Despite clear need and disproportionate risk, adolescents, and young people living with HIV (AYPLHIV) are underserved within the HIV response. “Peer support” increasingly forms part of adolescent and youth-responsive service packages as a class of implementation strategies that can support adolescents to access, engage, and sustain treatment. This paper examines examples of peer support for AYPLHIV within sub-saharan Africa to explore the determinants of successful implementation, outcomes and scale-up, as well as policy and programmatic implications.
Although adolescent peer support has been observed to be widely implemented, there are few examples of detailed program descriptions describing operational logistics or outcomes around peer support interventions. Nevertheless the few examples available provide preliminary support for the potential utility of peer support to improve AYPLHIV outcomes.
Implementation science research is an urgent imperative to examine applicability of peer support for this priority population. In the meantime, programs should move forward with implementation based on promising outcomes, programmatic experience, contextual understanding of challenges and gaps, and best practice examples.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
UNAIDS. 2017 estimates. UNAIDS. 2017. http://aidsinfo.unaids.org. Accessed 7 June 2019.
MacPherson P, Munthali C, Ferguson J, Armstrong A, Kranzer K, Ferrand R, et al. Service delivery interventions to improve adolescents’ linkage, retention and adherence to antiretroviral therapy and HIV care. Trop Med Int Health. 2015;20(8):1015–32. https://doi.org/10.1111/tmi.12517.
World Health Organization. Making health services adolescent friendly: developing national quality standards for adolescent-friendly health services. World Health Organization. 2012. https://apps.who.int/iris/bitstream/handle/10665/75217/9789241503594_eng.pdf?sequence=1. Accessed 12 July, 2019.
East PL, Hess LE, Lerner RM. Peer social support and adjustment of early adolescent peer groups. J Early Adolescence. 1987:7(2). https://doi.org/10.1177/0272431687072003.
Woollett N, Cluver L, Bandeira M, Brahmbhatt H. Identifying risks for mental health problems in HIV positive adolescents accessing HIV treatment in Johannesburg. J Child Adolesc Ment Health. 2017:29(1). https://doi.org/10.2989/17280583.2017.1283320.
Casale M, Boyes M, Pantelic M, Toska E, Cluver L. Suicidal thoughts and behaviour among South African adolescents living with HIV: can social support buffer the impact of stigma? J Affect Disord. 2019;245. https://doi.org/10.1016/j.jad.2018.10.102.
PEPFAR Solutions Database. Operation Triple Zero: empowering adolescents and young people living with HIV to take control of their health in Kenya. 2018. https://www.pepfarsolutions.org/solutions/2018/10/30/operation-triple-zero-empowering-adolescents-and-young-people-living-with-hiv-to-take-control-of-their-own-health. Accessed June 14, 2019.
Mark D, Armstrong A, Andrade C, Penazzato M, Hatane L, et al. HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub-Saharan African countries. J Int AIDS Soc. 2017;20(S3):21591. https://doi.org/10.7448/IAS.20.4.21591.
Medley A, Kennedy C, O’Reilly K, Sweat M. Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. AIDS Educ Prev. 2009;21(3):181–206. https://doi.org/10.1521/aeap.2009.21.3.181.
Kim CR, Free C. Recent evaluations of the peer-led approach in adolescent sexual health education: a systematic review. Perspect Sex Reprod Health. 2008;40(3):144–51. https://doi.org/10.1363/4014408.
Fox M, Rosen S. Systematic review of interventions to facilitate linkage to care to support development of the WHO 2015 Consolidated guidelines for the use of antiretroviral drugs for treating and preventing HIV infection. Boston University, 2015. Web Supplement B. .
Snyder K, Wallace B, Duby Z, Aquino L, Stafford D, et al. Preliminary results from Hlanganani (coming together): a structured support group for HIV-infected adolescents piloted in Cape Town, South Africa. Child Youth Serv Rev. 2014;45:114–21.
Willis N, Milanzi A, Mawodzeke M, Dziwa C, Armstron A, et al. Effectiveness of community adolescent treatment supporters (CATS) interventions in improving linkage and retention to care, adherence to ART and psychosocial well-being: a randomized trial among adolescents living with HIV in Zimbabwe. BMC Public Health. 2019;19:117. https://doi.org/10.1186/s12889-019-6447-4.
