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Peer support interventions for people living with HIV and AIDS (PLWHA) are effective, but their associated time and material costs for the recipient and the health system make them reachable for only a small proportion of PLWHA. Internet-based interventions are an effective alternative for delivering psychosocial interventions for PLWHA as they are more accessible. Currently, no reviews are focusing on internet-based interventions with peer support components. This scoping review aims to map the existing literature on psychosocial interventions for PLWHA based on peer support and delivered through the internet. We conducted a systematic scoping review of academic literature following methodological guidelines for scoping reviews, and 28 articles met our criteria. We summarized the main characteristics of the digital peer support interventions for PLWHA and how they implemented peer support in a virtual environment. Overall the reported outcomes appeared promising, but more robust evidence is needed.
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Internet-based peer support interventions for
people living with HIV: A scoping review
Stefanella Costa-CordellaID
, Aitana Grasso-Cladera
, Alejandra Rossi
Javiera DuarteID
, Flavia Guiñazu
, Claudia P. CortesID
1Centro de Estudios en Psicologı
´a Clı
´nica y Psicoterapia (CEPPS), Facultad de Psicologı
´a, Universidad
Diego Portales, Santiago, Chile, 2Instituto Milenio Depresio
´n y Personalidad (MIDAP), Santiago, Chile,
3Centro de Estudios en Neurociencia Humana y Neuropsicologı
´a (CENHN), Facultad de Psicologı
Universidad Diego Portales, Santiago, Chile, 4Web Intelligence Centre, Facultad de Ingenierı
´a Industrial,
Universidad de Chile, Santiago, Chile, 5Hospital Clı
´nico San Borja Arriara
´n & Fundacio
´n Arriara
´n, Santiago,
Chile, 6Departamento de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
Peer support interventions for people living with HIV and AIDS (PLWHA) are effective, but
their associated time and material costs for the recipient and the health system make them
reachable for only a small proportion of PLWHA. Internet-based interventions are an effec-
tive alternative for delivering psychosocial interventions for PLWHA as they are more acces-
sible. Currently, no reviews are focusing on internet-based interventions with peer support
components. This scoping review aims to map the existing literature on psychosocial inter-
ventions for PLWHA based on peer support and delivered through the internet. We con-
ducted a systematic scoping review of academic literature following methodological
guidelines for scoping reviews, and 28 articles met our criteria. We summarized the main
characteristics of the digital peer support interventions for PLWHA and how they imple-
mented peer support in a virtual environment. Overall the reported outcomes appeared
promising, but more robust evidence is needed.
Human Immunodeficiency Virus (HIV) affects more than 37.7 million people worldwide and
its prevalence is still increasing [1]. The primary HIV treatment is Antiretroviral Therapy
(ART) which works to suppress replication of the virus resulting in improved immune
response and reduced viral load. However, inadequate adherence to ART is associated with
morbidity and mortality [24].
Because of the essential role of adherence in the success of ART, a myriad of research has
been carried out to understand ART adherence. Among factors that predict HIV treatment
adherence, an important role has been found in psychosocial factors such as social support [5
7], HIV stigma [6,8,9], stress and depression [7,1014], violence [15,16] and alcohol and
other drug consumption [1719], which increase the probability of a disadvantageous outcome
by adding substance abuse stigma [20]. Consequently, different psychosocial interventions
have been developed to address treatment adherence, and they have increasingly been
PLOS ONE | August 30, 2022 1 / 17
Citation: Costa-Cordella S, Grasso-Cladera A,
Rossi A, Duarte J, Guiñazu F, Cortes CP (2022)
Internet-based peer support interventions for
people living with HIV: A scoping review. PLoS
ONE 17(8): e0269332.
Editor: Bronwyn Myers, South African Medical
Research Council, SOUTH AFRICA
Received: September 21, 2021
Accepted: May 18, 2022
Published: August 30, 2022
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication of
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
Copyright: ©2022 Costa-Cordella et al. This is an
open access article distributed under the terms of
the Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All files are available
from the OSF database (
Funding: This study was funded by the Chilean
National Agency of Research and Development
demonstrated to enhance HIV adherence and improve health in people living with HIV/AIDS
(PLWHA) [10,11,19,2126]. Peer support is the support provided by people who share life
experiences [27]. Applied to interventions, peer support typically includes group meetings,
support networks (either virtual or in-person), or peer-mentoring [28]. Peer support has been
a common and effective strategy for people living with stigmatized conditions [2932]. Peer
support is also efficient in lowering the overall costs of medical provision [3133].
Specifically, in PLWHA, peer support interventions have shown to address internalized
stigma [3438] adequately, reduce depressive symptomatology [34] and stress [3539],
enhance the quality of life and wellness [40], and improve treatment adherence [4148].
Peer support interventions are recommended in official health guidelines such as the Cen-
ter for Disease and Prevention [49] and the British HIV Association [50].
However, these services are rarely offered in HIV clinics due to existing structural barriers,
such as a lack of mental health services and difficulties in accessing services [51,52]. Against
this scenario, internet-based interventions have proliferated. These are easy to access by many
people due to resource-saving and flexible delivery [53]. Additionally, internet-based interven-
tions offer anonymity, are easily accessible, and are also scalable [51,5456]. Therefore, they
have been suggested as an alternative to overcome the barriers mentioned above [57,58].
