Family-Centred Care for Children and Adolescents Living With HIV in Sub-Saharan Africa: A Scoping Review.

Abstract

Introduction: Children and adolescents living with HIV in sub-Saharan Africa (SSA) continue to face significant barriers to diagnosis, treatment adherence, retention in care and psychosocial support, despite progress in prevention and treatment coverage. Family-centred care (FCC) has emerged as a promising model that positions families-not just individual children-as the central unit of care, with potential to improve clinical and psychosocial outcomes while addressing persistent gaps in health system responsiveness.

Methods: Our scoping review synthesized evidence on FCC implementation strategies and outcomes for children and adolescents living with HIV in SSA, to inform the development of a contextually relevant FCC intervention. We followed Arksey and O'Malley's five-stage framework and the PRISMA-ScR guidelines. A comprehensive search of peer-reviewed and grey literature published between 2000 and 2025 was conducted across multiple databases and organizational websites between May and July 2025. Fourteen studies met the inclusion criteria and were selected for analysis.

Results: FCC was conceptualized as a multidimensional framework integrating clinical care, psychosocial support, caregiver engagement, treatment literacy and community-based delivery. Implementation models ranged from facility-based integrated services to community-driven and hybrid approaches. Interventions commonly included antiretroviral therapy provision, family-based testing, counselling and enhanced psychosocial wellbeing. Community-based and decentralized models showed particular promise in improving retention and reducing structural barriers. However, gaps persist, including limited longitudinal data, underrepresentation of fathers and adolescent caregivers, narrow assumptions of nuclear family structures and a lack of standardized FCC frameworks.

Discussion: Most FCC interventions were small-scale and donor-funded, raising concerns regarding sustainability and health-system integration. Additionally, many studies assumed nuclear family structures, overlooking the role of extended and non-biological caregivers common in African contexts. The limited engagement of diverse caregiving networks and inconsistent conceptualization of FCC constrain its broader applicability and scalability.

Conclusions: FCC offers a compelling and contextually appropriate model for strengthening HIV care for children and adolescents in SSA. Advancing the FCC requires standardized frameworks, inclusive and context-sensitive programme design, and integration into national health systems to ensure equitable and sustainable delivery of holistic HIV care.