Table 8 Assessment of the quality of the qualitative evidence using the CERQual approach. This evidence examined themes that shaped experiences suggestive of wellbeing among YPLHIV in SSA
Summary of review finding | Studies contributing to review findings | Methodological limitations | Coherence | Adequacy | Relevance | CERQual assessment of confidence in the evidence | Explanation of CERQual assessment |
|---|---|---|---|---|---|---|---|
Theme 1-Social acceptance and belonging | |||||||
1.1. HIV-related stigma and discrimination Stigma negatively impacted wellbeing by reducing self-acceptance and challenging the ability to maintain positive relationships. Internalised and externalised stigma impeded the ability to derive meaning in and to life and consequently wellbeing. It negatively impacted self-worth, connectedness with others and self-acceptance, particularly among women. Moreover, it challenged the ability to build relationships and reciprocate love and affection. | 30 | Minor (16 studies with minor and 11 studies with moderate methodological concerns- i.e. methodological orientation, reflexivity) | Minor (Few concerns on the data from the primary data and review finding) | Minor (Most studies provided thick and rich descriptions on this theme) | Moderate (No study was informed by or discussed in the context of wellbeing theory, geographical spread- 15 studies from eastern sub-region, 15 studies from the southern sub-region, 1 study from West Africa, most studies conducted among 15–19 year-olds living with HIV | Moderate confidence | Minor concerns regarding methodological limitations, coherence and adequacy Moderate concerns regarding relevance |
1.2 Social support Positive relations were critical in promoting wellbeing. Supportive relationships with caregivers and trusting relationships with extended family members, peers, HCWs and support groups enhanced social acceptance and belonging. This in turn promoted a sense of meaning in and to life, and ultimately wellbeing Unsupportive relationships reinforced feelings of social isolation. Moreover, sexual norms embedded within these networks compromised wellbeing, particularly among women. | 28 | Minor (15 studies with minor and 11 studies with moderate methodological concerns- i.e., methodological orientation, reflexivity) | Minor (Few concerns on the data from the primary data and review finding) | Minor (Most studies provided thick and rich descriptions on this theme) | Moderate (No study was informed by or discussed in the context of wellbeing theory, geographical spread- 14 studies conducted in the eastern sub-region, 14 studies conducted in the southern sub-region, 1 study from West Africa, most studies conducted among 15–19 year-olds living with HIV | Moderate confidence | Minor concerns regarding methodological limitations, coherence and adequacy Moderate concerns regarding relevance |
Theme 2- Coping | |||||||
The ability to manage daily lived realities was important for wellbeing. YPLHIV drew on religion and faith to help understand the meaning of life. This may have engendered a sense of control, belongingness and relatedness and thereby brought meaning to and in life. Similarly, goals and aspirations brought meaning and purpose to life. Strong social support networks fostered positive coping. Negative coping strategies such as social withdrawal, self-blame and anticipation of death reduced ability to finding meaning in life and thus undermined wellbeing | 23 | Minor (5 studies with minor and 18 studies with moderate methodological concerns- i.e. methodological orientation, reflexivity) | Minor (Few concerns on the data from the primary data and review finding) | Minor (Most studies provided thick and rich descriptions on this theme) | Moderate (No study was informed by or discussed in the context of wellbeing theory, geographical spread- 12 studies from eastern sub-region, 11 studies from the southern sub-region, 1 study from West Africa, most studies conducted among 15–19 year-olds living with HIV | Moderate confidence | Minor concerns regarding methodological limitations, coherence and adequacy Moderate concerns regarding relevance |
Standard of living | |||||||
Fulfilling socio-economic roles were important for wellbeing. It served to enhance meaning in and to life and created purpose in life. Household food insecurity compromised ART adherence and positive mental health functioning and possibly wellbeing. Broader economic constraints challenged the ability of young men to attain desired educational and career goals. This reduced their sense of social value and threatened wellbeing. | 11 | Moderate (4 studies with minor and 7 studies with moderate methodological concerns- i.e. reflexivity, lack of thick descriptions in the analysis or description of diverse cases) | Moderate (Several concerns on the data from the primary data and review finding) | Moderate (Few studies provided thick and rich descriptions on this theme) | Moderate (No study was informed by or discussed in the context of wellbeing theory, majority of the data are from men and caregivers. Geographical spread- 5 studies conducted in southern sub-region, 5 studies conducted in the eastern sub-region, 1 study conducted in western sub-region | Moderate confidence | Moderate concerns regarding methodological limitations, coherence, adequacy, relevance |