{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:00:38Z","timestamp":1792789238461,"version":"4.5.0"},"reference-count":43,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of P\u00e9cs","id":[{"id":"https:\/\/ror.org\/037b5pv06","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/037b5pv06","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behav. Sci.","Behavioral Sciences"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/bs16091680","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T09:01:38Z","timestamp":1789981298000},"page":"1680","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Economic Empowerment Interventions on Mental Health Outcomes Among People Living with HIV in Low and Middle-Income Countries: A Systematic Literature Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7845-8295","authenticated-orcid":false,"given":"Peter Onchuru","family":"Mokaya","sequence":"first","affiliation":[{"name":"Doctoral School of Health Sciences, Faculty of Health Sciences, University of P\u00e9cs, 7622 P\u00e9cs, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5778-3980","authenticated-orcid":false,"given":"Evans Kasmai","family":"Kiptulon","sequence":"additional","affiliation":[{"name":"Doctoral School of Health Sciences, Faculty of Health Sciences, University of P\u00e9cs, 7622 P\u00e9cs, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahabo Adi","family":"Galgalo","sequence":"additional","affiliation":[{"name":"Doctoral School of Health Sciences, Faculty of Health Sciences, University of P\u00e9cs, 7622 P\u00e9cs, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Elmadani","sequence":"additional","affiliation":[{"name":"Doctoral School of Health Sciences, Faculty of Health Sciences, University of P\u00e9cs, 7622 P\u00e9cs, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2916-1145","authenticated-orcid":false,"given":"Gabriella","family":"Hideg-Feh\u00e9r","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Institute of Physiotherapy and Sport Science, University of P\u00e9cs, 7622 P\u00e9cs, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s12981-020-00291-2","article-title":"Food insecurity and the risk of depression in people living with HIV\/AIDS: A systematic review and meta-analysis","volume":"17","author":"Ayano","year":"2020","journal-title":"AIDS Research and Therapy"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Bernard, C., Dabis, F., and De Rekeneire, N. (2017). Prevalence and factors associated with depression in people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis. PLoS ONE, 12, (8).","DOI":"10.1371\/journal.pone.0181960"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"l6890","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline","volume":"368","author":"Campbell","year":"2020","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"113946","DOI":"10.1016\/j.socscimed.2021.113946","article-title":"Evaluating potential mediators for the impact of a family-based economic intervention (Suubi+Adherence) on the mental health of adolescents living with HIV in Uganda","volume":"280","author":"Byansi","year":"2021","journal-title":"Social Science & Medicine (1982)"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1007\/s10461-025-04628-8","article-title":"Spillover effects of an agricultural livelihood intervention among people living with HIV on community empowerment in Kenya","volume":"29","author":"Chi","year":"2025","journal-title":"AIDS and Behavior"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1097\/QAD.0000000000003948","article-title":"The impact of financial incentives on mental health among adults in HIV care in Lake Zone, Tanzania","volume":"38","author":"Chitle","year":"2024","journal-title":"AIDS"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"20260","DOI":"10.7448\/IAS.18.7.20260","article-title":"Social protection: Potential for improving HIV outcomes among adolescents","volume":"18","author":"Cluver","year":"2015","journal-title":"Journal of the International AIDS Society"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S2352-4642(19)30033-1","article-title":"Improving lives by accelerating progress towards the UN sustainable development goals for adolescents living with HIV: A prospective cohort study","volume":"3","author":"Cluver","year":"2019","journal-title":"The Lancet Child & Adolescent Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/S2352-4642(22)00101-8","article-title":"From surviving to thriving: Integrating mental health care into HIV, community, and family services for adolescents living with HIV","volume":"6","author":"Cluver","year":"2022","journal-title":"The Lancet Child & Adolescent Health"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Conteh, N. K., Latona, A., and Mahomed, O. (2023). Mapping the effectiveness of integrating mental health in HIV programs: A scoping review. BMC Health Services Research, 23, (1).","DOI":"10.1186\/s12913-023-09359-x"},{"key":"ref_11","unstructured":"Covidence (2026). Covidence systematic review software [Computer software], Veritas Health Innovation. Available online: https:\/\/www.covidence.org."