values, goals etc. | Ten group sessions and 2 individual sessions, 2 jointly with caregivers, each lasting 90 min (3 times a month for a period of 4 months) | Face-to-face | Peers (young adult group leaders) | |
Peer-led Trauma Informed Cognitive Behavioural Therapy | Group | Indigenous leader outreach model: a) psychosocial health education b) relaxation training c) cognitive restructuring d) adherence barriers e) caregiver psychological education. | Six 2-h sessions over 2 months (Sundays); booster session after 12-month assessment | Face-to-face | Peers (indigenous youth leaders) | |
Holden et al. (2019) [47] | Stepping Stones | Group | A holistic and transformative approach includes 3 types of change: psychological (changes in understandings of the self), convictional (revision of belief systems), and behavioural (changes in actions). Gendered and child’s rights focused framework. | A session every morning and every afternoon each weekday. Each community participated in a block of sessions covering Part 1 (sessions 1–15), then, in the next school holidays, a second block for Part 2 (sessions 16–29) (8 months). | Face-to-face | Volunteer facilitators (counsellors) |
Hosek et al. (2018) [48] | ACCEPT | Individual/Group | Disability-stress-coping model and incorporates information and skills-building activities guided by both social cognitive theory and the information-motivation-behavioural skills model. Focused on youth newly diagnosed with HIV. | Three individual sessions, 6 group sessions of 2 h, occurring weekly (10 weeks) | Face-to-face | HCW & Peer |
Jeffries et al. (2016) [49] | UCare4Life | Individual | Culturally-appropriate text messages in domains such as treatment and appointment adherence, HIV basics, clinical visits, and risk reduction | Mean of 12 texts per week for 3 months | ICTc/SMS | ICT |
Letourneau et al. (2013) [50] | Multisystemic therapy (MST) | Individual/Family | Therapists drew upon a menu of evidence-based intervention techniques that included cognitive-behavioural therapy, parent training, behavioural family systems therapy and communication skills training. | Families were seen for a mean of 2.2 visits per week across a mean of 6 months | Face-to-face/ICT | Trained counsellor/therapist |
Mimiaga et al. (2019) [51] | Positive STEPS (based on ‘Life Steps’) | Individual | Behavioural technology-based intervention: Step 1: 2-way personalised text messages; Step 2: adolescent-specific adherence counselling & video vignettes. | Five 1-h sessions delivered over 8 weeks | Face-to-face | Trained counsellor (master’s level) |
Naar-King et al. (2006) [52] | Healthy Choices | Individual | Motivational enhancement for 2 targeted risk behaviours, combining MI with CBT. | Four sessions (60 min) over 10 weeks | Face-to-face | Trained counsellor |
Naar-King et al. (2009) [53] | Healthy Choices | Individual | Motivational interviewing for 2 targeted risk behaviours, enhancing intrinsic motivation for change. | Four sessions (60 min) over 10 weeks | Face-to-face | Trained counsellor |
Rongkavilit et al. (2014) [54] | Healthy Choices | Individual | Motivational interviewing for 3 targeted risk behaviours (sexual risk and either alcohol use or medication adherence). Exploring barriers, change plans. | Four sessions (60 min) over 12 weeks | Face-to-face | Trained counsellor |
Webb et al. (2017) [55] | Mindfulness-based stress reduction (MBSR) | Individual | Components: (1) didactic material on topics related to mindfulness (2) experiential practice of various mindfulness techniques during group sessions (e.g. meditations, yoga); and (3) discussions on the application of mindfulness to everyday life. | Nine sessions, duration not reported | Face-to-face | Trained counsellor |
Whiteley et al. (2018) [56] | iPhone game (BattleViro) | Individual | Multi-level gaming intervention for youth living with HIV guided by the Information Motivation and Behavioural Skills (IMB) model. Youth battle HIV and engage with healthcare providers. | Game available for 14 weeks. Twice weekly game-related text messages guided by monitoring device data for first 8 weeks. | ICT/Game | ICT/Game |
