Economic Empowerment Interventions on Mental Health Outcomes Among People Living with HIV in Low and Middle-Income Countries: A Systematic Literature Review.

Abstract

There is strong evidence of the correlation between economic hardship and poor mental health outcomes among people living with HIV (PLHIV). However, the causal efficacy and mechanisms of specific economic interventions through which they contribute to mental health improvement among PLHIV remain fragmented and inconsistent. This systematic review aims to collate and synthesize existing evidence on the effect of economic empowerment interventions on mental health symptoms among PLHIV in low- and middle-income countries (LMICs). We conducted a comprehensive literature review that adhered to the PRISMA guidelines for methodological rigor and transparency. Comprehensive searches were conducted in PubMed, Web of Science, Embase, CINAHL, Scopus, and MEDLINE. We conducted a narrative synthesis of 11 studies: two cohorts, two qualitative, one intervention (non-randomized), and six randomized clinical trials. We registered this review with PROSPERO (CRD420251152471). The process theory served as an analytical framework. Evidence suggests that multi-component economic empowerment interventions (e.g., combined savings, skills training, and psychological support) may be associated with improved mental health among PLHIV in LMICs. Qualitative evidence from other studies suggested that reduced financial stress and strengthened psychological resources may contribute to improved mental health. The effectiveness of the intervention depends not only on simple cash transfers but also on a theoretically sound integrated approach. Interventions were more effective among lower-income groups. Integration of multi-component economic and psychosocial interventions into standard HIV care could improve mental health outcomes among PLHIV in LMICs and is hereby recommended by this study.