title: Interventions targeting sexual and reproductive health and rights outcomes of young people living with HIV: a comprehensive review of current interventions from sub-Saharan Africa.
abstract: BACKGROUND
  A growing number of young people (ages 10-24) are living with HIV (YPLWH) in sub-Saharan Africa (SSA). These YPLWH have particular needs and challenges related to their sexual and reproductive health and rights (SRHR). Contextual factors including gender inequalities, violence, stigma, and discrimination and lack of tailored services undermine YPLWH's SRHR.
  
  
  OBJECTIVE
  Understand the scope and impact of interventions targeting YPLWH to improve SRH-related outcomes in SSA.
  
  
  METHODS
  We undertook a review to synthesise evaluated interventions (qualitative, quantitative, or mixed methods) aimed at improving the SRH outcomes of YPLWH in SSA with outcomes based on a World Health Organization framework of comprehensive SRHR approaches for women living with HIV. Using inclusion criteria, only six interventions were identified.
  
  
  RESULTS
  Interventions sought to improve a range of direct and indirect SRH outcomes, including sexual behaviour, adherence, disclosure, and mental health. Four overarching issues emerged: 1) all interventions were structured according to cognitive behavioural therapy theories of behaviour change - while showing promise they do not tackle the wider gender, social, and economic contexts that shape YPLWH's SRH; 2) 'significant others' were included in two of the interventions, but further work needs to consider how to leverage parental/guardian support appropriately; 3) interventions only accessed young people who were already linked to care, participants were likely to have better SRH outcomes than those potentially more vulnerable YPLWH; and 4) none of the interventions explored the sexuality of young people.
  
  
  CONCLUSIONS
  There have been a limited number of evaluated interventions to strengthen SRH of YPLWH in SSA, and gaps exist in addressing the SRHR needs of YPLWH. Intervention approaches require greater scope and depth, including the need to address structural and contextual challenges.
authors.affiliation: Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal (UKZN), Durban, South Africa; pretoriusl@ukzn.ac.za.
authors.forename: Leandri
authors.initials: L
authors.lastname: Pretorius
authors.affiliation: Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal (UKZN), Durban, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gibbs
authors.affiliation: Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal (UKZN), Durban, South Africa.
authors.forename: Tamaryn
authors.initials: T
authors.lastname: Crankshaw
authors.affiliation: Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal (UKZN), Durban, South Africa.
authors.forename: Samantha
authors.initials: S
authors.lastname: Willan
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara; D002648:Child; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology; D054624:Health Status Disparities; D006801:Humans; D060728:Reproductive Health; D034121:Reproductive Health Services / Q000458:organization & administration; D046269:Reproductive Rights; D012725:Sexual Behavior / Q000523:psychology*; D057545:Social Stigma; D055815:Young Adult
keywords: HIV; intervention; sexual and reproductive health and rights; sub-Saharan Africa; young people