Introduction

Vision correction through spectacle wear represents a critical healthcare intervention globally, with uncorrected refractive error remaining one of the leading causes of visual impairment worldwide.¹ While advancements in optical lens technology have significantly improved vision correction capabilities, delivering these benefits ultimately depends on proper spectacle fit. Ill-fitting frames cause physical discomfort and can lead to optical misalignment, reduced compliance, and persistent visual impairment.^2–4

The global eyewear market continues to expand and is projected to reach USD 178.95 billion by 2026.⁵ However, this growth has not been accompanied by equivalent advances in frame designs that accommodate global populations’ anthropometric diversity. Particularly in Africa, where over 1.3 billion people represent tremendous genetic and phenotypic diversity, the availability of properly fitting eyewear remains a significant challenge.^1,6,7

Historical and contemporary eyewear design has predominantly been informed by European and, more recently, East Asian anthropometric measurements.³ These standards often fail to accommodate the distinct facial features common across various African populations, including differences in nasal bridge height, interpupillary distance, facial width, and orbital structure.^8,9 The result is a substantial disparity in eyewear fit for many African consumers, contributing to discomfort, dissatisfaction, and reduced adherence to the prescribed vision correction.³

The implications of this design mismatch extend beyond mere comfort, affecting clinical outcomes, social acceptance of eyewear, and market accessibility. As vision care programs expand across Africa, addressing this fundamental challenge of appropriate frame design becomes increasingly important for sustainable eye health interventions.¹⁰

This narrative review aims to synthesize existing literature on African facial anthropometry related to spectacle frame design, explore current challenges in eyewear fit for African populations, and identify emerging solutions and opportunities in this field. By bridging knowledge from anthropometry, optical design, materials science, and cultural considerations, this review seeks to contribute to developing more inclusive and appropriate eyewear solutions for African consumers.

Methodology

This study employed a narrative review approach to synthesize existing literature on African facial anthropometry and its implications for spectacle frame design. A comprehensive search was conducted using academic databases, including PubMed, Google Scholar, Scopus, and EBSCOHost. Keywords used in the search included “African facial anthropometry”, “spectacle frame design”, “eyewear fit”, “craniofacial dimensions”, “spectacle frame design”, and “ethnic variations in eyewear.”

Inclusion criteria comprised peer-reviewed journal articles, books, and industry reports providing insight into the anthropometric characteristics of African populations and their relevance to eyewear design. Studies published between 2000 and 2025 were prioritised to ensure contemporary relevance, though seminal older works were included where appropriate. Studies focusing exclusively on Eurocentric and Asian facial models without comparative analysis were excluded.

The literature retrieved was reviewed for key themes, including nasal bridge structure, facial width, temple length, head shape, and cheekbone prominence. Additionally, studies on material innovations, technological advancements, and localised eyewear production were considered to explore solutions for improving spectacle frame fit for African users.

Data were analyzed qualitatively to identify trends, challenges, and future research and product development implications. This methodological approach ensures a comprehensive understanding of the subject matter while highlighting the gaps in the existing literature that warrant further investigation.

Anthropometric Considerations in Spectacle Frame Design

Critical Facial Measurements for Eyewear Fit

The proper fit of spectacle frames depends on several key facial measurements that determine how frames sit on the face and align with the eyes. These critical measurements include:

Interpupillary Distance (IPD)

The distance between the pupil centres affects lens centration and the optical performance of spectacles. Research has demonstrated significant variations in IPD across different populations, with implications for frame bridge width requirements.^8,11,12

Nasal Root Height and Width

The height and width of the nasal root directly impact how frames sit on the face. A lower nasal bridge height may cause frames to slide down, while width variations affect pressure distribution and stability.¹³

Bitragal Width

This measurement across the face at the ear level influences the required frame width and temple length. Frames that are too narrow or wide relative to this measurement cause discomfort through excessive pressure or instability.¹⁴

Frontozygomatic Distance

The distance between the outer corners of the eye orbits affects frame front size and lens positioning. This measurement varies significantly across populations and may impact peripheral vision through spectacle frames.^15–17

Head Circumference

This measurement influences temple length requirements and overall frame stability. Variations in head circumference affect the tension required for frames to remain secure without causing discomfort.^11,15

Vertex Distance

The distance from the corneal apex to the back surface of the spectacle lens affects optical performance, particularly for higher prescriptions. Anthropometric variations influencing this distance have direct clinical implications.¹⁸

These measurements form the foundation for ergonomic frame design, with deviations from the intended fit potentially causing both physical discomfort and optical performance issues. Studies by Naude and Campbell,³ Halladay et al,¹¹ Rosyidi et al.,¹⁵ and Tian and Ball¹⁹ have demonstrated that even small discrepancies between facial anthropometry and frame dimensions can significantly impact the wearers’ comfort and compliance.

