Background: Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged interventions for adolescents. The main objective of this study was to identify whether and how interventions targeting adolescent SRHR and HIV with a focus on pregnant and parenting adolescents in SSA include mental health components and how these components and their outcomes have been reported in the literature. Methods: We carried out a two process scoping review approach between 01.04.2021 and 23.08.2022. In the first stage, we searched the PubMed database to identify studies focusing on adolescents and young people aged 10 to 24 from 2001 to 2021. We identified studies focusing on HIV and SRHR that had mental health and psychosocial aspects to the interventions. Our search yielded 7025 studies. Of these 38 were eligible based on our screening criteria that covered interventions, and on further scrutiny, using PracticeWise, an established coding system, we identified select problems and practices to provide a more granular assessment of how interventions developed for this context mapped on to specific problems. At this second stage process, we selected 27 studies for inclusion as actual interventional designs for further systematic scoping of their findings and we used the Joanna Briggs Quality Appraisal checklist to rate these studies. This review was registered within the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42021234627. Findings: Our first set of findings is that when coding problems and solutions, mental health concerns were the least common category of problems targeted in these SRHR/HIV interventions; nevertheless, psychoeducation and cognitive behavioral strategies such as improved communication, assertiveness training, and informational support were offered widely. Of the 27 interventional studies included in the final review, 17 RCTs, 7 open trials, and 3 mixed designs, represented nine countries of the 46 countries in SSA. Intervention types included peer, community, family, digital, and mixed modality interventions. Eight interventions focused on caregivers and youth. Social or community ecology associated problems (being an orphan, sexual abuse, homelessness, negative cultural norms) were the most common risk factors and were more frequent than medical issues associated with HIV exposure. Our findings highlight the relevance and centrality of social issues related to adolescent mental and physical health along with the need to strengthen multimodal interventions along the lines of problems we have identified in our review. Interpretation: Combined interventions jointly addressing adolescent SRHR, HIV, and mental health have been relatively understudied, despite evidence that adverse social and community factors are rampant in this population. Funding: MK was funded by Fogarty International Center K43 TW010716-05 and lead the initiative.
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines.28 The study has been suitably registered within PROSPERO, registration number CRD42021234627. Articles for this systematic review were found through the electronic web-based literature database PubMed. The search strategy was developed, and searches were conducted in April 2021 led by health sciences librarian. After reviewing these initial search results, the search strategy was revised to August 2022 to better capture SSA countries and the target population. The revised search string is included in Appendix 1 and is the basis of this review. Our search strategy included keywords including but not limited to: mental health treatment for pregnant adolescents, psychosocial interventions for behavioral health programs for teenage pregnancy, mental health interventions for adolescent pregnancy, mental health promotion of pregnant and parenting adolescents, mental health treatment for adolescent mothers, mental health treatment for pregnant teenagers, mental health interventions for parenting adolescents, mental health interventions for adolescent fathers, mental health promotion in adolescent fathers, anxiety, stress and depression interventions for in adolescent mothers, anxiety, stress and depression interventions for pregnant adolescents, reproductive health interventions for adolescent mothers, HIV prevention and promotion for pregnant and parenting adolescents, SRHR interventions for pregnant adolescents, SRHR and HIV interventions for adolescent parents, SRHR and HIV interventions for adolescent fathers and mothers. The search strategy included Medical Subject Headings (MeSH) and their synonyms in addition to keywords. We applied a title/abstract limiter on keywords to restrict results to SSA countries and SRHR. We also included the Boolean operator NOT to exclude non-SSA LMIC countries. Filters were applied after we ran the search string in PubMed to limit the results to English language publications between 2001 and 2022. Titles and abstracts were screened to exclude studies without an interventional program. We predefined our search using Population, Intervention, Comparison, Outcome and Study (PICOS). The search identified 7025 articles (see Fig. 1). The initial screening was done by two reviewers (AL, BRG) independently and systematically searched for all articles with reference to inclusion and exclusion criteria. Each reviewer screened titles and then abstracts to select the articles that met the inclusion criteria. Those articles that did not meet the inclusion criteria were excluded. Full texts of 38 articles were reviewed for coding of problems and solutions