Mental health and psychosocial interventions integrating sexual and reproductive rights and health, and HIV care and prevention for adolescents and young people (10–24 years) in sub-Saharan Africa: a systematic scoping review

eClinicalMedicine, Volume 57, Year 2023

Ukuhunyushwa

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.

I-AI Digest

Study Justification:

– Interventions targeting combined sexual and reproductive health, HIV management, and mental health care in sub-Saharan Africa (SSA) are limited.
– 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 study aims 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.

Study Highlights:

– The study followed a two-process scoping review approach.
– A total of 27 interventional studies were included in the final review.
– The interventions represented nine countries in SSA and included various types such as peer, community, family, digital, and mixed modality interventions.
– Social or community ecology associated problems were the most common risk factors identified.
– Psychoeducation and cognitive behavioral strategies were widely offered in the interventions.

Study Recommendations:

– There is a need to strengthen multimodal interventions that address the identified social issues related to adolescent mental and physical health.
– Mental health concerns should be given more attention in SRHR/HIV interventions for adolescents.
– Future interventions should focus on improving communication, assertiveness training, and informational support for adolescents.

Key Role Players:

– Researchers and academics specializing in adolescent health, SRHR, HIV, and mental health.
– Health professionals, including doctors, nurses, and psychologists, with expertise in adolescent health.
– Policy makers and government officials responsible for health and social welfare programs.
– Non-governmental organizations (NGOs) working in the field of adolescent health and rights.
– Community leaders and advocates for adolescent health.

Cost Items for Planning Recommendations:

– Research funding for conducting further studies and evaluations of multimodal interventions.
– Training and capacity building for health professionals and community workers.
– Development and implementation of educational materials and resources.
– Program monitoring and evaluation costs.
– Advocacy and awareness campaigns.
– Infrastructure and equipment for delivering interventions (e.g., digital platforms, community centers).
– Collaboration and coordination costs between different stakeholders.

Amandla Obufakazi

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines, and the search strategy was comprehensive. The study included a total of 27 interventional studies, which were assessed using the Joanna Briggs Quality Appraisal checklist. However, the abstract does not provide specific details about the findings and outcomes of the included studies. To improve the strength of the evidence, it would be helpful to provide a summary of the key findings and conclusions from the included studies, as well as any limitations or areas for further research.

Abstract

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.

Izinto zokwakha

Emisha

Based on these findings, potential innovations to improve access to maternal health could include:

1. Integrating mental health components: Given the low focus on mental health concerns in the identified interventions, there is a need to integrate mental health components into maternal health programs. This could involve providing mental health screenings, counseling services, and support for pregnant and parenting adolescents.

2. Strengthening multimodal interventions: The study highlighted the relevance and centrality of social issues related to adolescent mental and physical health. To address these issues, it is important to strengthen multimodal interventions that address both the social determinants of health and the specific problems faced by pregnant and parenting adolescents.

3. Peer and community interventions: The study identified peer and community interventions as one of the intervention types. Expanding and scaling up these interventions could improve access to maternal health by leveraging social support networks and community resources.

4. Digital interventions: The study also identified digital interventions as one of the intervention types. Utilizing digital platforms and technologies, such as mobile apps or telehealth services, could improve access to maternal health information, counseling, and support for pregnant and parenting adolescents.

5. Caregiver-focused interventions: The study found that some interventions focused on caregivers and youth. Including caregivers in maternal health interventions can provide additional support and resources for pregnant and parenting adolescents.

Overall, these potential innovations aim to address the gaps identified in the study and improve access to maternal health for pregnant and parenting adolescents in sub-Saharan Africa.

AI Innovations Description

The recommendation that can be developed into an innovation to improve access to maternal health based on the described study is to integrate mental health and psychosocial interventions with sexual and reproductive rights and health (SRHR) and HIV care and prevention for adolescents and young people in sub-Saharan Africa.

