Bernard Nhlanhla Mabuza

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.

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.