Ongoing studies | ||||||
Agwu & Trent (2020) [57] | Tech2Check - technology-enhanced community health nursing intervention | Individual | Field visits by a Community Health Nurse trained in disease intervention protocols, including clinical assessment, case management, counseling, and a behavioural intervention coupled with text messaging support for medication and self-care reminders. | Not stated | Face-to-face/text messaging | HCW |
Amico et al. (2019) [58] | TERA (Triggered Escalating Real-Time Adherence) | Individual | Remote ‘face-to-face’ coaching with the assigned adherence coach; 1-way, discrete SMS text message; 2-way interactive outreach SMS from the coach if the electronic dose monitoring (EDM) bottle remains unopened after 1.5 h post dose time; incorporation of dosing data collected via the electronic dose monitoring into follow-up visits to facilitate problem-solving. | Coaching baseline, week 4 and week 12; continuous EDM with SMS outreach (12-week intervention) | Face-to-face/ ICT | Trained counsellors (TERA coaches) |
Belzer et al. (2018) [59] | Text message/Cell Phone support (SMART)/Scale-it-Up Programme | Individual | Adherence facilitators that assess if the participant has taken their ART for the day, encourage adherence and engage the participant in brief problem-solving around identified barriers. | Call once a day for 3 months, Mon-Fri | Telephone | Trained counsellors (AFs) |
Donenbeg & Dow (2016) [60] | IMPAACT Trauma Informed (TI) Cognitive Behavioural Therapy (CBT) (Group-Based Intervention to Improve Mental Health and Adherence Among Youth Living with HIV in Low-Resource Settings) | Group | Group-based psychosocial health education, cognitive restructuring, and mastery of trauma; identifying and problem-solving barriers to adherence; relaxation training. | Adolescents: Six 2-h TI-CBT group sessions led by IYL during weeks 1–6 and one 2-h booster TI-CBT group session at 6 months; Caregivers: Two 2-h group sessions led by adult study staff during weeks 1–6 and one 2-h booster group session at 6 months; Mixed-gender groups | Face-to-face | Peers (trained indigenous youth peer leaders) |
Horvath et al. (2019) [61] | YouThrive | Individual | 1) Social support component: interface for participants to interact asynchronously through message posting; 2) ART and HIV related content presented as ‘Thrive tips’; 3) Medication adherence and mood self-monitoring: ‘My check-in’ feature; 4) Goal setting and monitoring: interface called ‘My Journey’; 5) weekly SMS to encourage youth to visit website; 6) Game mechanics: YT uses points that accumulate. | Access to website for 5 months, 3 thrive tips per day, weekly SMS engagement message | ICT | ICT – moderated by trained research staff |
Mimiaga et al. (2018) [62] | Positive STEPS | Individual | Step 1) Low-intensity, daily, personalised, two-way text messages; Step 2) Each session incorporates adolescent-specific adherence counseling, digital video vignettes focused on adherence problems and challenges. | Step 1: 12 months; Step 2: five sessions of 50 min (duration of intervention unclear) | ICT/Face-to-face | Trained counsellor (master’s level) |
Outlaw & Naar (2020) [63] | Motivational Enhancement System for Adherence (MESA) | Individual | Two computer-based sessions: 1) decisional balance exercise, confidence modules and goal setting, activities to boost self-efficacy. Personal feedback immune status and HIV knowledge. 2) Adherence behaviour over previous month, with actual adherence feedback, adherence behaviour over previous month and consequences of that behaviour. | 2 brief sessions one month apart | ICT | Computer-delivered |
Arnold et al. (2019) [64] | Stepped Care Intervention | Individual | Level 1) Enhanced Care plus automated messaging and monitoring intervention (AMMI). Level 2) Secure, private online/social media peer-support intervention. Level 3) Participants who fail to achieve viral suppression at levels 1 or 2 of the intervention will be assigned to a coaching intervention. | Level 1 text messages: 1–5 text messages per day for 24 months; Level 2 not reported; Level 3 not reported | ICT/face-to-face/phone | Trained counsellors (coaches) |
