Brian van Wyk

Background: Adolescents living with HIV (ALHIV) in sub-Saharan Africa experience poorer outcomes across the HIV care cascade than other age groups because of intersecting developmental, psychosocial and structural barriers. Peer navigation has emerged as a promising strategy to support engagement in care, yet evidence on its effectiveness and implementation for ALHIV remains fragmented. Aim: To synthesise evidence on peer navigation and peer-led psychosocial support interventions for adolescents living with HIV. Method: A rapid review was conducted in accordance with PRISMA 2020 principles. PubMed and EBSCOhost databases were searched for qualitative, quantitative and mixed-methods studies published between 2013 and 2025. Results: Fourteen studies conducted across eight countries were included. Peer navigation interventions were typically delivered by young adults living with HIV who were stable on treatment and trained to provide psychosocial, adherence and health system navigation support. Most studies reported improvements in antiretroviral therapy adherence, retention in care and viral suppression, although effects varied by context and were not always sustained. Psychosocial benefits included reduced stigma, strengthened trust and improved self-efficacy. Implementation findings indicated high acceptability and feasibility, supported by structured training and supervision, alongside challenges related to sustainability and structural barriers such as transportation costs. Conclusion: Peer navigation is a valuable component of adolescent-friendly HIV care in sub-Saharan Africa, particularly when integrated within responsive clinical systems and complemented by strategies addressing structural vulnerability. Contribution: This review consolidates regional evidence on peer navigation for ALHIV and provides implementation-relevant insights to inform the integration and scale-up of peer-led models within public sector HIV services.

Background/Objectives: Adolescents living with HIV (ALHIV) face compounded health and psychosocial challenges while managing lifelong antiretroviral therapy (ART). Mental health difficulties among ALHIV are strongly associated with suboptimal adherence and disengagement from care. While mental illness is well documented, limited empirical evidence exists on the influence of positive mental wellness on adherence self-efficacy among ALHIV. This study assessed mental wellness among ALHIV and identified key psychosocial predictors of adherence self-efficacy in public healthcare facilities in Cape Town, South Africa. Methods: A cross-sectional survey was conducted among ALHIV (N = 251) aged 10–19 years who were receiving ART at public healthcare facilities across the Cape Town metropole. Participants completed an electronic questionnaire that assessed ten mental wellness domains and adherence self-efficacy. Descriptive statistics were calculated to summarise participant characteristics and mental wellness scores, while Pearson correlations and multiple linear regression were done to identify associations and independent predictors of adherence self-efficacy using SPSS v29. Results: Most participants were aged 15–19 years (76.9%) and diagnosed with HIV at birth (68.9%). Mental wellness scores were high across all domains (M = 3.14–3.71). Hope (M = 3.71), spirituality (M = 3.58), and purpose in life (M = 3.52) were the highest-rated domains. All mental wellness domains were positively correlated with adherence self-efficacy (p < 0.001), with the strongest associations being purpose in life (r = 0.66), self-acceptance (r = 0.66) and resilience (r = 0.66). Hope (p < 0.001), resilience (p = 0.001), purpose in life (p = 0.03) and self-acceptance (p = 0.012) emerged as significant independent predictors. Conclusions: Positive mental wellness and adolescent-centred psychosocial support in routine HIV care may strengthen adherence self-efficacy and support adolescents’ confidence in managing treatment.

Adolescents living with HIV (ALHIV) face ongoing challenges with treatment adherence and engagement in care, resulting in lower viral suppression rates compared to adults. Peer navigation has shown promise in supporting psychosocial well-being and adherence among adults, but evidence specific to adolescents in sub-Saharan Africa (SSA) remains limited. This qualitative evidence synthesis (QES) describes and assesses the quality of qualitative and mixed-methods studies on peer navigation and support interventions for ALHIV receiving antiretroviral therapy in SSA. Eligible studies, published in English between January 2015 and October 2025, were identified through a comprehensive search strategy in PubMed, Scopus, CINAHL, and APA PsycArticles. Data were extracted and analyzed thematically using Atlas.ti, and aligned with the Context–Intervention–Mechanism–Outcome (CIMO) framework. PNs in the studies were young people living with HIV who provided education, counselling and adherence support to their peers who were ALHIV. Effective programmes featured structured training, supportive supervision, and flexible delivery models adapted to adolescents’ preferences. Mechanisms of change included trust-building, emotional support, disclosure coaching and empowerment. Reported outcomes included improved adherence, clinic attendance and various psychosocial indicators. However, challenges such as stigma, role ambiguity, limited remuneration, and lack of policy guidance constrained the sustainability and scalability of PN programs. Overall, peer navigation interventions appear effective in strengthening adolescent HIV care when PNs are adequately trained, supervised and contextually adapted. The variation in how peer navigation and support interventions for ALHIV are delivered and designed, along with the lack of standardization of the interventions, may affect the generalizability of the findings and the rollout of PN programs across SSA.

