Intergenerational spillover effects of antiretroviral therapy in sub-Saharan Africa

A scoping review and future directions for research

Bibliographic Data

ID21880973
AuthorsHenning Schröder (0000-0002-9542-3393, Heidelberg University, corresponding author), H Manisha Yapa (0000-0002-0100-4754, The University of Sydney), Francesc Xavier Gómez-Olivé (0000-0002-4876-0848, University of the Witwatersrand), Harsha Thirumurthy (0000-0002-3308-7603, University of Pennsylvania), Janet Seeley (0000-0002-0583-5272, London School of Hygiene & Tropical Medicine), Till Bärnighausen (0000-0002-4182-4212, Heidelberg University), Jan-Walter De Neve (0000-0003-0090-8249, Heidelberg University)
Year2023
Volume8
Issue4
Pagese011079
Publication date2023-04-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2022-011079
PMID37068847
OpenAlexW4366084711
LanguageEN
Citations received1
References cited78

BACKGROUND: Antiretroviral therapy (ART) may influence individuals who do not receive the intervention but who are connected in some way to the person who does. Relatively little is known, however, about the size and scope of, what we term, spillover effects of ART. We explored intergenerational spillover effects of ART in sub-Saharan Africa (SSA) and identified several directions for future research. METHODS: We conducted a scoping review between March and April 2022. We systematically searched PubMed, PsycINFO, EconLit, OTseeker, AIDSInfo, Web of Science, CINHAL, Google Scholar and African Index Medicus. We analysed the distribution of included studies over time and summarised their findings. We examined the intergenerational impact of ART provision to working-age adults living with HIV on children ('downward' spillover effects) and older adults ('upward' spillover effects). We categorised types of intergenerational spillover effects according to broad themes which emerged from our analysis of included studies. FINDINGS: We identified 26 studies published between 2005 and 2022 with 16 studies assessing spillover effects from adults to children (downward), and 1 study explicitly assessing spillover effects from working-age adults to older adults (upward). The remaining studies did not fully specify the direction of spillover effects. Most spillover effects of ART to household and family members were beneficial and included improvements in wealth, labour market outcomes, health outcomes and health services utilisation, schooling, and household composition. Both children and older adults benefited from ART availability among adults. Detrimental spillover effects were only reported in three studies and included financial and opportunity costs associated with health services utilisation and food insecurity in the first year after ART. CONCLUSIONS: ART may lead to substantial spillover effects across generations and sectors in SSA. Further research is needed to capitalise on positive spillover effects while mitigating potential negative spillover effects. The returns to investments in large-scale health interventions such as ART may be underestimated without considering these societal benefits

Antiretroviral therapy · Economics · Environmental health · Family medicine · Spillover effect · Viral load · Adolescent Sexual and Reproductive Health · HIV/AIDS Research and Interventions · Medicine · Poverty, Education, and Child Welfare · Psychology

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