Sam-Agudu et al. (2017) [65] | Adolescent Coordinated Transition | Group | Altering paediatric-adult visits; monthly peer-led organised support group with curriculum content; a case management team consisting of a physician, a nurse, and a trained patient advocate. | 4 times during pre-transfer (at 3, 6, 9, and 12 months); 3 times after transfer to adult clinic (at 15, 18 and 21 months) (total 36 months) | Face-to-face | HCW & Peer |
Sibinga (2018) [66] | Mindfulness-based stress reduction (MBSR) | Group | 1) Material related to mindfulness, meditation, yoga, mind-body connection; 2) Experiential practice of mindful meditation; 3) Group discussions focused on problem-solving related to barriers to effective practice. | 2-h sessions every week for 8 weeks and one 3-h session in week 9 | Face-to-face | Trained counsellor (MBSR instructor) |
Subramanian et al. (2019) [67] | Integrated Care Delivery of HIV Prevention and Treatment (SHIELD) | Group | SHIELD: Educational modules on HIV prevention and treatment, general wellness, SRH, communication skills etc.; youth clubs. | Modules: a three-session, six-module program; Youth clubs: meet twice per month for 12 months; Modules for family members: 2 sessions, 4-module programme | Face-to-face | Peers for youth clubs; Unclear who will facilitate educational sessions |
Study ID | Intervention name | Intervention aim | Self-management domains addressed | Self-management abilities targeted |
---|---|---|---|---|
Cell Phone Support | To provide participating youth living with HIV with a consistent, accessible and supportive relationship in which problem-solving solutions to adherence barriers along with tangible assistance and informational advice. | Self-regulation | Problem-solving | |
Social facilitation | Negotiated collaboration | |||
Bhana et al. 2014) [42] | Vuka Family Programme (based on CHAMP) | To deliver critical information to facilitate discussions and problem-solving within and between families in multi-family groups. | Knowledge and beliefs | Illness knowledge |
Self-regulation | Problem solving Communication Identity management | |||
Mental Health Intervention Sauti ya Vijana (SYV; The Voice of Youth) | To improve treatment adherence, reduce mental health symptoms and increase youth resilience. | Knowledge and beliefs | Illness-knowledge Self-efficacy Motivation | |
Self-regulation | Coping Goal setting Emotional control Self-evaluation Identity management Social support | |||
Social facilitation | Negotiated collaboration | |||
Peer-led Trauma Informed Cognitive Behavioural Therapy | To increase ART adherence by reducing depression, trauma, and gender-based violence (GBV). | Knowledge and beliefs | Illness knowledge | |
Self-regulation | Problem solving Coping Emotional control Identity management | |||
Holden et al. (2019) [47] | Stepping Stones | To build resilience among children with HIV. | Knowledge and beliefs | Illness knowledge Self-efficacy Motivation |
Self-regulation | Goal setting Action plans Assertiveness Emotional control Self-evaluation | |||
Social facilitation | Negotiated collaboration Social support | |||
Hosek et al. (2018) [48] | ACCEPT | To assist young adults newly diagnosed with HIV to engage in the healthcare system in order to improve medical, psychological and public health outcomes. | Knowledge and beliefs | Illness knowledge |
Self-regulation | Decision-making Action plans Coping Goal setting Emotional control | |||
Social facilitation | Social support Shared-decision-making | |||
Jeffries et al. (2016) [49] | UCare4Life | To increase retention in care and HIV medication adherence. | Knowledge and beliefs | Illness knowledge Self-efficacy |
Self-regulation | Self-monitoring - reminders | |||
Social facilitation | Participation | |||
