Interventions to improve access to sexual and reproductive health services for adolescents living with HIV in sub-Saharan Africa: a scoping review.

Abstract

Adolescents living with HIV (ALHIV) face barriers to accessing sexual and reproductive health (SRH) services, negatively affecting their health and quality of life. These challenges are particularly pronounced in sub-Saharan Africa (SSA), where HIV prevalence, unintended pregnancies and child marriage remain high. This review aimed to map interventions designed to improve SRH access for ALHIV in SSA, applying Levesque's framework to identify facilitators and barriers from supply-side and demand-side perspectives. Review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, EMBASE and Web of Science were searched, alongside institutional grey literature, for English and French language studies published between 2010 and 2024. Studies were included if they focused on ALHIV aged 10-19 years in SSA, regardless of HIV acquisition mode and used experimental, quasi-experimental, qualitative or observational designs. Two independent reviewers screened studies in Covidence, extracted data on study design, population, intervention components and delivery settings and mapped barriers and facilitators using Levesque's framework. Findings were synthesised narratively. of 6835 records screened, 14 studies met inclusion criteria. Interventions ranged from comprehensive strategies addressing financial, infrastructural and psychological barriers to targeted approaches like education and stigma reduction, implemented across schools, clinics, communities and digital platforms. Most studies emphasised service acceptability, with 13 of 14 highlighting cultural relevance, while approachability, physical accessibility and affordability received less attention. Key barriers included fear of HIV disclosure and stigma, whereas facilitators, including peer support, community outreach and digital platforms, enhanced engagement, trust and comfort with SRH services. Improving access to SRH services for ALHIV in SSA requires adolescent-friendly, integrated, context-specific interventions that combine stigma reduction, peer and community engagement, digital innovations and financial support to overcome barriers and improve SRH outcomes. Open Science Framework (https://doi.org/10.17605/OSF.IO/7PBEW).