Recent reviews of internet-based interventions have significantly impacted outcomes,
including adherence, viral load, mental health, and social support for PLWHA [59,60].
However, none of the reviews has focused on peer support interventions delivered virtually.
We conducted a scoping review to map the existing literature on psychosocial interventions
for PLWHA based on peer support and delivered through the internet. We chose the scoping
review methodology developed by Peters and colleagues [61] since it allows comprehensive
identification of the types and nature of psychosocial interventions for PLWHA, based on peer
support and delivered through the internet described in the published literature [61]. Specifi-
cally, this review aims to answer the following questions: 1) What internet-based peer support
interventions are available for PLWHA? What are their main characteristics? 2) How do the
available interventions integrate peer support?
To our knowledge, this is the first systematic effort to provide such an overview.
Protocol and registration
We conducted a systematic scoping review of the peer-reviewed academic literature following
the Joanna Briggs Institute (JBI) methodological guidance for scoping review [62] and the Pre-
ferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for
scoping reviews [63] Our pre-registered protocol containing the detailed methods is available
at Open Science Framework ( (S1 Appendix).
Eligibility criteria
We included studies about psychosocial interventions designed explicitly for PLWHA and
AIDS, based on peer support and delivered through technological devices and/or the internet.
For this scoping review, any comparator was relevant for inclusion, and studies without a com-
parator were also assessed for eligibility. All available publications were eligible for inclusion
(e.g., articles -any design, excluding systematic and scoping reviews-articles in conference pro-
ceedings, websites, chapters in textbooks). This scoping review had no limitations regarding
the time of publication and duration of the intervention and no language restriction. S1 and S2
Appendices show the eligibility criteria and the search strategy.
Internet-based peer support interventions for PLWHA
PLOS ONE | August 30, 2022 2 / 17
(Agencia Nacional de Investigacio
´n y Desarrollo de
Chile) through FONDEF to CC (ID20I10174), and
the Chilean National Agency of Research and
Development (Agencia Nacional de Investigacio
´n y
Desarrollo de Chile) through FONDECYT to AR (N˚
1190610). The funders had no role in study design,
data collection and analysis, decision to publish, or
preparation of the manuscript.
Competing interests: The authors have declared
that no competing interests exist.
Information sources
A comprehensive literature research of electronic bibliographic databases was conducted in
PUBMED, Web of Science (WOS), and CINAHL Complete (through EBSCO). This selection
was made according to our institutional availability/accessibility; for this reason, some data-
bases were excluded (e.g., EMBASE, Cochrane). All databases and sources of information were
consulted on March 10, 2022. The reference lists of 13 relevant reviews on the topic were
screened [19,25,26,6473].
We developed the search strategy using the PRESS (Peer Review of Electronic Search Strate-
gies) checklist [74], which was adapted to three databases. This step was conducted by the
investigators (S.C.C. & A.G.C.) without the collaboration of a librarian due to institutional lim-
itations. The words used were related to telemedicine or internet-delivered interventions (i.e.,
ehealth, digital health, mobile health), HIV or AIDS, and peer support or support group (for
the complete search string, see S3 Appendix) were searched in the articles’ title. No other limi-
tation was applied to the search.
Sources of evidence selection
The database and manual searches were exported into Microsoft Excel [75]. Duplicate papers
were removed. Two reviewers (S.C.C. & A.G.C.) independently screened each article for inclu-
sion by title, excluding articles that failed the eligibility criteria. Then, the same two reviewers
independently screened the article by abstract using a Google form questionnaire containing
details to inform decision-making about inclusion/exclusion. Disagreements between review-
ers were resolved through an iterative consensus process involving multiple rounds of deliber-
ative discussion.
Data charting process
The authors developed a Google form questionnaire with detailed instructions (S.C.C. & A.G.
C.) and were approved by the research team to achieve the charting process. This form was
guided by the objectives of the present review, being the items related to articles’ characteriza-
tion and their conceptualization of peer support. To ensure internal consistency, some articles
were codified in duplicate by two authors (S.C.C. & A.G.C.) and the rest was done indepen-
dently by the same researchers.
Data items
First, articles’ data were sought regarding study characterization: 1) year of publication; 2)
location of the study; 3) study design/article type; 4) population; 5) name of the intervention;
and 6) type of technology used. Then, the articles were revised to identify their conceptualiza-
tion of the peer support component of the intervention (i.e., peer support application).
Synthesis of results
Data was summarized in a narrative account following the guidelines for scoping reviews [76].
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Selection of sources of evidence
The initial search yielded 517 articles, and 15 more were found by manual search from reviews’
citations. After the removal of duplicate titles, 416 articles were left. Then, two authors (S.C.C.
& A.G.C.) screened titles and abstracts, and 28 articles were included in the review and went
through the codification process (Fig 1).
Characteristics of sources of evidence
As shown in Table 1, of the total of included articles, 13 were published during 2017–2019
[7789], eight during 2020–2022 [9097], four during the 2014–2016 period [98101], two
were published during 2008–2010 [102,103], and one during 2011–2013 [104].
