A synthesis of dimensions of wellbeing among adolescents and young people living with HIV from Sub-Saharan Africa for measurement in economic evaluation : a qualitative overview of reviews

Abstract

BACKGROUND : Adolescents and young people living with HIV (AYPLHIV) in sub-Saharan Africa (SSA) face intersecting structural and psychosocial challenges that compromise their wellbeing, yet these realities are poorly captured by generic wellbeing measures used in economic evaluations. This overview of reviews synthesised evidence from SSA to identify key determinants of social wellbeing to inform the co-development of a contextually relevant wellbeing scale suitable for economic evaluations in the region. METHODS : We searched reviews published between January 2000 and September 2023 across ten databases on EBSCOhost, Ovid, and Web of Science. The conduct and reporting of this overview followed the Preferred Reporting Items for Overviews of Reviews guidelines. Eligible reviews included quantitative, qualitative, and mixed-methods studies examining wellbeing or mental health among AYPLHIV aged 10–24 years in SSA. Review quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Data were synthesised thematically, mapped onto Keyes Social Wellbeing framework, and study selection presented with a PRISMA flow diagram. RESULTS : Sixteen medium-to-high quality reviews were included. South Africa (n = 15) and Uganda (n = 14) were the most represented countries. Most reviews focused on adolescents aged 10–19 years (n = 11). Our analysis identified five recurring themes central to the social wellbeing of AYPLHIV: social support, acceptance and belonging, self-acceptance, aspirations and goals, and coping. These themes aligned with Keyes’ Social Wellbeing model, with social support and acceptance and belonging reflecting social integration, and aspirations and goals reflecting social contribution. Key psychological wellbeing constructs identified included positive relationships, self-acceptance, purpose in life, and environmental mastery. CONCLUSIONS : These domains reflect both personal experiences and structural realities yet remain underrepresented in commonly used wellbeing measures. This is a critical limitation, as economic evaluations often rely on generic instruments that fail to capture what matters most to AYPLHIV in SSA. Future research should develop a wellbeing scale that incorporates these domains, is sensitive to socioeconomic context, and can be collected alongside socioeconomic status indicators. Embedding such a measure into evaluation systems would improve the accuracy, equity, and policy relevance of economic evaluations and ensure that investments reflect AYPLHIV’s lived realities.