The following diagram depicts anthropometric measurements that may be relevant to spectacle frame design (Figure 1):

Figure 1 Facial anthropometric measurements relevant to spectacle frame design (designed by authors). (a) Inner-intercanthal distance. (b) Outer-intercanthal distance. (c) Nose width. (d) Face width. (e) Head width. (f) Frontal angle. (g) Temple length. (h) interpupillary distance. (i) crest angle.

African Facial Anthropometry: Key Findings

Research on African facial anthropometry has revealed distinct patterns that differentiate these populations from European and Asian groups for whom most spectacle frames are designed. While acknowledging the tremendous diversity within the African continent, several commonalities have been identified that have particular relevance to eyewear design:

Nasal Bridge Characteristics

The nasal bridge represents one of spectacle fit’s most critical anatomical features. Research has consistently demonstrated significant variation in nasal bridge dimensions across different African populations. Farkas et al²⁰ conducted comprehensive anthropometric studies across multiple ethnic groups and found that individuals of African descent typically present with wider and flatter nasal bridges compared to Caucasian populations.

Interpupillary Distance

Pivnick documented that African populations generally exhibit wider interpupillary distances compared to European counterparts.²¹ Their research indicated a mean IPD of approximately 66.1 mm in adult African males compared to or mm in European males. Whilst in more recent studies, Halladay et al¹¹ noted that Malawi children could wear eyewear designed for the Chinese population. This further highlights the variation in interracial facial anthropometric measurements. A study by Butler et al,²² noted that the mean IPD was significantly greater than international standards used in mass-produced eyewear, suggesting potential issues with optical centration in standard spectacle frames. Modrolu et al²³ and Moodley et al² emphasised that improper alignment of optical centres, often resulting from inappropriate IPD consideration in eyewear design, can induce prismatic effects, causing visual discomfort and adaptation issues.

Facial Width Measurements

Oladipo et al¹⁶ conducted anthropometric studies in Nigeria and found that bizygomatic width (the maximum distance between the most lateral points of the zygomatic arches) was significantly greater in their study population compared to Caucasian reference standards. In another comparative study of facial dimensions across multiple ethnicities, they noted that African populations typically exhibited greater facial width-to-height ratios than Asian and European populations.⁹ This finding has significant implications for temple length and frame front dimensions in eyewear design.

Bitemporal Proportions

Ofodile and Bhokari²⁴ documented greater bitemporal widths in African populations than European reference standards. Their work suggested that standard eyewear frames often provide insufficient temple coverage for individuals of African descent. Naude and Campbell³ highlighted that ill-fitting temple dimensions represent one of the most common complaints among African eyewear consumers, with many reporting discomforts due to excessive temple pressure or insufficient temple length.

Orbital Structure

Barretto and Mathog²⁵ observed that African populations typically present with larger orbital apertures and more slightly rectangular orbital shapes compared to the more circular orbits common in European populations. Jilani et al²⁶ documented greater orbital heights in African populations compared to Asian populations, while orbital widths were comparable. These findings suggest the need for different approaches to lens shape and frame design to appropriately accommodate these variations.

These anthropometric differences have substantial implications for spectacle fit. Conventional frames, which are typically designed based on European facial structures often create fitting challenges for African wearers. Common issues include frames slipping down the nose due to lower nasal bridge height, bridge pinching or visible gaps resulting from broader nasal structures, and temple discomfort or looseness caused by variations in head circumference. Additionally, differences in IPD can lead to optical misalignment, while variations in orbital and cheekbone structure may result in frame front instability or localized pressure points, ultimately compromising both comfort and visual performance.