The study found that interventions targeting combined SRHR, HIV management, and mental health care for adolescents in sub-Saharan Africa are limited. However, it highlighted the importance of addressing common determinants of poor mental, psychosocial, and SRHR outcomes through multimodal and multipronged interventions.

The innovation could involve developing comprehensive programs that integrate mental health support, SRHR education, HIV prevention and care, and psychosocial interventions specifically tailored for adolescents and young people. These programs could be implemented in various settings such as schools, communities, and healthcare facilities.

Key components of the innovation could include:

1. Psychoeducation: Providing information and education on mental health, SRHR, and HIV prevention and care to increase awareness and knowledge among adolescents.

2. Cognitive-behavioral strategies: Implementing strategies such as improved communication, assertiveness training, and informational support to enhance mental well-being and promote healthy behaviors.

3. Peer and community support: Engaging peers and community members as sources of support and guidance for adolescents, creating a supportive environment for their mental and reproductive health.

4. Digital interventions: Utilizing digital platforms and technologies to deliver mental health and SRHR information, counseling, and support to reach a wider audience of adolescents.

5. Family involvement: Involving caregivers and family members in the interventions to provide support and promote positive mental and reproductive health outcomes for adolescents.

6. Addressing social and community factors: Recognizing and addressing social issues such as orphanhood, sexual abuse, homelessness, and negative cultural norms that contribute to poor mental and reproductive health outcomes among adolescents.

By integrating these components into innovative interventions, access to maternal health can be improved by addressing the mental health and psychosocial needs of adolescents and young people in sub-Saharan Africa.

AI Innovations Methodology

Based on the provided description, the study conducted a systematic scoping review to identify interventions targeting adolescent sexual and reproductive health, HIV management, and mental health care in sub-Saharan Africa (SSA). The objective was to determine whether these interventions include mental health components and how these components and their outcomes were reported in the literature. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered within the International Prospective Register of Systematic Reviews (PROSPERO).

The methodology involved a two-stage process. In the first stage, the PubMed database was searched to identify studies focusing on adolescents and young people aged 10 to 24 from 2001 to 2021. The search strategy included keywords related to mental health, psychosocial interventions, sexual and reproductive health, HIV, and adolescent pregnancy. The search yielded 7025 studies, which were screened based on inclusion and exclusion criteria.

In the second stage, 38 studies were selected for further scrutiny. The researchers used the PracticeWise Clinical Coding System to identify select problems and practices in the interventions. From these 38 studies, 27 interventional designs were included for a systematic scoping of their findings. The Joanna Briggs Quality Appraisal checklist was used to rate the quality of these studies.

The coding system focused on study characteristics, sample characteristics, problems or concerns experienced by participants, and practice elements of the interventions. Problem codes were grouped into categories such as ecology, education, medical, mental health, resources, and others. Intervention targets and components were also coded.

The full texts of the selected articles were reviewed by three researchers to extract data on study characteristics, intervention details, recruitment procedures, outcomes, statistical analysis, and conclusions. The quality and suitability of the articles were assessed using the Joanna Briggs Critical Appraisal checklist.

Due to heterogeneity between the studies, a meta-analysis was not conducted. Instead, a scoping review was performed, focusing on interventional studies targeting improvements in sexual and reproductive health outcomes. The quality appraisal of the included studies provided insights into the strength of the interventional evidence and methodological issues.

It’s important to note that this methodology specifically applies to the described study and may vary for other research projects.

Ababhali & Co-Ababhali

Statistics:

Authors: 12

Identifiers:

DOI: 10.1016/j.eclinm.2023.101835

Research Areas:

Community Interventions, Disparities, Genetics and Genomics, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Mental Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Violence and Injury

Study Design:

Cohort Study, Cross Sectional Study, Grounded Theory, randomised-control-trial

Study Approach:

Mixed-methods, Quantitative, Systematic Review

Yabelana ngalokhu: