Peer-reviewed article
Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework
Juliet Iwelunmor, Ucheoma Nwaozuru, Chisom Obiezu‐Umeh, Florida Uzoaru, John E. Ehiri et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined 25 economic empowerment programs designed to prevent HIV among adolescent girls and young women in sub-Saharan Africa. The review evaluated how well researchers reported on five key implementation outcomes: reach, effectiveness, adoption, implementation, and maintenance. Most studies reported effectiveness and adoption results, but few reported on implementation costs, program fidelity, or long-term maintenance. The authors call for better reporting of real-world implementation factors to help governments decide whether these programs are worth scaling up.
Key points
- Efficacy/effectiveness was reported in 74.4% of interventions, while maintenance was reported in only 26.4%
- All 25 interventions reported sample size and intervention location, but none reported intervention fidelity
- Only 12% of interventions reported implementation costs, limiting knowledge about program affordability
- 32% of studies reported characteristics of non-participants, making it unclear who programs reach
- Review calls for improved reporting of adoption, implementation costs, and maintenance to support policy decisions
Limitations
This is a systematic review of reporting quality, not an assessment of intervention effectiveness itself. The review cannot determine whether economic empowerment programs actually work to prevent HIV, only whether researchers adequately reported on implementation outcomes; therefore it does not provide evidence on what works best or for whom.
Abstract
BACKGROUND: Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention's impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. METHODS: We searched PubMed, Ovid/MEDLINE, Science Direct, Ebscohost, PsycINFO, Scopus, and Web of Science for EE HIV interventions for AGYW in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions were summarized and synthesized across included interventions. RESULTS: A total of 25 unique interventions (reported in 45 articles) met the predefined eligibility criteria. Efficacy/effectiveness 19(74.4%) was the highest reported RE-AIM dimension, followed by adoption 17(67.2%), reach 16(64.0%), implementation 9(38.0%), and maintenance 7(26.4%). Most interventions reported on RE-AIM components such as sample size 25(100.0%), intervention location 24(96.0%), and measures and results for at least one follow-up 24(96.0%). Few reported on RE-AIM components such as characteristics of non-participants 8(32.0%), implementation costs 3(12.0%), and intervention fidelity 0(0.0%). CONCLUSIONS: Results of the review emphasize the need for future economic empowerment HIV prevention interventions for AGYW in SSA to report multiple implementation strategies and highlight considerations for translating such programs into real-world settings. Researchers should pay close attention to reporting setting-level adoption, implementation cost, and intervention maintenance. These measures are needed for policy decisions related to the full merit and worth of EE HIV interventions and their long-term sustainability for AGYW.