Abstract
Although HIV services are expanding, few have reached the scale necessary to support universal viral suppression of individuals living with HIV. The purpose of this systematic review was to summarize the qualitative evidence evaluating public health HIV interventions to enhance linkage to care, antiretroviral drug (ARV) adherence, and retention in care. We searched 19 databases without language restrictions. The review collated data from three separate qualitative evidence reviews addressing each of the three outcomes along the care continuum. 21,738 citations were identified and 24 studies were included in the evidence review. Among low and middle-income countries in Africa, men living with HIV had decreased engagement in interventions compared to women and this lack of engagement among men also influenced the willingness of their partners to engage in services. Four structural issues (poverty, unstable housing, food insecurity, lack of transportation) mediated the feasibility and acceptability of public health HIV interventions. Individuals living with HIV identified unmet mental health needs that interfered with their ability to access HIV services. Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care, shaping the context of service delivery among important subpopulations.
•Among low and middle-income countries in Africa, men living with HIV had decreased engagement in HIV interventions compared to women.•Several structural issues mediated the feasibility and acceptability of HIV interventions.•Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care.
Qualitative research such as in-depth interviews can be useful to better understand social factors that influence the success or failure of public health interventions. This study combined data from three separate systematic reviews of qualitative evidence. The purpose was to better understand the social context of interventions focused on improving HIV services. Men living with HIV were less likely to receive HIV services like routine HIV testing compared to women. A wide range of non-health issues, such as access to poverty and unstable housing, influenced the feasibility of HIV interventions.