Letourneau et al. (2013) [50] | Multisystemic therapy (MST) | To address medication adherence problems in children with HIV. | Self-regulation | Communication |
Social facilitation | Negotiated collaboration | |||
Mimiaga et al. (2019) [51] | Positive STEPS (based on ‘Life Steps’) | To address adolescent-specific barriers to HIV medication adherence among heterosexual and Lesbian-Gay-Bisexual (LGB), perinatally and behaviourally infected youth. | Knowledge and beliefs | Illness knowledge Self-efficacy Motivation |
Self-regulation | Goal setting Action plans Problem solving Emotional control Coping | |||
Social facilitation | Social support Negotiated collaboration Participation | |||
Naar-King et al. (2006) [52] | Healthy Choices | To move people along the stages of change (motivation for change), help them to review costs and benefits (decisional balance), and improve self–efficacy. | Knowledge and beliefs | Self-efficacy Motivation |
Self-regulation | Goal setting Planning Action plans Self-monitoring Reflective thinking | |||
Social facilitation | Resource utilisation | |||
Naar-King et al. (2009) [53] | Healthy Choices | To move people along the stages of change, help them to review costs and benefits (decisional balance), and improve self-efficacy; to improve viral load (viral suppression). | Knowledge and beliefs | Self-efficacy Motivation |
Self-regulation | Goal setting Planning Action plans Self-monitoring Reflective thinking | |||
Rongkavilit et al. (2014) [54] | Healthy Choices | To increase motivation for healthy behaviours – specifically risk behaviours. | Knowledge and beliefs | Self-efficacy Motivation |
Self-regulation | Goal setting Planning Action plans Self-monitoring Reflective thinking | |||
Webb et al. (2017) [55] | Mindfulness-based stress reduction (MBSR) | To increase mindfulness and other elements of self-regulation as well as improved HIV disease management; to enhance present-focused awareness, reducing preoccupation with the past and the future. | Self-regulation | Problem-solving Emotional control Coping |
Whiteley et al. (2018) [56] | iPhone game (BattleViro) | To empower youth to improve adherence by increasing information, motivation and behavioural skills. | Knowledge and beliefs | Illness knowledge Self-efficacy Motivation |
Social facilitation | Negotiated collaboration Social support |
Risk of bias of included studies
Effects of self-management interventions on outcomes
Comparison 1: self-management interventions addressing one to two self-management domains vs control
Summary of findings: Self-management interventions compared to control in adolescents living with HIV | |||||
---|---|---|---|---|---|
Patient or population: Adolescents living with HIV; Setting: Low-, middle-, and high-income countries; Intervention: Self-management interventions with 1–2 components; Comparison: Usual care | |||||
Outcome | Follow-up | Pooled effect (95%CI) | No. of participants (studies) | Certainty of evidence (GRADE) | Comments |
Confidence | 3 months | MD 0.35 (0.01 to 0.69) | 33 (1 trial) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may increase confidence at 3-month follow-up and may make little or no difference to confidence at 4-, 6-, 9- and 12-month follow-ups, but the evidence is very uncertain. |
4 months | MD 0.00 (−0.26 to 0.26) | 96 (1 trial) | |||
MD 0.35 (−2.12 to 2.82) | 61 (1 trial) | ||||
6 months | MD 0.14 (−0.32 to 0.60) | 31 (1 trial) | |||
9 months | MD 0.10 (−0.17 to 0.37) | 91 (1 trial) | |||
12 months | MD 0.21 (−0.22 to 0.64) | 31 (1 trial) | |||
Adherence (self-reported) | 3 months | SMD 0.19 (−0.09 to 0.48) | 198 (3 trials) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may make little or no difference to self-reported adherence at 3-, 6- and 9-month follow-ups, and may increase adherence at 12-month follow-up, but the evidence is very uncertain. |
6 months | SMD 0.71 (−0.02 to 1.44) | 31 (1 trial) | |||
9 months | SMD 0.11 (−0.30 to 0.52) | 91 (1 RCT) | |||
12 months | SMD 1.16 (0.39 to 1.93) | 31 (1 trial) | |||