The majority of articled revised were studies conducted in the United States (12) [77,
8082,84,88,90,94,95,99,100,104], three were from Kenya [86,92,102] and three from
South Africa [85,93,101]. Locations like China, the United Kingdom and Zambia had
two studies included in this review [79,87,91,96,98,103] and, from the total of articles
included, only one article was from Malaysia, Nigeria, Tanzania and Uganda [78,83,89,
Regarding the study type, eight of the included articles corresponded to pilot studies [77,
79,86,88,92,101,102,104], while seven articles explicitly indicate a clinical trial type of design
[83,85,86,90,95,96,98], as well as five protocols [8082,93,94] and five qualitative studies
[87,91,99,100,103]. Only two Randomized Controlled Trials [78,97], and one cohort study
Fig 1. PRISMA flowchart.
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Synthesis of results
Peer support interventions. Table 2 summarizes the total of interventions included and
reviewed in this work. Only 20 of the total of 28 mentioned a specific name for the
Interventions’ main characteristics. The total of interventions included were codified
according to their characteristics such as target population, eHealth type and the objective of
each intervention. Table 3 summarizes the information of these categories.
Target population. All the interventions were exclusively conducted for PLWHA. Of the
total of interventions reviewed, 10 of them were orientated to an adult population (18 years or
older) [77,78,88,94,95,98,99,102104], nine were tailored for children, adolescents, and
young adults [7981,8486,90,97,101], three interventions were exclusively designed for
adolescents [83,93,96], and only one was made exclusive for young adults [100]. Finally, four
interventions were orientated to other populations (e.g., mothers, female sex workers, men
who have sex with other men [MSM]) [82,87,89,91].
Type of digital health. The interventions used a myriad of digital tools to be delivered. The
use of social networking platforms such as Facebook and WhatsApp was one of the most fre-
quent strategies (n = 7) of the reviewed studies [79,83,85,92,93,100,101], as well as the use
Table 1. Characterization of included articles.
Articles’ Characteristics
Year of Publication n (%)
2008–2010 2 (7.14)
2011–2013 1 (3.57)
2014–2016 4 (14.28)
2017–2019 13 (46.42)
2020–2022 8 (28.57)
China 2 (7.14)
Kenya 3 (10.71)
Malaysia 1 (3.57)
Nigeria 1 (3.57)
South Africa 3 (10.71)
Tanzania 1 (3.57)
Uganda 1 (3.57)
UK 2 (7.14)
USA 12 (42.85)
Zambia 2 (7.14)
Type of Study
8 (28.57)
Other Clinical Trials
7 (25)
5 (17.85)
Qualitative 5 (17.85)
Randomized Clinical Trial 2 (7.14)
Randomized Clinical Trial 1 (3.57)
Pilot,feasibility and acceptability trials.
All types of clinical trial designs (e.g. pre-post, with no control group).
Protocols for Randomized Controlled Trials and other designs.
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of websites (n = 7) [8082,86,98,102,103]. The development of a smartphone App was also
present in 4 interventions [77,88,96,99], along with the use of SMS and phone calls to estab-
lish communication between peers [78,81,85,93]. Only three studies developed a web-based
platform [84,94,95], two used SMS communication exclusively [87,97], and two interven-
tions were delivered via videoconference [90,98]. Only one intervention showed the partici-
pants´ videos made by peers [104].
Interventions’ goals. The most common objectives were treatment adherence (n = 14) [78,
80,8286,88,89,92,95,99,102,104], and social support (n = 7) [77,83,91,94,96,101,103].
Five of the interventions were dedicated to retention in care [87,88,93,95,101], and four to
viral load suppression [78,80,90,95]. Two interventions were oriented to stigma reduction
[92,104] and the other two to increase HIV knowledge [83,98]. Finally, the aims of well-being
[100], mental health [92], and legal support [94] were included only once each.
Peer support implementation. The role of peer support was incorporated differently in
the revised interventions. Some interventions combined more than one strategy to implement
Table 2. Interventions’ name.
Interventions’ Name
Winstead-Derlega et al.,
Positive Project
Broaddus et al., 2015 My YAP Family
Henwood et al., 2016 Khaya HIV Positive
Flickinger et al., 2017 Positive Links
Westergaard et al., 2017 mPeer2Peer
Dulli et al., 2018 SMART Connections
Horvath et al., 2018 Thrive With Me
Hacking et al., 2019 The Virtual Mentors Program
Horvath et al., 2019 YouTHrive
Ivanova et al., 2019 ELIMIKA
Knudson et al., 2019 China MP3 (Multi-component HIV Intervention Packages for Chinese MSM)
Navarra et al., 2019 ACCESS (Adherence Connection for Counseling, Education, and Support)
Tun et al., 2019 CBHTC+ (Intervention within Sauti project)
Hay et al., 2020 4MNetwork
MacCarthy et al., 2020 SITA (SMS as an Incentive To Adhere)
Ochoa et al., 2021 LINX App / LINX App Plus
Simpson et al., 2021 Insaka
Steinbock et al., 2022 End+dDisparities ECHO Collaborative
Stockman et al., 2021 LinkPositively
Zanoni et al., 2022 InTSHA (Interactive Transition Support for Adolescents Living With HIV using
Social Media)
Mo & Coulson,2008 Unnamed
Wools-Kaloustian et al.,
Mi et al., 2015
Abdulrahman et al., 2017
Senn et al., 2017
Rotheram et al., 2019
St Clair-Sullivan et la.,
Chory et al., 2022
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Table 3. Main characteristics of the included interventions.
