From surviving to thriving: integrating mental health care into HIV, community, and family services for adolescents living with HIV

Cluver, Lucie D; Sherr, Lorraine; Toska, Elona; Zhou, Siyanai; Mellins, Claude-Ann; Omigbodun, Olayinka; Li, Xiaoming; Bojo, Samuel; Thurman, Tonya; Ameyan, Wole; Desmond, Chris; Willis, Nicola; Laurenzi, Christina; Nombewu, Amahle; Tomlinson, Mark; Myeketsi, Noxolo

doi:10.1016/s2352-4642(22)00101-8

Cited by 58HIV/AIDS Research and InterventionsAdolescent and Pediatric HealthcareMental Health Treatment and Access

From surviving to thriving: integrating mental health care into HIV, community, and family services for adolescents living with HIV

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Cluver, Lucie D, Sherr, Lorraine, Toska, Elona, Zhou, Siyanai, Mellins, Claude-Ann, Omigbodun, Olayinka, Li, Xiaoming, Bojo, Samuel +8 more·2022·The Lancet Child & Adolescent Health

DOI 10.1016/s2352-4642(22)00101-8

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Abstract

Adolescents are a crucial generation, with the potential to bring future social and economic success for themselves and their countries. More than 90% of adolescents living with HIV reside in sub-Saharan Africa, where their mental health is set against a background of poverty, familial stress, service gaps, and an HIV epidemic that is now intertwined with the COVID-19 pandemic. In this Series paper, we review systematic reviews, randomised trials, and cohort studies of adolescents living with and affected by HIV. We provide a detailed overview of mental health provision and collate evidence for future approaches. We find that the mental health burden for adolescents living with HIV is high, contributing to low quality of life and challenges with adherence to antiretroviral therapy. Mental health provision is scarce, infrastructure and skilled providers are missing, and leadership is needed. Evidence of effective interventions is emerging, including specific provisions for mental health (eg, cognitive behavioural therapy, problem-solving, mindfulness, and parenting programmes) and broader provisions to prevent drivers of poor mental health (eg, social protection and violence prevention). We provide evidence of longitudinal associations between unconditional government grants and improved mental health. Combinations of economic and social interventions (known as cash plus care) could increase mental health benefits. Scalable delivery models include task sharing, primary care integration, strengthening families, and a pyramid of provision that differentiates between levels of need, from prevention to the care of severe disorders. A turning point has now been reached, from which complacency cannot persist. We conclude that there is substantial need, available frameworks, and a growing evidence base for action while infrastructure and skill acquisition is built.

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Poor mental health among adolescents with HIV adversely affects HIV treatment outcomes, retention in care, and quality of life, and is often associated with lapsed adherence to antiretroviral therapy.
“Such poor mental health levels among AWH are problematic because they adversely affects HIV treatment outcomes [4], retention in care [12], and quality of life [13] and are often associated with lapsed adherence to antiretroviral therapy (ART) [11,12,14,15].”
From Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial (2024) · cites this paper as [4]

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Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial
Musanje, K., Kasujja, R., Camlin, C. S., Hooper, N., Hope-Bell, J., Sinclair, D. L., Kibanja, G. M., Mpirirwe, R., Kalyango, J. N., & Kamya, M. R. (2024) · PLoS ONE · doi:10.1371/journal.pone.0301988 · Cited by 10 · see citing works

Authors: Cluver, L. D., Sherr, L., Toska, E., Zhou, S., Mellins, C.-A., Omigbodun, O., Li, X., Bojo, S., Thurman, T., Ameyan, W., Desmond, C., Willis, N., Laurenzi, C., Nombewu, A., Tomlinson, M., & Myeketsi, N.
Affiliations: University of Cape Town (ZA)
University College London (GB)
Columbia University Irving Medical Center (US)
University of Ibadan (NG)
University of South Carolina (US)
Tulane University (US)
World Health Organization (CH)
University of KwaZulu-Natal (ZA)
Stellenbosch University (ZA)
Queen's University Belfast (GB)
University of the Western Cape (ZA)
Corresponding author: Cluver, Lucie D
ORCID: Cluver, Lucie D
Sherr, Lorraine
Toska, Elona
Zhou, Siyanai
Mellins, Claude-Ann
Omigbodun, Olayinka
Li, Xiaoming
Thurman, Tonya
Ameyan, Wole
Desmond, Chris
Willis, Nicola
Laurenzi, Christina
Tomlinson, Mark
Venue: The Lancet Child & Adolescent Health
Publisher: Elsevier BV
Published: 2022-08
Volume: 6
Issue: 8
Pages: 582-592
ISSN: 2352-4642 (ISSN-L)
DOI: 10.1016/s2352-4642(22)00101-8
OpenAlex: W4283258437
Cited by: 58
References: 99
Citations by year: 2026: 16 · 2025: 12 · 2024: 14 · 2023: 13 · 2022: 3
FWCI: 1.61
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (am, 165 d)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: The Lancet Child & Adolescent Health (acceptedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Research Portal (Queen's University Belfast) (submittedVersion)
Funders: European Research Council
Nuffield Foundation (CPF/41513)
Oxford University
John Fell Fund, University of Oxford (103/757, 161/033)
Research England
Claude Leon Foundation (08 559/C)
International AIDS Society (155-Hod, 2018/625-TOS)
National Institutes of Health
Department of Health and Social Care
National Health Research Institutes
National Institute of Mental Health
John E Fogarty International Center (K43TW011434)
Medical Research Council (MR/R022372/1|)
Seventh Framework Programme (313421)
Leverhulme Trust (PLP-2014-095)
Department for International Development, UK Government
Oak Foundation (OFIL-20-057, R46194/AA001)
Economic and Social Research Council (K1311-KEA-004, IAA-MT13-003, 1602-KEA-189)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords: adolescents living with HIV, mental health, HIV care integration, antiretroviral therapy adherence, quality of life, cognitive behavioral therapy, mindfulness, parent training, social protection, violence prevention, unconditional cash transfers, task sharing, primary care integration, family strengthening, sub-Saharan Africa, COVID-19 pandemic
MeSH terms: COVID-19, Adolescent, Humans, Mental Health, Quality of Life, HIV Infections, Pandemics

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From surviving to thriving: integrating mental health care into HIV, community, and family services for adolescents living with HIV

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