Mavhu W, Willis N, Mufuka J, Mangenah C, Mvududu K, et al. Evaluating a multi-component, community-based program to improve adherence and retention in care among adolescents living with HIV in Zimbabwe: study protocol for a cluster randomized controlled trial. Trials. 2017;18(1):478.
MacKenzie R, van Lettow M, Gondwe C, Nyirongo J, Singano V, et al. Greater retention in care among adolescents on antiretroviral treatment accessing “Teen Club” an adolescent-centred differentiated care model compared with standard of care: a nested case-control study at a tertiary referral hospital in Malawi. J Int AIDS Soc. 2017;20(3):e25028. https://doi.org/10.1002/jia2.25028.
Barker D, Enimil A, Galarraga O, Bosomtwe D, Mensah N, et al. In-clinic adolescent peer group support for engagement in sub-Saharan Africa: a feasibility and acceptability trial. J Int Assoc Provid AIDS Care. 2019;18:1–8. https://doi.org/10.1177/2325958219835786.
van de Ven R, Antelman G, Mukaminega M, Edward C, Van’t Pad, Bosch J. Do peer-led adolescent support groups improve retention? Lessons learnt from Tanzania. Abstract WEPEE732, presented at the International AIDS Conference. 2018. Amsterdam, Netherlands.
Nsanzugwanko N, Mlowezi A, Hassan M, Godfrey F, Kweka A, et al. Using adolescent peer educators to increase retention at Mnazi Mmoja hospital, Zanzibar. Abstract presentation, 2nd International Workshop on HIV & Adolescence. 2018. Cape Town, South Africa.
Musiime F, Lutaaya A, Amuge P, Ssebunya R, Bitimwine H, Kekitiinwa A. Improving retention in HIV care of adolescents through a peer to peer approach in western Uganda. Abstract presentation, 2nd International Workshop on HIV & Adolescence 2018, Cape Town, South Africa.
Ammon N, Mason S, Corkery JM. Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: a systematic review. Public Health. 2018;157:20–31. https://doi.org/10.1016/j.puhe.2017.12.010.
Mark D, Bloch K, Cluver L, Toska E, Ronan A, et al. The power of peers: multi-country analysis of adolescent viral suppression in sub-Saharan Africa. Abstract WEPEE721, presented at the International AIDS Conference. 2018. Amsterdam, Netherlands.
Nabukeera-Barungi N, Elyanu P, Asire B, Katureebe C, Lukabwe I, et al. Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda. BMC Infect Dis. 2015;15:520. https://doi.org/10.1186/s12879-015-1265-5.
Wogrin C, Mutsinze A, Willis N. Adolescent peer support in addressing mental health and high viral load. Abstract presentation, 2nd International Workshop on HIV & Adolescence. 2018. Cape Town, South Africa.
Zanoni BC, Sibaya T, Cairns C, Haberer JE. Barriers to retention in care are overcome by adolescent-friendly services for adolescents living with HIV in South Africa: a qualitative analysis. AIDS Behav. 2019;23(4):957–65. https://doi.org/10.1007/s10461-018-2352-6.
Mupambireyi Z, Bernays S, Bwakura-Dangarembizi M, Cowan FM. “I don’t feel shy because I will be among others who are just like me…”: the role of support groups for children perinatally infected with HIV in Zimbabwe. Child Youth Serv Rev. 2014;45:106–13. https://doi.org/10.1016/j.childyouth.2014.03.026.
Ndlovu L, Ronan, A, Ngoato, T, Mark D, Hatane L. Differentiated service delivery for adolescents and young people living with HIV: a situational analysis in South Africa. Abstract presented at the 9th SA AIDS Conference. 2019. Durban, South Africa.
Henwood R, Patten G, Barnett W, Hwang B, Metcalf C, et al. Acceptability and use of a virtual support group for HIV-positive youth in Khayelitsha, Cape Town using the Mxit social networking platform. AIDS Care. 2016;28(7):898–903. https://doi.org/10.1080/09540121.2016.1173638.
Teasdale C, Alwar T, Chege D, Fayorsey R, Hawken M, Abrams E. Impact of youth and adolescent friendly services on retention of 10–24-year-olds in HIV care and treatment programs in Nyanza. Kenya. JAIDS. 2016;71(2):e56–9.
Ridgeway K, Dulli LS, Murray KR, Silverstein H, Dal Santo L, Olsen P, et al. Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: a systematic review of the literature. PloS One. 2018;13:e0189770. https://doi.org/10.1371/journal.pone.0189770.
