Application of the theory of planned behaviour to HIV management and prevention in sub-Saharan Africa: a systematic review

Around 70% of global Human Immunodeficiency Virus (HIV) diagnoses are in sub-Saharan Africa (SSA), where sexual transmission remains the primary mode of HIV transmission. Poor outcomes among persons living with HIV (PLHIV) in SSA are linked to delayed diagnosis, poor linkage to HIV care and suboptimal adherence to antiretroviral therapy (ART). This study is a systematic review of published articles on the application of the theory of planned behaviour (TPB) to HIV prevention and management in SSA. A systematic search was conducted in Google Scholar, Embase, Scopus and PubMed and institutional library searches. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A study conducted in South Africa in 2012 revealed that TPB explained 12% of the variance in intention to adhere to ART. This was slightly higher in Tanzania where the TPB constructs explained 14.7% of intention to adhere to ART. Interestingly the variance was much higher in Malawi where attitudes, subjective norms and perceived behavioural control explained 55% of the variance of intention to adhere to ART. Studies conducted in Ghana, Tanzania, Ethiopia and South Africa revealed that attitude towards the behaviour was a predictor of intention to use condoms consistently. Among all the constructs of the TPB, subjective norms and attitudes towards the behaviour were found to have the most influence on the intention to adhere to ART and consistent condom use. Interventions to improve HIV management and prevention in SSA using the TPB should focus on the significant proximal constructs.