led by three reviewers (BC, KB, RG). Eleven studies were excluded in the second round that focused only on the interventional design. Four reviewers (OM, JN, SJ, and MK) met to seek extract data on the selected articles to develop a review of key outcomes and characterise the studies. Prisma flowchart. The principal method of identifying studies suitable for the review involved searching the databases previously mentioned led by CM. There were no duplicate papers that were removed, and studies were screened for eligibility according to the inclusion and exclusion criteria based on their title and abstract by two researchers (BR and AL). After that, both researchers read the full texts for eligibility (n = 38). Disagreements on full texts were discussed with a third reviewer (MK). On these 38 studies, a team of three reviewers, BC, KB, RG carried out a detailed review of problems and core elements of intervention characteristics. In a second stage review process, two authors reviewed data and discussed with a third reviewer to resolve in case of discrepancies (OM, JN and SJ). Extracted information included: region, country, study population and demographics from participants; details of the intervention with sufficient information for replication; study methodology; recruitment and sample procedures; enrolment start and end rates, as well as follow-up length; outcomes and times of measurement; statistical analysis used; key conclusions; and relevant references to similar studies. Portions of the coding were conducted using an amended version of the PracticeWise Clinical Coding System,29 which allows a structured summary of the research literature according to multiple variables related to study design, sample and context characteristics, intervention targets and intervention practice elements. The coding system for the current study focused on four sets of variables relevant to the aims of the current study: (1) study characteristics (i.e. design), (2) sample characteristics (e.g. ethnicity, age, maternal status, locations), (3) problems or concerns experienced by sample participants, and (4) practice elements, which represent discrete clinical procedures that make up a packaged intervention.30,31 Thirty-seven problem codes were available and grouped into the following six categories: ecology, education, medical, mental health, resources, and other. Problem codes were binary, such that if the concern characterised any participant, the entire sample was coded as positive for that concern. In addition to problems described in the samples, four intervention targets were coded: (1) sexual and reproductive health, (2) mental health, (3) interpersonal/empowerment skills (e.g., how to manage conflict or build a supportive social network), and (4) adult life skills (e.g., finances, housing, and vocation). Intervention targets differed from problems, in that targets were inferred from intervention descriptions as representing some part of the focus of the intervention. Intervention components (i.e., the specific procedures used to address these targets) were characterised using 85 practice element codes. Coders were also permitted to write in codes that did not fit existing practices. Practice elements were coded at the level of the active intervention arms (condition); thus, a study that included two active treatments (including treatment as usual) would have practice elements coded for each treatment condition. Each article was coded independently by two members of the research team who possess expert content knowledge of youth interventions and who have extensive professional experience using the PracticeWise Clinical Coding System. Each coder first coded six studies independently and then met to discuss clarifications to the coding system. Each coder then coded an additional six studies, following which Cohen’s Kappas (κ) were calculated and coders met to discuss additional coding clarifications. Coders then divided the remaining studies and each coded half independently. Reliabilities for study and sample characteristics, as well as problem types, have been previously reported and shown to be good to excellent (i.e., κ = 0.66–1.00; 31). In the current study, κ for practice elements appearing at least twice in the reliability sample ranged from 0.59 to 1.0 (average κ = 0.83). Three researchers independently reviewed the full texts for quality and suitability. All eligible articles were assessed using Joanna Briggs Critical Appraisal checklist.32 The tool helps to examine the appropriateness of the study aim, adequacy and methodology, study design, data collection, study selection, data analysis, presentation of findings, author’s discussions, and conclusion. Any discrepancies were discussed until a consensus was reached. Due to heterogeneity between the studies, we concluded that a meta-analysis would not be appropriate. As a result, a scoping review was done focusing on interventional studies targeting improvements in a SRHR outcome.33 We carried out a quality appraisal of the studies reported in the review to provide pointers to strength of the interventional evidence and methodological issues. Our study is a systematic scoping review and we did not need ethics approval for secondary data analysis. There were no primary data collection; therefore, no informed consent was needed. The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. All authors confirm that they had full access to all the data in the study and accept responsibility to submit for publication.