},{"key":"ref_12","unstructured":"Critical Appraisal Skills Programme (2025, November 17). Critical Appraisal Skills Programme (CASP). (Qualitative checklist), Available online: http:\/\/www.casp-uk.net\/casp-tools-checklists."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1080\/17441690902942472","article-title":"What makes a structural intervention? Reducing vulnerability to HIV in community settings, with particular reference to sex work","volume":"5","author":"Evans","year":"2010","journal-title":"Global Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gacau, K. K., Mugendi, G., Kiragu, G., Ngayo, M. O., and Omosa, G. (2024). Burden and predictors of anxiety disorder among HIV patients on ART in Nairobi Kenya. PLoS Mental Health, 1, (2).","DOI":"10.1371\/journal.pmen.0000072"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1290427","DOI":"10.1080\/16549716.2017.1290427","article-title":"A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours","volume":"10","author":"Gibbs","year":"2017","journal-title":"Global Health Action"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e394","DOI":"10.1016\/S2352-3018(22)00290-9","article-title":"The effects of cash transfer programmes on HIV\/AIDS prevention and care outcomes: A systematic review and meta-analysis of intervention studies","volume":"10","author":"Magno","year":"2023","journal-title":"The Lancet HIV"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gurnani, V., Beattie, T. S., Bhattacharjee, P., CFAR Team, Mohan, H., Maddur, S., Washington, R., Isac, S., Ramesh, B., Moses, S., and Blanchard, J. F. (2011). An integrated structural intervention to reduce vulnerability to HIV and sexually transmitted infections among female sex workers in Karnataka state, south India. BMC Public Health, 11, (1).","DOI":"10.1186\/1471-2458-11-755"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1007\/s10461-017-1997-x","article-title":"Evaluations of structural interventions for HIV prevention: A review of approaches and methods","volume":"22","author":"Iskarpatyoti","year":"2018","journal-title":"AIDS and Behavior"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Katana, P. V., Abubakar, A., Nyongesa, M. K., Ssewanyana, D., Mwangi, P., Newton, C. R., and Jemutai, J. (2020). Economic burden and mental health of primary caregivers of perinatally HIV infected adolescents from Kilifi, Kenya. BMC Public Health, 20, (1).","DOI":"10.1186\/s12889-020-8435-0"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"341","DOI":"10.2989\/16085906.2016.1241288","article-title":"The intersection of antiretroviral therapy, peer support programmes, and economic empowerment with HIV stigma among HIV-positive women in West Nile Uganda","volume":"15","author":"Kellett","year":"2016","journal-title":"African Journal of AIDS Research"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1080\/09540121.2013.845287","article-title":"A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention","volume":"26","author":"Kennedy","year":"2014","journal-title":"AIDS Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"117546","DOI":"10.1016\/j.socscimed.2024.117546","article-title":"The long-term impact of family economic empowerment on viral suppression and mental health outcomes among adolescents living with HIV in low-income settings: A cluster-randomized controlled trial in Southern Uganda","volume":"364","author":"Kizito","year":"2025","journal-title":"Social Science & Medicine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.socscimed.2010.04.027","article-title":"Poverty and common mental disorders in low and middle income countries: A systematic review","volume":"71","author":"Lund","year":"2010","journal-title":"Social Science & Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"h1258","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical research council guidance","volume":"350","author":"Moore","year":"2015","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e25977","DOI":"10.1002\/jia2.25977","article-title":"Prevalence and factors associated with mild depressive and anxiety symptoms in older adults living with HIV from the Kenyan coast","volume":"25","author":"Mwangala","year":"2022","journal-title":"Journal of the International AIDS Society"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1007\/s10461-019-02443-6","article-title":"Microfinance interventions and HIV treatment outcomes: A synthesizing conceptual framework and systematic review","volume":"23","author":"Nadkarni","year":"2019","journal-title":"AIDS and Behavior"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e25722","DOI":"10.1002\/jia2.25722","article-title":"Mental health interventions for persons living with HIV in low- and