Adherence (Electronic pill monitoring) | 4 months | SMD 0.29 (− 0.21 to 0.8) | 61 (1 trial) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may make little or no difference to adherence at 4-month follow-up, but the evidence is very uncertain. |
Sexual risk behaviour | 4 months | MD 0.4 (−0.76 to 1.56) | 96 (1 trial) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may make little or no difference to sexual risk behaviour at 4- and 9-month follow-ups, but the evidence is very uncertain. |
9 months | MD −0.90 (−2.39 to 0.59) | 91 (1 trial) | |||
Viral load (log 10) | 4 months | MD −0.12 (− 0.45 to 0.2) | 157 (2 trials) | ⨁⨁◯◯ LOW a,b | HIV self-management interventions compared to usual care for adolescents living with HIV may make little or no difference to viral load at 4- and 9-month follow-ups. At 6- and 12-month follow-ups, HIV self-management interventions compared to usual care may decrease viral load, but the evidence is very uncertain. |
6 months | MD −1.70 (−2.65 to − 0.75) | 30 (1 trial) | ⨁◯◯◯ VERY LOW a,b,c | ||
9 months | MD −0.02 (− 0.30 to 0.26) | 237 (2 trials) | ⨁⨁◯◯ LOW a,b | ||
12 months | MD −1.00 (− 1.89 to −0.11) | 31 (1 trial) | ⨁◯◯◯ VERY LOW a,b,c | ||
Depression | 3 months | SMD −0.27 (− 0.56 to 0.01) | 194 (3 trials) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may make little or no difference to depression at 3-, 6-, 9- and 12-month follow-ups, but the evidence is very uncertain. |
6 months | SMD −0.57 (−1.29 to 0.15) | 31 (1 trial) | |||
9 months | SMD −0.12 (− 0.48 to 0.25) | 117 (2 trials) | |||
12 months | SMD −0.26 (− 0.97 to 0.45) | 31 (1 trial) |
Patient reported outcomes
Knowledge and understanding of illness
Confidence (self-efficacy for taking ART)
Motivation for taking ART
Mindfulness
Social support
Patient behaviours
Adherence to ART
Sexual risk behaviour
Self-care abilities (substance use)
Health status
Viral suppression
CD4 count
Quality of life
Emotional health
Mental health
Psychological health
Impact
Comparison 2: self-management interventions addressing all three components vs control groups
Summary of findings: Self-management interventions compared to control in adolescents living with HIV | |||||
---|---|---|---|---|---|
Patient or population: Adolescents living with HIV; Setting: Low-, middle-, and high-income countries; Intervention: Self-management interventions with all 3 components; Comparison: Usual care | |||||
Outcome | Follow-up | Pooled effect (95%CI) | No. of participants (studies) | Certainty of evidence (GRADE) | Comments |
Confidence | 6 months | MD 0.80 (−0.12 to 1.72) | 93 (1 trial) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may make little or no difference to confidence at 6-month follow-up, but the evidence is very uncertain. |
Adherence (self-reported) | 6 months | SMD 0.67 (0.27 to 1.07) | 107 (2 trials) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may increase self-reported adherence at 6-month follow-up, but the evidence is very uncertain. |
Adherence (more than 95%) | 9 months | RR 1.14 (1.20 to 1.65) | 177 (1 trial) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may increase the likelihood of achieving over 95% adherence at 9-month follow-up, but the evidence is very uncertain. |
Sexual risk behaviour | 3 months | MD −11.97 (−25.45 to 1.51) | 51 (1 trial) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may make little or no difference to sexual risk behaviour at 3-month follow-up, but the evidence is very uncertain. |
Viral load (log 10) | 3 months | MD −0.66 (−1.21 to − 0.11) | 51 (1 trial) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may decrease viral load at 3-month follow-up and may make little to no difference at 6-month follow-up, but the evidence is very uncertain. |
6 months | MD −0.84 (−1.69 to 0.01) | 93 (1 trial) | |||
Depression | 6 months | MD −0.60 (−2.67 to 1.47) | 93 (1 trial) | ⨁◯◯◯ VERY LOW a,b,c | HIV self-management interventions compared to usual care for adolescents living with HIV may make little or no difference to depression at 6-month follow-up, but the evidence is very uncertain. |