Adolescent-friendly HIV care services that integrate peer support, counseling, and family-centered approaches are showing promise in improving treatment outcomes among young people living with HIV in eastern and southern Africa, according to a new systematic review published in The Lancet Regional Health – Africa.
The review examined 11 studies conducted across six African countries—Uganda, Malawi, Zimbabwe, Namibia, Lesotho, and Eswatini—focusing on adolescents aged 10 to 19 years. Researchers assessed whether differentiated service delivery (DSD) approaches improved retention in care, adherence to antiretroviral therapy (ART), and viral load suppression among adolescents living with HIV.
The researchers noted that adolescents continue to face unique challenges in HIV treatment compared to adults.
“Adolescents aged 10–19 living with HIV (ALHIV) face persistent challenges across the HIV treatment cascade and often have poorer treatment outcomes compared to adults living with HIV,” the authors wrote.
The review found that several adolescent-focused interventions, particularly Teen Clubs and peer-led support models, improved treatment engagement and adherence in some settings. Teen Clubs provide young people with peer interaction, psychosocial support, health education, counseling, and ART refill services in adolescent-friendly environments.
In Malawi, adolescents enrolled in Teen Clubs showed higher retention in care and improved viral suppression compared to those receiving standard care. Similarly, a peer-led intervention in Zimbabwe significantly reduced virological failure among adolescents by providing community- and clinic-based support.
The study also found that psychosocial and family-based interventions played an important role in improving medication adherence. In Uganda, group cognitive behavioral therapy and family-support interventions increased the likelihood that adolescents would take their medication consistently.
According to the review, emotional and social factors remain critical in determining whether adolescents stay on treatment.
“Adolescent adherence is shaped not only by access and visit frequency but also by stigma, disclosure, motivation, mental health, and social support,” the authors wrote.
Despite these encouraging findings, the study reported that results varied across countries and programs. In some settings, adolescent-focused interventions performed similarly to standard HIV care, suggesting that certain health systems already provide relatively strong support services.
The review further revealed that younger adolescents aged 10 to 14 years generally achieved better outcomes than older adolescents aged 15 to 19 years. Researchers attributed this to factors such as caregiver supervision and increased clinical oversight among younger age groups, while older adolescents often face additional social pressures, stigma, and treatment fatigue.
Although the researchers described the evidence as promising, they cautioned that the overall quality of evidence remains limited because of differences in study methods and outcome measurements.
The researchers called for stronger and more standardized studies across Africa to better determine which HIV service-delivery approaches are most effective for adolescents living with HIV.
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