Universal Health Coverage (UHC) is the cornerstone of equitable health systems and service delivery. Achieving UHC requires both "whole of government" and "whole of society" approaches that are vital for building resilient health systems that promote physical and mental wellness for all communities. In this paper, we review several theories of stakeholder engagement (SE) and argue that meaningful SE - as opposed to stakeholder management - is essential for fostering early participation and democratic decision-making in the transformation of health systems towards UHC. We recommend several key steps to promote early and inclusive SE that actively solicit input from diverse community members, establish open platforms for dialogue, and leverage the expertise and resources of various sectors. By creating a collaborative environment that includes each individual, whether an educator, policymaker, family member, or business leader, amongst others, we can advance the goals of UHC and build health systems that benefit everyone.

Introduction: The COVID-19 pandemic strained health systems globally, including South Africa. The Western Cape provincial health department responded by mobilizing resources, expanding infrastructure, and implementing control measures like community screening and public health campaigns. Additionally, the department established a COVID-19 Steering Committee to facilitate equitable access and increase vaccine uptake through community engagement with civil society. This paper describes the lessons learned from this process to guide future community and stakeholder engagement. Methods: A qualitative review of documents from April 2021 to October 2022 was conducted. Data consisting of 21 sets of meeting minutes, which were subjected to reflexive thematic analysis using ATLAS.ti. Ethics clearance was obtained from Stellenbosch University Health Research ethics committee and permission for the study from the Western Cape Government Department of Health. Results: Themes revealed how strategic intentions translated into actions to boost vaccine uptake and foster community trust. Efforts involved culturally sensitive communication, capacity building for health workers, and high adaptability. Key actions included multisectoral coordination, countering misinformation, logistical problem-solving, managing power imbalances between government and civil society leaders, and addressing socio-economic barriers. Conclusions: Community engagement is vital for effective emergency responses. Building trust and community ownership by involving diverse stakeholders and addressing resource inequities are central to the success of health interventions. This study highlights the importance of multisectoral collaborations and tackling social power differentials to foster inclusive responses.

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems, posing risks for adolescents living with HIV (ALHIV) in resource-limited, high HIV-prevalence settings. These disruptions threatened antiretroviral therapy (ART) adherence, viral load suppression (VLS) and retention in care (RiC). Aim: This study aimed to compare treatment outcomes of ALHIV on ART in the Khayelitsha and Eastern Substructure (KESS) before and during the COVID-19 pandemic. Setting: The study was performed in KESS, Cape Town, South Africa. Methods: A retrospective cohort analysis was conducted among ALHIV aged 10–19 years receiving ART at public health facilities, pre-COVID-19 (before 01 March 2020) and during COVID-19 (01 March 2020–31 December 2021). Sociodemographic, clinical, and treatment data were analysed. Descriptive and inferential statistics compared outcomes and determined factors associated with VLS (< 1000 copies/mL) using SPSS v.30. Results: Data from 1702 ALHIV (pre-COVID-19) and 2733 ALHIV (during COVID-19) were analysed. Viral load suppression declined from 82.1% to 64.8%, while full VLS (< 50 copies/mL) from 70.8% to 53.7% (p = 0.065). Antiretroviral therapy adherence fell from 96.4% to 70.0% (p < 0.001), and RiC 80.3% to 76.3% (p < 0.001). In multivariate analysis, higher CD4 count, and consistent ART adherence predicted VLS. Conclusion: Antiretroviral therapy adherence and VLS rates among ALHIV declined during COVID-19. Adolescent-centred healthcare delivery models are needed to ensure continuity of HIV treatment during public health emergencies. Contribution: This study provides local evidence on the pandemic’s impact in a high-burden South African context. By quantifying declines in ART adherence, RiC, and VLS, it highlights ALHIV vulnerabilities and the need to strengthen adolescent-responsive, resilient healthcare systems.

Background: Adolescents living with human immunodeficiency virus (HIV) face disproportionately poor treatment outcomes because of a combination of psychosocial, structural and health systems challenges. Despite efforts to implement adolescent-friendly and differentiated service delivery models in Zambia, gaps remain in the organisation and delivery of care. Aim: This study aimed to explore how HIV services for adolescents are delivered and experienced by healthcare workers and programme managers in Lusaka District. Setting: The study was conducted across six health facilities in Lusaka District, Zambia, representing different levels of the health system and providing HIV care to adolescents. Methods: A descriptive qualitative design was employed. Thirty purposively selected participants (24 healthcare workers and six HIV programme managers) participated in individual in-depth interviews (IDIs) conducted between 20 February 2025 and 30 April 2025 using a semi-structured interview guide. Data were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Results: Inductive content analysis identified three themes: programmatic responses, highlighting strategic leadership, policy direction, adolescent-focused service delivery and workforce capacity building; implementation challenges, including inadequate infrastructure, health system limitations and individual-level barriers; and opportunities for improved programmatic response and service delivery, emphasising improvements in policy, health systems, infrastructure and service delivery. Conclusion: Although notable progress has been made in expanding adolescent HIV services in Lusaka, gaps in infrastructure, workforce and social support continue to affect programme effectiveness. Strengthening adolescent-responsive and sustainable care is essential to improve retention, viral suppression and Zambia’s progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets in the adolescent HIV cascade. Contribution: This study highlights barriers and opportunities in adolescent HIV programming in Lusaka, emphasising leadership, policy, service delivery and workforce capacity, while noting ongoing system and individual challenges. The findings can inform policy and practice to strengthen adolescent-responsive HIV care in Zambia and similar contexts.