Interventions’ Main Characteristics
Reference Target Population Digital Health Tool Interventions’ Objective
et al., 2012
Rural adults (18 or older) iPod preprogrammed with peer
health videos
Improve treatment adherence and reduce the
perception of stigma
Broaddus et al.,
Young adults (16–25 years) Private Facebook group Improve patient well-being
Henwood et al.,
Adolescents and young adults (12–25 years) Chat-room through MXit social
networking platform
Retain youth throughout the continuum of care
and provide ongoing social support within a peer
learning environment
Flickinger et al.,
Adults (18 or older), attending a university clinic Smartphone App Improve treatment adherence
Westergaard et al.,
Adults (18 or older), history of substance abuse Smartphone App Support HIV treatment for patients who had been
marginally engaged in care
Dulli et al., 2018 Adolescents (15–19 years), on ART treatment Private Facebook group Improve HIV knowledge, social support, and
treatment adherence
Horvath et al.,
Men (MSM
), suboptimal adherence to treatment Website and SMS Assess the impact of the intervention on the target
Hacking et al., 2019 Adolescents and young adults (12–25 years), newly
diagnosed HIV positive, not in treatment
Smartphone communication
(SMS, phone call or WhatsApp)
Improve treatment adherence by referring patients
to an adherence club
Horvath et al.,
Adolescents and young adults (15–24 años) Website Enhance treatment adherence and improve other
outcomes (e.g. decreased viral load)
Ivanova et al., 2019 Adolescents and young adultos (15–24 years), all level of
Website Improve treatment adherence
Knudson et al.,
Men (MSM) newly diagnosed HIV positive SMS Facilitate engagement in care and initiation of
antiretroviral therapy
Navarra et al.,
Adolescents and young adults (16–29 years), belonging to
ethnic minority (African Americans and Hispanics/
Mobile platform Improve treatment adherence
Tun et al., 2019 Female sex workers (FSW) WhatsApp Improve treatment adherence
Hay et al., 2020 Mothers WhatsApp Improve social support (informational, emotional,
and practical support)
MacCarthy et al.,
Adolescents and young adults (15–24 years), taking ART SMS Improve treatment adherence
Ochoa et al., 2021 Adults (18 or older), male Black or African American,
belonging to a sexual minority
Web based mobile App Provide social and legal resources and peer
Simpson et al.,
Adolescent pregnant women (28–34 weeks of pregnancy) Smartphone (message platform) Assess the feasibility and acceptability of this
mobile phone-based support group intervention
Steinbock et al.,
Adolescents and young adults (13–24 years), men (MSM)
with men of color, Black/African American and Latina
women, and transgender people
Videoconferences Improve rates of viral suppression
Stockman et al.,
Adults (18 or older) Woman with African American,
Black, or of African descent and experience of
interpersonal violence
Web based App Improve retention in care, treatment adherence,
and viral suppression
Zanoni et al., 2022 Adolescents (15–19 years), with perinatally acquired HIV Smartphone (websites, phone
call, WhatsApp)
Evaluate the retention in care during the transition
from pediatric to adult care
Mo & Coulson,
Adults Website Improve social support
et al., 2009
Adults, stable in cART treatment Website Improve treatment adherence
Mi et al., 2015 Adults (18 or older), men (MSM) Website, online sessions
(discussion and counseling)
Promote safe sex behaviors and access to HIV
et al., 2017
Adults SMS, phone call Enhance treatment adherence and improve other
outcomes (e.g. decreased viral load)
Senn et al., 2017 Adults (18 or older), black men (MSM) Smartphone App Improve retention in care and treatment
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peer support. The communication via posts in a group board or online forums was one of the
most common interventions (n = 7) [7982,94,99,103], followed by the use of peer counsel-
ors (n = 5) [78,81,84,87,98] and the use of SMS or WhatsApp to establish contact between
peers (n = 5) [81,88,9193]. Implementing trained peers to provide psychosocial and logisti-
cal support was also a strategy for four of the revised interventions [77,85,86,102], and the
use of online support groups was also frequently presented in the interventions [83,90,100,
101]. Two of the reviewed studies used online focus groups [96,97], one implemented peer
education [89], and only one used videos made by peers [104]. At last, one intervention gener-
ated a strategy of matched peers who had similar trauma experiences [95]. As an important
component, three of the reviewed interventions incorporated peer support anonymously [79,
96,99]. Table 4 summarizes the type of peer support implemented by each intervention.
This review aimed to systematically scope the empirical literature on peer-support psychoso-
cial interventions for PLWHA. More specifically, we aimed to 1) identify the existent digital
peer support interventions currently available for PLWHA; 2) summarize the main character-
istics of the available interventions 3) examine how the interventions implemented peer sup-
port in a virtual environment.