Morolake O, Stephens D, Welbourn A. Greater involvement of people living with HIV in health care. J Int AIDS Soc. 2009;12(4). https://doi.org/10.1186/1758-2652-12-4.
Born LJ, Wamulume C, Neroda KA, Quiterio N, Giganti MJ, Morris MJ, et al. Evaluation of a task-shifting strategy involving peer educators in HIV care and treatment clinics in Lusaka, Zambia. J Public Health Afr. 2012:e3–3. https://doi.org/10.4081/jphia.2012.e3.
Proctor EK, Powell BJ, Mc Millen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8(139). https://doi.org/10.1186/1748-5908-8-139.
Mark D, Ngombe A, Burford G, Renaud N, Djoumessi V, Tunnacliffe E, et al. Project REACH: a facility-based peer support model across 20 facilities in five sub-Saharan African countries. Abstract presented at the 21st International AIDS Conference. 2016. Durban, South Africa.
Mark D, Lovich R, Walker D, Burdock T, Ronan A, Ameyan W, et al. Lessons from service delivery: the nuts and bolts of providing adolescent peer support in low-resource settings. Abstract presented at the 2nd International HIV Adolescence Workshop. 2018. Cape Town, South Africa.
Ronan A, Mark D, Soeters H, Makota G, Ndlovu L, Phillips L, et al. Peer supporters a crucial prong in the HIV response: perspectives of health providers. Abstract presented at the 10th IAS Conference on HIV Science. 2019. Mexico City, Mexico.
Gittings L, Mark D, Taing L, Soeters H, Hatane L. “If you trust us, help us to do it by ourselves”: Promising practices in peer support for adolescents and young people living with HIV. Abstract presented at the 8th SA AIDS Conference. 2017. Durban, South Africa.
Soeters H, Mark D, Ronan A, Papier L, Burdock T, Davids M, et al. Advocates in action: peer supporters driving change on the frontlines of service delivery. Abstract presented at the 11th International Workshop on HIV Pediatrics. 2019. Mexico City, Mexico.
Hindin MJ, Kalamar AM, Thompson TA, Upadhyay UD. Interventions to prevent unintended and repeat pregnancy among young people in low-and middle-income countries: a systematic review of the published and gray literature. J Adolescent Health. 2016;59(3):8–15. https://doi.org/10.1016/j.jadohealth.2016.04.021.
PATA. Review of legislation and national HIV policies impacting adolescents and young people living in East and Southern Africa. PATA. 2019.http://teampata.org/wp-content/uploads/2019/06/Policy-Brief_2019.pdf. Accessed 13 July, 2019.
UN General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development. Report No. A/RES/70/1, United Nations, 2015.
World Health Organization. Universal Health Coverage Fact sheet. 2018. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc). Accessed 24 July 2019.
Child EWE. Global strategy for women’s, children’s and adolescents’ health. 2015. Every Woman Every Child.
World Health Organization. Global Accelerated Action for the Health of Adolescents (AAHA!): guidance to Support Country Implementation. 2017. https://apps.who.int/iris/bitstream/handle/10665/255415/9789241512343-eng.pdf?sequence=1. Accessed 24 July 2019.
World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. World Health Organization. 2016. https://www.who.int/hiv/pub/arv/arv-2016/en/. Accessed 24 July, 2019.
Green LW, Ottoson JM, Garcia C, Hiatt RA. Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annual Review of Public Health. 2009;30:151–74. https://doi.org/10.1146/annurev.publhealth.031308.100049.
World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. 2018. https://apps.who.int/iris/bitstream/handle/10665/275474/9789241550369-eng.pdf?ua=1. Accessed 24 July 2019.
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76. https://doi.org/10.1007/s10488-010-0319-7.
This publication has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Centers for Disease Control and Prevention (CDC).
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights
This article does not contain any studies with human or animal subjects performed by any of the authors.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Implementation Science
About this article
Cite this article
Mark, D., Hrapcak, S., Ameyan, W. et al. Peer Support for Adolescents and Young People Living with HIV in sub-Saharan Africa: Emerging Insights and a Methodological Agenda. Curr HIV/AIDS Rep 16, 467–474 (2019). https://doi.org/10.1007/s11904-019-00470-5
- Implementation science