Introduction: Adolescents living with HIV (ALHIV) on antiretroviral therapy (ART) globally report lower rates of viral suppression because of challenges to remain adherent and engage in HIV treatment. Psychosocial support is critical to meet the unique needs of ALHIV. Peer navigation has been found to be effective in supporting adults in ART adherence, but the evidence for adolescents is scant. Given the large proportion of adolescents on ART in sub-Saharan Africa, peers hold promise to deliver psychosocial support. The aim of this qualitative evidence synthesis is to review qualitative and mixed-methods studies describing experiences of peer navigation and support interventions for ALHIV on ART in sub-Saharan Africa. Methods and analysis: The population–concept–context configuration will be applied to identify suitable studies on ALHIV and on ART (population) and experiences of peer navigation and support (concept) and conducted in sub-Saharan African countries (context). The review will only include studies published in the English language. The following databases will be searched: PubMed, Wiley Library Online, EbscoHost (PsycArticles), MEDLINE, Scopus, CINAHL, WHO database and Google Scholar, for eligible qualitative studies published from January 2015 (to ensure relevance) to November 2025. Two-stage screening will be done by two reviewers independently. Extracted data will be thematically analysed with Atlas.Ti (v25) software. A narrative synthesis will be conducted to describe the reported outcomes, experiences and challenges with receiving and delivery of peer navigation and support interventions in sub-Saharan Africa. The review will adhere to Preferred Reporting Items for Systematic reviews and Meta-Analyses and Enhancing Transparency in Reporting the Synthesis of Qualitative Research reporting guidelines. Ethics and dissemination: Ethics approval is not required for this qualitative evidence synthesis. The findings will be submitted to a peer-reviewed journal and disseminated to via conference proceedings. PROSPERO registration number: CRD42024541951.

Background: Adolescents living with human immunodeficiency virus (HIV) aged 10–19 years account for 1.7 million globally, with 82% residing in sub-Saharan Africa. Older adolescents (15-19 years) assume greater responsibility for their own care, often leading to reduced adherence, lower retention, and poorer health outcomes. Understanding the role of healthcare workers (HCWs), key stakeholders in the HIV care continuum, is essential to strengthening transition practices and health system responses. Aim: To describe HCWs’ perspectives on transition practices for adolescents living with HIV in the Cape Town Metropole, South Africa. Setting: Six public primary health facilities in the Cape Town Metropole, South Africa. Methods: A descriptive qualitative design was used. Data were collected through in-depth, semi-structured interviews with 16 HCWs and analysed thematically. Results: Healthcare workers identified challenges to optimal transition (theme 1), including delayed disclosure, low adolescent readiness, and inconsistent transition processes. Health service responses (theme 2), such as youth clubs and provider-adolescent relationships, were supportive but unevenly applied. Gaps and recommendations (theme 3) included improving youth club management and ensuring system-wide support to enhance engagement and continuity of care. Conclusion: Successful transition to adult HIV care requires structural and psychosocial support mechanisms. Healthcare workers play a critical role and should be supported to consistently implement adolescent-friendly services during and post-transition. Contribution: This study offers system-level insights to inform policy, HCW training, and integrated models of care tailored to adolescents living with HIV in primary health settings in South Africa.

Background: HIV treatment, adherence, and retention in care are fundamental in achieving viral load suppression (VLS) and fighting the HIV pandemic. The Government of Eswatini has decentralised antiretroviral treatment (ART) services and introduced differentiated HIV service delivery models to improve treatment outcomes for all people living with HIV, including young people. It is imperative to investigate the success of these initiatives in improving VLS in young people living with HIV (YPLHIV) in Eswatini.Objective: To determine the factors associated with VLS amongst YPLHIV (15 to 24 years) who are on ART in Eswatini.Methodology: A retrospective cohort analysis of 4 334 YPLHIV on ART in Eswatini between January 2018 and December 2021 was conducted. The Statistical Package for Social Scientists version 25 was used to determine the factors associated with viral suppression through bivariate and logistic regression analysis.Results: The prevalence of viral suppression (< 1 000 copies/mL) was 92.9%. After adjusting for all covariates, the likelihood of viral suppression remained significantly higher among YPLHIV who were female (AOR = 2.06; CI 1.04-4.11), had enrolled on the fast-track ART care model (AOR = 2.14; CI 1.09-4.20), and were receiving 4 to 5 months' (AOR = 5.88; CI 3.14-11.02) and 6+ months' (AOR = 3.55; CI 1.67-7.53) of medication.Conclusion: The national HIV treatment program in Eswatini exceeded the UNAIDS target of 90% virologic suppression for YPLHIV who are enrolled for ART for more than six months. However, to meet the revised 95% target, tailored interventions are required to strengthen long-term adherence and retention in care for YPLHIV on ART.