Twenty-eight studies were identified in a systematic search across peer-reviewed journals.
Papers were primarily pilot studies and protocols published in North America or Africa
within the last 5 years. This recent increase in papers reflects the growing interest in develop-
ing peer-support eHealth interventions for PLWHA. Even though only three studies were
RCT, the relatively large number of RCT protocols suggests that this field will continue grow-
ing in the coming years. Participants were mainly HIV+ adults predominantly from minority
ethnic, racial and/or sexual backgrounds. None of the studies was conducted in Latin America,
which is problematic considering the high prevalence of HIV (approximately 1.8 million peo-
ple in 2017) [105,106], the difficulties presented in achieving the 90-90-90 targets designated
by UNAIDS [107], and the tendency for late treatment initiation [105].
Social networks and messaging apps (such as Facebook or WhatsApp) were the most fre-
quently used digital health tools, which is consistent with research suggesting the increasing
validity of psychosocial interventions using social networks for different populations [108
110]. Considering the ongoing massification of both smartphones [111113] and access to the
internet worldwide [114,115], this is a positive finding and suggests that there are indeed
eHealth interventions that could be more widely accessed.
Table 3. (Continued)
Interventions’ Main Characteristics
Reference Target Population Digital Health Tool Interventions’ Objective
Rotheram et al.,
Adolescents and young adults, all level of treatment Website, SMS, and phone call Promote retention in care during treatment
continuum in youth
St Clair-Sullivan et
la., 2019
Adolescents and young adults (16–24 years), currently
receiving HIV care
Smartphone communication
(WhatsApp and Facebook)
Identify barriers to HIV care and the acceptability
and of mHealth to improve treatment adherence
Chory et al., 2022 Children and adolescents (10–19 years), on ART
WhatsApp Enhance treatment adherence, reduce stigma and
improve mental health
Men who have Sex with other Men.
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The most common peer activity was the participation in social networking posting, peer
counseling, and peer discussions and conversations through WhatsApp or other social mes-
saging services, which are considered to be an asynchronous form of technology [116].
Interestingly, very few interventions [78,9698] incorporating face-to-face synchronic
interaction were identified. Even though numerous studies have shown that synchronous tech-
nologies (such as real-time video conferencing) are a valid method to deliver group psychoso-
cial interventions [116,117], real-time activities present constraints (i.e., scheduling) that can
be overcome with asynchronous technologies[116].
Also, digital support emerges as a promising approach to complement healthcare [118,
119]. For instance, through digital peer support, patients may have more efficient access to
both health care services and HIV-related information (e.g., whether and how often the person
should seek medical assistance based on symptoms).
Table 4. Description of how the peer support was implemented.
Peer Support Implementation
Reference Peer Support Type
Winstead-Derlega et al.,
Peer messages delivered through videos
Broaddus et al., 2015 Online support groups
Henwood et al., 2016 Online and face to face support groups
Flickinger et al., 2017 Interaction through a community message board (CMB) with anonymous usernames
Westergaard et al., 2017 Peer trained to deliver intensive psychosocial and logistical support
Dulli et al., 2018 Support groups moderated by trained peers
Horvath et al., 2018 Online forum, social network posts
Hacking et al., 2019 Peer as trained mentees that contact recently diagnosed people to attend an adherence
Horvath et al., 2019 Online forum, messages and social network posts
Ivanova et al., 2019 Peer as trained mentees that contact diagnosed people to participated in an adherence
Knudson et al., 2019 Face to face counseling and contact with via SMS
Navarra et al., 2019 Peers trained as coaches
Tun et al., 2019 Peer education
Hay et al., 2020 WhatsApp groups
MacCarthy et al., 2020 Focus group
Ochoa et al., 2021 Online forum
Simpson et al., 2021 Focus group, first interviews and SMS communication
Steinbock et al., 2022 Online support group
Stockman et al., 2021 Match with a trained and trauma-informed virtual peer, communication via
Zanoni et al., 2022 WhatsApp groups
Mo & Coulson,2008 Messages posted at an online board
Wools-Kaloustian et al.,
Instructors that mediates between medical attention and patients giving advices
Mi et al., 2015 Online peer counseling and giving information via website
Abdulrahman et al., 2017 Online peer counseling
Senn et al., 2017 SMS texting with participants
Rotheram et al., 2019 Social media forums and coaching via SMS, phone, or in-person
St Clair-Sullivan et la.,
Online support forum
Chory et al., 2022 WhatsApp groups
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It is worth noting that although internet-based interventions may help ease difficulties in
access for some PLWHA—access to these interventions may be limited for some populations
and marginalized groups (e.,g., older people, people with severe mental health conditions, peo-
ple with specific disabilities,) [120122]. Likewise, the risk of digital exclusion may make a
strong point for face to face services.
Our scoping review has two main limitations. Firstly, it was conducted only in 3 databases
(PUBMED, Web of Science, and CINAHL Complete). The selection of these databases was
due to a limited institutional budget; for this reason, some databases were excluded (e.g.,
EMBASE, Cochrane).
Secondly, and also due to institutional limitations, we did not count with the collaboration
of a librarian, which may have had an impact on the expertise in designing and refining the
main gsearch of our paper.