middle-income countries: A systematic review","volume":"24","author":"Musisi","year":"2021","journal-title":"Journal of the International AIDS Society"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Nwogwugwu, C., Favor, C., Fu, Y., and Iheanacho, T. (2025). Interventions integrating mental health services into HIV care in Africa; a Scoping Review. International Journal of Public Health, 70.","DOI":"10.3389\/ijph.2025.1608137"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Nyongesa, M. K., Mwangi, P., Kinuthia, M., Hassan, A. S., Koot, H. M., Cuijpers, P., Newton, C. R. J. C., and Abubakar, A. (2021). Prevalence, risk and protective indicators of common mental disorders among young people living with HIV compared to their uninfected peers from the Kenyan coast: A cross-sectional study. BMC Psychiatry, 21, (1).","DOI":"10.1186\/s12888-021-03079-4"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Rosen, J. G., Phiri, L., Chibuye, M., Namukonda, E. S., Mbizvo, M. T., and Kayeyi, N. (2021). Integrated psychosocial, economic strengthening, and clinical service-delivery to improve health and resilience of adolescents living with HIV and their caregivers: Findings from a prospective cohort study in Zambia. PLoS ONE, 16, (1).","DOI":"10.1371\/journal.pone.0243822"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"g7647","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation","volume":"349","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1080\/09540121.2023.2222576","article-title":"The impact of cash incentives on mental health among adults initiating antiretroviral therapy in Tanzania","volume":"36","author":"Sheira","year":"2024","journal-title":"AIDS Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"31999","DOI":"10.3402\/gha.v9.31999","article-title":"The impact of a livelihood program on depressive symptoms among people living with HIV in Cambodia","volume":"9","author":"Shimizu","year":"2016","journal-title":"Global Health Action"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Stoner, M. C. D., Kilburn, K., Godfrey-Faussett, P., Ghys, P., and Pettifor, A. E. (2021). Cash transfers for HIV prevention: A systematic review. PLoS Medicine, 18, (11).","DOI":"10.1371\/journal.pmed.1003866"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1136\/bmjebm-2020-111651","article-title":"Summarising good practice guidelines for data extraction for systematic reviews and meta-analysis","volume":"26","author":"Taylor","year":"2021","journal-title":"BMJ Evidence-Based Medicine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1016\/j.socscimed.2012.02.033","article-title":"Food insecurity, depression and the modifying role of social support among people living with HIV\/AIDS in rural Uganda","volume":"74","author":"Tsai","year":"2012","journal-title":"Social Science & Medicine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s13006-023-00600-1","article-title":"\u201cIt has changed my life\u201d: Unconditional cash transfers and personalized infant feeding support\u2014A feasibility intervention trial among women living with HIV in western Kenya","volume":"18","author":"Tuthill","year":"2023","journal-title":"International Breastfeeding Journal"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e25787","DOI":"10.1002\/jia2.25787","article-title":"HIV-sensitive social protection for vulnerable young women in East and Southern Africa: A systematic review","volume":"24","author":"Loutfi","year":"2021","journal-title":"Journal of the International AIDS Society"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"120196","DOI":"10.1016\/j.jad.2025.120196","article-title":"Addressing depression, stress, and hopelessness through an economic and relationship-strengthening intervention: Findings from a pilot randomized controlled trial among people with HIV in Malawi","volume":"392","author":"Mulauzi","year":"2026","journal-title":"Journal of Affective Disorders"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1037\/hea0000688","article-title":"Effects of trauma, economic hardship, and stress on neurocognition and everyday function in HIV","volume":"38","author":"Watson","year":"2019","journal-title":"Health Psychology"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Wollburg, C., Steinert, J. I., Reeves, A., and Nye, E. (2023). Do cash transfers alleviate common mental disorders in low- and middle-income countries? A systematic review and meta-analysis. PLoS ONE, 18, (2).","DOI":"10.1371\/journal.pone.0281283"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/9\/1680\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:27:36Z","timestamp":1790051256000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/9\/1680"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":43,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["bs16091680"],"URL":"https:\/\/doi.org\/10.3390\/bs16091680","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]}}}