Contextual and culturally adapted interventions to improve HIV outcomes: a scoping review.

backgroundAntiretroviral therapy is widely available, yet structural, social, and cultural barriers still limit human immunodeficiency virus prevention and care. Prevention tools such as consistent condom use and pre-exposure prophylaxis (PrEP) remain essential. Interventions that ignore local context and culture often have low uptake, especially among adolescents, Indigenous communities, and sexual minorities.

objectiveTo map and synthesize contextually and culturally adapted interventions that aim to improve outcomes related to human immunodeficiency virus.

methodThis scoping review followed the Arksey and O Malley framework and the PRISMA ScR guideline. We searched Scopus, PubMed, and CINAHL used keywords for human immunodeficiency virus, contextual delivery, and cultural adaptation. Eligible studies involved people living with human immunodeficiency virus or populations at substantial risk. Interventions had to be tailored to setting or culture in health care or community contexts. We defined contextual or cultural adaptation as development or modification with local stakeholder input and the inclusion of culturally salient elements such as values, norms, language, imagery, community delivery agents, or locally meaningful practices. As a scoping review, we did not conduct formal study-level quality appraisal. Data were extracted with a standardized form and synthesized narratively.

resultsEighteen studies met the inclusion criteria. Interventions included community-based counseling and peer programs; digital approaches such as mobile and electronic health (including short message service reminders, smartphone applications, and tele-counseling); complementary mind-body strategies; and couple or family models tailored for marginalized groups. Seven cross-cutting themes appeared: (1) culturally grounded psychosocial support; (2) technology-enabled adherence and care engagement; (3) mind-body strategies addressing stigma, stress, and resilience; (4) couple and family involvement for communication and support; (5) tailoring for adolescents and structurally marginalized groups; (6) addressing specific sexual behaviours and HIV prevention (e.g., reducing condomless sex, increasing HIV testing, and uptake of PrEP and post-exposure prophylaxis [PEP]); and (7) quality-of-life and mental-health enhancement. Many studies reported improvements associated with these approaches, such as better adherence, lower stigma, increased HIV testing and PrEP uptake, and reductions in condomless sex, alongside gains in psychological resilience and mental health. Effects on clinical endpoints were mixed, and some studies reported null findings.

conclusionsContextual and cultural adaptation is a promising direction for improving engagement with human immunodeficiency virus prevention and care. Future research should use adequately powered evaluations in diverse settings, assess durability and scalability in routine systems, and report adaptation processes in enough detail to support replication.