In this review we have summarized the digital peer support interventions currently available
for PLWHA, their main characteristics, and the way in which they implemented peer support
in a virtual environment.
Overall the reported outcomes appeared promising, especially regarding potential improve-
ments in treatment adherence and enhanced perceived social support. Future research should
focus on continuing collecting data through RCTs studies in diverse social contexts. Having
robust diverse evidence of the effectiveness of this type of interventions may help expand the
scope and the impact of different treatments.
Supporting information
S1 Appendix. Pre-registration protocol at open science framework. Protocol developed by
the researchers following the Open Science Framework guidelines.
S2 Appendix. Eligibility criteria. List of the eligibility criteria used to assess the articles for
S3 Appendix. String of search. Full string of search implemented in PUBMED. The string of
search was adapted to each database.
S4 Appendix. Preferred Reporting Items for Systematic reviews and Meta-Analyses exten-
sion for Scoping Reviews (PRISMA-ScR) checklist. Checklist completed by the researchers
following PRISMA guidelines.
Author Contributions
Conceptualization: Stefanella Costa-Cordella, Aitana Grasso-Cladera, Javiera Duarte, Claudia
P. Cortes.
Data curation: Stefanella Costa-Cordella.
Formal analysis: Stefanella Costa-Cordella, Aitana Grasso-Cladera.
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PLOS ONE | August 30, 2022 10 / 17
Funding acquisition: Alejandra Rossi, Claudia P. Cortes.
Investigation: Stefanella Costa-Cordella, Aitana Grasso-Cladera.
Methodology: Stefanella Costa-Cordella, Aitana Grasso-Cladera, Javiera Duarte.
Project administration: Stefanella Costa-Cordella.
Resources: Stefanella Costa-Cordella.
Supervision: Stefanella Costa-Cordella, Alejandra Rossi, Claudia P. Cortes.
Validation: Stefanella Costa-Cordella.
Visualization: Stefanella Costa-Cordella, Aitana Grasso-Cladera.
Writing original draft: Stefanella Costa-Cordella, Aitana Grasso-Cladera.
Writing review & editing: Stefanella Costa-Cordella, Aitana Grasso-Cladera, Alejandra
Rossi, Javiera Duarte, Flavia Guiñazu, Claudia P. Cortes.
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Internet-based peer support interventions for PLWHA
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Background Mobile phone-based interventions have been demonstrated in different settings to overcome barriers to accessing critical psychosocial support. In this study, we aimed to assess the acceptability and feasibility of a phone-based, peer-to-peer support group intervention for adolescent pregnant women aged 15–24 years living with HIV in Zambia. Methods Sixty-one consenting participants were recruited from Antenatal Clinics of two large urban communities in Lusaka. They were invited to participate in the mobile phone-based intervention that allowed them to anonymously communicate in a small group led by a facilitator for 4 months. A mixed methods approach was used to assess acceptability and feasibility, including a focus group discussion, pre- and post-intervention interview and analysis of the content of the text message data generated. Results Participants reported finding the platform “not hard to use” and enjoyed the anonymity of the groups. Seventy-one percent of participants ( n = 43) participated in the groups, meaning they sent text messages to their groups. Approximately 12,000 text messages were sent by participants (an average of 169 messages/user and 6 mentors in 6 groups. Topics discussed were related to social support and relationships, stigma, HIV knowledge and medication adherence. Conclusion The study showed that the intervention was acceptable and feasible, and highlighted the potential of the model for overcoming existing barriers to provision of psychosocial support to this population.
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Mobile technologies represent potentially novel and scalable intervention delivery platforms for adolescents living with HIV (ALWH) in low- and middle-income countries. We conducted a prospective, mixed methods pilot study to evaluate the acceptability and feasibility of the WhatsApp® platform to deliver individual counseling services and facilitate peer support for ALWH in western Kenya. Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. After 6 months, participants described their experiences with the intervention. Treatment adherence, stigma, and mental and behavioral health were assessed prospectively. Participants reported overall positive experiences and indicated that the platform encouraged peer network development. They endorsed potential benefits for treatment adherence, stigma reduction, and mental and behavioral health. All participants supported intervention expansion. In western Kenya, WhatsApp® was an acceptable and feasible platform for mobile counseling and peer support for ALWH.
