Adherence to antiretroviral treatment (ART) is crucial for managing HIV, but remains a challenge, particularly for adolescents living with HIV (ALHIV), especially in low- and middle-income countries (LMICs). These adolescents face physiological, emotional, psychological, and social challenges during their transition from pediatric to adult care, along with sociopolitical and contextual barriers such as poverty and limited resources. Technology-enabled interventions, leveraging adolescents' frequent use of the internet and social media, offer potential solutions by supporting self-management, promoting autonomy, and providing privacy and support. While technology-enabled interventions have shown promise in high-income countries, evidence of their effectiveness, acceptability, and feasibility in LMICs is limited. Previous reviews have focused on specific aspects or geographical regions, lacking a comprehensive assessment of effectiveness, acceptability, and feasibility across diverse LMIC contexts. This review aimed to fill this gap by addressing three key questions: 1. What technology-enabled interventions have been implemented in LMICs to support and deliver healthcare to ALHIV (aged 10–19 years)? 2. What is the effectiveness of various technology-enabled health interventions in general health and well-being and treatment outcomes of ALHIV in LMICs? 3. What is the feasibility, acceptability, and fidelity of the various technology-enabled health interventions for ALHIV in LMICs?

Several systematic reviews have examined the effectiveness of technology-enabled interventions for various adolescent health issues, including health promotion, prevention, mental health, and chronic conditions. However, the generalizability of these findings to diverse contexts, marginalized groups, and specific health conditions like HIV is limited. Reviews on technology-enabled interventions for adults living with HIV have demonstrated positive impacts on treatment access, self-management, adherence, and retention in care. In sub-Saharan Africa, e-health interventions have shown potential for improving adherence and retention at a low cost. However, prior reviews on technology-enabled interventions for ALHIV have been limited in scope, often focusing on a small number of studies or specific outcome measures, notably lacking detailed evaluations of feasibility, acceptability, and fidelity. This creates a critical knowledge gap, hindering the development and scale-up of effective interventions for this vulnerable population.

This systematic review followed a seven-step process guided by Egger, Davey, and Smith [33] and adhered to PRISMA-P guidelines [34], registered with PROSPERO (CRD42022336330). The search strategy encompassed eight electronic databases (Ebscohost, CINAHL, ERIC, MEDLINE, PubMed, SCOPUS, Science Direct, and Sabinet), Google Scholar, ClinicalTrials.gov, the WHO trials portal, grey literature, and reference lists of included studies. Inclusion criteria specified adolescents aged 10–19 years as the primary study population, technology-enabled interventions directly supporting healthcare, quantitative and qualitative studies published between 2010 and 2022 in LMICs, and studies reporting health-related outcomes and/or acceptability, feasibility, and fidelity. Review studies and interventions not directly involving adolescents were excluded. Two reviewers independently screened titles and abstracts, and full-text articles were reviewed for eligibility. Data were extracted using a predefined form and the TIDieR checklist [36] to describe intervention components. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT) [37]. Data synthesis was narrative due to the limited number and heterogeneity of included studies.

The search yielded 267 records, with 11 studies meeting the inclusion criteria (five ongoing studies were identified but excluded). Most studies were conducted in Africa (Nigeria, Uganda, South Africa, Kenya), with one each in Guatemala and Argentina. Study designs included RCTs, non-RCTs (pre-post and matched controls), and a qualitative study. A total of 1544 participants were included. Regarding primary outcomes, only two studies showed significant improvements in ART adherence related to the intervention. There was mixed evidence on viral load improvements; the effect on retention in care was not significant, with one study showing improved linkage to care. One study reported a significant improvement in HIV knowledge, while another showed a non-significant improvement. No significant effects were found for secondary outcomes such as social support, self-efficacy, mental health, stigma, or behavioral outcomes. Acceptability and feasibility were high for most interventions, primarily social media and SMS-based. Fidelity varied; challenges included device capability, network connectivity, data access, and engagement levels. Qualitative data highlighted the potential benefits of creating a sense of community and peer support but also indicated concerns about anonymity and confidentiality in online groups.

This review found weak evidence for the effectiveness of technology-enabled interventions on ALHIV health outcomes in LMICs, although acceptability and feasibility were generally high. The lack of a strong theoretical base in most interventions is a limitation, as is the heterogeneity in study designs and outcome measures. The findings highlight the importance of considering device capabilities, network connectivity, data access, literacy levels, and the adolescents' preferences for technology platforms when designing interventions. The use of existing, widely accessible platforms such as SMS or WhatsApp appears to be more effective than Facebook or web-based platforms. Challenges related to intervention fidelity, response rates, and engagement need to be addressed. The qualitative data suggests that the benefits of community and social support should be leveraged in intervention design.

There is a need for theoretically grounded technology-enabled interventions that are integrated into existing healthcare systems to ensure sustainability and scalability. Future research should include larger, rigorously designed studies to establish the effectiveness of these interventions on ALHIV health outcomes in LMICs, paying particular attention to the role of intervention components, technology design, and platform choices. Needs assessments and active involvement of ALHIV and healthcare workers in the design and implementation phases are critical for the successful development and implementation of technology-enabled interventions for this population.

The limited number of studies and their heterogeneity pose limitations on the generalizability of findings. The focus on studies published in English may have introduced publication bias, and the quality of included studies varied. The diversity of interventions and outcome measures makes direct comparisons challenging. Lack of reporting on sustainability and integration with existing healthcare services also limits the interpretation of long-term impacts.