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Introduction South Africa (SA) has the highest number of people living with HIV (PLWH) globally, and a significant burden of alcohol and other drug use (AOD). Although integrating AOD treatment into HIV care may improve antiretroviral therapy (ART) adherence, this is not typically routine practice in SA or other low-resource settings. Identifying interventions that are feasible and acceptable for implementation is critical to improve HIV and AOD outcomes. Methods A pilot randomized hybrid type 1 effectiveness-implementation trial (N = 61) was conducted to evaluate the feasibility and acceptability of Khanya, a task-shared, peer-delivered behavioral intervention to improve ART adherence and reduce AOD in HIV care in SA. Khanya was compared to enhanced treatment as usual (ETAU), a facilitated referral to on-site AOD treatment. Implementation outcomes, defined by Proctor’s model, included feasibility, acceptability, appropriateness and fidelity. Primary pilot effectiveness outcomes were ART adherence at post-treatment (three months) measured via real-time electronic adherence monitoring, and AOD measured using biomarker and self-report assessments over six months. Data collection was conducted from August 2018 to April 2020. Results and discussion Ninety-one percent of participants (n = 56) were retained at six months. The intervention was highly feasible, acceptable, appropriate and delivered with fidelity (>90% of components delivered as intended by the peer). There was a significant treatment-by-time interaction for ART adherence (estimate = −0.287 [95% CI = −0.507, −0.066]), revealing a 6.4 percentage point increase in ART adherence in Khanya, and a 22.3 percentage point decline in ETAU. Both groups evidenced significant reductions in alcohol use measured using phosphatidylethanol (PEth) (F(2,101) = 4.16, p = 0.01), significantly decreased likelihood of self-reported moderate or severe AOD (F(2,104) = 7.02, p = 0.001), and significant declines in alcohol use quantity on the timeline follow-back (F(2,102) = 21.53, p < 0.001). Among individuals using drugs and alcohol, there was a greater reduction in alcohol use quantity in Khanya compared to ETAU over six months (F(2,31) = 3.28, p = 0.05). Conclusions Results of this pilot trial provide initial evidence of the feasibility and acceptability of the Khanya intervention for improving adherence in an underserved group at high risk for ongoing ART non-adherence and HIV transmission. Implementation results suggest that peers may be a potential strategy to extend task-sharing models for behavioral health in resource-limited, global settings.
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This study aimed to identify alcohol use patterns associated with viral non-suppression among women living with HIV (WLWH) and the extent to which adherence mediated these relationships. Baseline data on covariates, alcohol consumption, ART adherence, and viral load were collected from 608 WLWH on ART living in the Western Cape, South Africa. We defined three consumption patterns: no/light drinking (drinking ≤ 1/week and ≤ 4 drinks/occasion), occasional heavy episodic drinking (HED) (drinking > 1 and ≤ 2/week and ≥ 5 drinks/occasion) and frequent HED (drinking ≥ 3 times/week and ≥ 5 drinks/occasion). In multivariable analyses, occasional HED (OR 3.07, 95% CI 1.78–5.30) and frequent HED (OR 7.11, 95% CI 4.24–11.92) were associated with suboptimal adherence. Frequent HED was associated with viral non-suppression (OR 2.08, 95% CI 1.30–3.28). Suboptimal adherence partially mediated the relationship between frequent HED and viral non-suppression. Findings suggest a direct relationship between frequency of HED and viral suppression. Given the mediating effects of adherence on this relationship, alcohol interventions should be tailored to frequency of HED while also addressing adherence.
Full-text available Background Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.
In the U.S., Black women living with HIV/AIDS (WLHA) are affected disproportionately by interpersonal violence, which often co-occurs with adverse mental health and/or substance use, and exacerbates existing poor HIV care outcomes. Peer navigation has been successful in improving HIV care; however, HIV clinics often lack resources for sustainability and may not account for socio-structural barriers unique to Black WLHA. To address this gap, we developed LinkPositively, a culturally-tailored, trauma-informed WebApp for Black WLHA affected by interpersonal violence to improve HIV care outcomes. Using focus group data from nine Black WLHA and peer navigators, we developed LinkPositively. Core components include: virtual peer navigation to facilitate skill-building to cope with barriers and navigate care; social networking platform for peer support; educational and self-care tips; GPS-enabled resource locator for HIV care and support service agencies; and medication self-monitoring/reminder system. If efficacious, LinkPositively will shift the HIV prevention and care paradigm for Black WLHA.
Background Adolescents living with perinatally acquired HIV often have poor retention in care and viral suppression during the transition from pediatric to adult-based care. Objective The aim of this study is to evaluate a mobile phone–based intervention, Interactive Transition Support for Adolescents Living With HIV using Social Media (InTSHA), among adolescents living with perinatally acquired HIV as they transition from pediatric to adult care in South Africa. Methods InTSHA uses encrypted, closed group chats delivered via WhatsApp (Meta Platforms Inc) to develop peer support and improve communication between adolescents, their caregivers, and health care providers. The intervention is based on formative work with adolescents, caregivers, and health care providers and builds on several existing adolescent support programs as well as the Social-ecological Model of Adolescent and Young Adult Readiness for Transition (SMART). The final InTSHA intervention involves 10 modules conducted weekly through moderated WhatsApp group chats with adolescents and separately with their caregivers. We will randomly assign 80 South African adolescents living with perinatally acquired HIV who are aware of their HIV status and aged between 15 and 19 years to receive either the intervention (n=40) or standard of care (n=40). Results We will measure acceptability of the intervention as the primary outcome and evaluate feasibility and preliminary effectiveness for retention in care and viral suppression after completion of the intervention and at least 6 months after randomization. In addition, we will measure secondary outcomes evaluating the impact of the InTSHA intervention on peer support, self-esteem, depression, stigma, sexual education, connection to health care providers, and transition readiness. Enrollment began on April 15, 2021. As of December 31, 2021 a total of 78 out of expected 80 participants have been enrolled. Conclusions If successful, the intervention will be evaluated in a fully powered randomized controlled trial with a larger number of adolescents from urban and rural populations to further evaluate the generalizability of InTSHA. Trial Registration NCT03624413; International Registered Report Identifier (IRRID) DERR1-10.2196/35455
Context: Although viral suppression rates have recently increased among people with HIV, specific populations still experience disparities in health outcomes, a priority in the national response to end the HIV epidemic. Purpose: The end+disparities ECHO Collaborative, a quality improvement initiative among HIV providers in the United States from June 2018 to December 2019, created virtual communities of practice to measurably increase viral suppression rates in populations disproportionately affected by HIV: men who have sex with men of color, Black/African American and Latina women, youth aged 13 to 24 years, and transgender people. Methods: Participating Ryan White HIV/AIDS Program-funded providers prioritized their improvement efforts to focus on one target population and joined virtual affinity sessions with other providers focused on that population for guidance by subject matter experts and exchanges with peer providers. During 9 submission cycles, providers reported their viral suppression data for the preceding 12 months. Main outcome measures: The principal outcome measures were changes in viral suppression rates among 4 target populations and changes in viral suppression gaps compared with the rest of HIV-infected patients served by the same agency. Results: A total of 90 providers were included in the data analyses with an average of 110 775 reported patients, out of which 19 442 represented the targeted populations. The average viral suppression rates for agency-selected populations increased from 79.2% to 82.3% (a 3.9% increase), while the remaining caseload increased at a lower rate from 84.9% to 86.1% (a 1.4% increase). The viral suppression gap was reduced from 5.7% to 3.8%, a 33.5% reduction. Improvements were found across all target populations. Conclusions: The collaborative demonstrated improved health outcomes and reductions in HIV-related health disparities, moving toward ending the HIV epidemic. The model of utilizing low-cost videoconferencing technologies to create virtual communities of learning is well suited to mitigate other disease-related disparities, nationally and abroad.
Background and aims Addressing the burden of disease associated with substance use is a global priority, yet access to treatment is limited, particularly in low- and middle-income countries (LMICs). Peers, individuals with lived experience of substance use, may play an important role in expanding access to treatment, supporting outcomes, and reducing stigma. While peer-delivered services for substance use have been scaling up in high-income countries (HICs), less is known about their application in LMICs. This systematic review synthesizes the evidence of peer-delivered services for substance use in LMICs. Methods PsycINFO, Embase, Global Health, PubMed, and six region-specific databases were searched, and articles that described peer-delivered services for substance use and related outcomes in LMICs were included. Risk of bias was evaluated using tools appropriate for each study design. To provide a more stringent evaluation of structured interventions, a subset of articles was analyzed using the Cochrane Effective Practice and Organization of Care (EPOC) framework. Results The search yielded 6540 articles. These were narrowed down to 34 included articles. Articles spanned four continents, included quantitative and qualitative methodologies, and primarily targeted infectious disease risk behaviors. Ten articles were included in the EPOC sub-analysis. In the context of high risk of bias, some of these articles demonstrated positive impacts of the peer-delivered services, including reductions in risk behaviors and increases in infectious disease knowledge scores, while many others showed no significant difference in outcomes between peer intervention and control groups. Conclusions Peer-delivered services may be feasible for addressing substance use and reducing infectious disease risk behaviors in LMICs, where there are severe human resource shortages. Globally, peers’ lived experience is valuable for engaging patients in substance use treatment and harm reduction services. Further research is needed to better characterize and quantify outcomes for peer-delivered services for substance use in LMICs.
Multiple intersecting stigmas and discrimination related to sex, gender, HIV, and race/ethnicity may challenge HIV prevention and treatment service utilization, particularly among youth. This scoping review describes recent and ongoing innovative mobile health (mHealth) interventions among youth in the United States that aim to reduce stigma as an outcome or as part of the intervention model. To identify examples of stigma-mitigation via mHealth, we searched peer-reviewed published literature using keyword strategies related to mHealth, HIV, stigma, and youth (ages 10 to 29). We identified eleven articles that met our inclusion criteria, including three describing data from two randomized controlled trials (RCTs), five describing pilot studies, one describing the process evaluation of an ongoing intervention, one describing formative work for intervention development, and one published study protocol for an ongoing intervention. We review these articles, grouped by HIV prevention and care continuum stages, and describe the mHealth approach used, including telehealth, simulation video games, motion comics, smartphone applications (apps), social media forums, online video campaigns, video vignettes, and a computerized behavioral learning module. Four studies focused on preventing primary acquisition through individual-level behavior change (e.g., reducing condomless anal intercourse), three focused on increasing HIV testing, three focused on linking to prevention services [e.g., pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP)] and one focused on promoting adherence to antiretroviral therapy (ART). Our review did not identify any published studies using mHealth with a primary aim to reduce stigma as a way to improve care engagement and increase viral suppression among youth in the United States. Additional RCTs and implementation studies examining the effectiveness of mHealth stigma-reduction interventions on HIV-related outcomes are needed to end the HIV epidemic among youth. mHealth offers unique advantages to address the complex intersecting stigma barriers along the HIV continuum to improve HIV-related outcomes for youth.