Regional Variations Within Africa

While certain anthropometric patterns appear common across African populations, significant regional variations exist that further complicate spectacle frame design. The continent’s tremendous genetic diversity manifests in measurable craniofacial differences between populations:

Southern Africa

Black South African women exhibit wider nasal widths, averaging 40.4 mm in a study conducted by Wilson et al⁹ and greater nasal tip projection compared to the Congolese and African American populations. Their facial height proportions also diverge from neoclassical norms, with shorter upper facial thirds relative to mid and lower thirds.⁹ Among Zimbabwean rural populations, studies show narrower interpupillary distances of 60.7 mm in males and 59.5 mm in females but larger bitemporal width of 147.7 mm in males and 141.3 mm in females compared to Asian and Caucasian populations.²⁷ These metrics conflict with standard frame designs, leading to discomfort and poor fit.

Eastern Africa

Studies have shown that Kenyan and Sudanese populations exhibit distinct midface-to-lower face ratios compared to Southern African groups, necessitating adjustments in frame curvature and lens positioning.⁹

West Africa

Schoolchildren in Enugu, Nigeria, prioritize frame aesthetics, favouring oval shapes 47.2% and metallic colours 29.5%, with rural children more likely to choose thicker frames.²⁸ These preferences intersect with anthropometric needs, such as broader head widths observed in Ghanaian studies.²⁹ West African populations generally have shorter front-to-bend measurements than Southern African groups, possibly influencing the sidepiece design.

North Africa

Limited published data exists, but proximity to Mediterranean and Middle Eastern populations suggests narrower nasal bridges and smaller head widths compared to sub-Saharan regions. Urban centres like Cairo may exhibit hybrid features due to migration, though rural areas likely retain more homogeneous traits.

The following Table 1 is a summary of key facial anthropometric measurements relevant to spectacle frame design – specifically, nasal width, nasal bridge height, intercanthal width, facial width, and temple length, across African, European, and Asian populations. These values are means or typical ranges reported in relevant literature.

Table 1 A Summary of Key Facial Anthropometric Measurements Relevant to Spectacle Frame Design

Urban vs Rural Dynamics in Eyewear Fit and Access

The dynamics of spectacle frame access, use, and fit vary significantly between urban and rural settings, influenced by differences in infrastructure, cultural perceptions, and facial anthropometry.

Access and Infrastructure

Urban areas host optical chains and private optometry practices offering a wide selection of spectacle frames, including modern, customizable options. These environments often support onsite adjustments and professional fittings. In contract, rural regions are more reliant on sporadic outreach services or informal vendors who supply generic, often ill-fitting frames.³⁴ For example, in rural Zimbabwe, 54.2% of vision impairment due to uncorrected refractive error is exacerbated by limited access to eyecare services and appropriate spectacle correction.^27,35

Cultural Perceptions

Cultural attitudes toward spectacles differ between urban and rural populations. Urban youth tend to view eyewear as both a vision aid and a fashion accessory, often favouring lightweight, trendy, and expressive frame styles.^28,34 In contrast, many rural populations perceive spectacles primarily as medical devices, which contributes to lower adoption rates and poor compliance. Negative beliefs or stigma surrounding spectacle wear—especially for children—persist in some rural areas, where they may be associated with illness, disability, or age.³⁴ These perceptions can undermine public health efforts to improve visual outcomes through corrective eyewear.

Anthropometric Variability

Urbanisation and migration patterns have led to increased diversity in facial features within city populations, resulting in a wider range of anthropometric measurements. This necessitates the availability of adjustable or customisable frame designs to accommodate the heterogeneity in facial dimensions. Conversely, rural populations often exhibit more homogenous anthropometric profiles, which theoretically allows for targeted frame designs. However, these communities typically lack access to frames tailored to their specific facial dimensions. Generic imported frames—usually based on European or East Asian facial standards—fail to align with the broader nasal widths, flatter nasal bridges, and wider interpupillary distances more common in African rural populations.³⁴

This analysis underscores the need for location-specific approaches in spectacle frame design, distribution, and promotion. Addressing rural-urban disparities requires not only improved infrastructure and access but also culturally sensitive, anthropometrically appropriate eyewear solutions that promote comfort, compliance, and visual health equity.

Current Challenges in Spectacle Frame Design in African Populations

Commercial Availability and Market Gaps

The global eyewear industry has historically underserved African markets with appropriately designed frames. Several factors contribute to this persistent gap:

Dominance of Eurocentric Design Standards

Globally, the spectacle frame industry continues to be dominated by Eurocentric anthropometric norms. Over 80% of eyewear designs are based on European and North American facial measurements,³ resulting in widespread fit mismatches for many African consumers. This legacy of Eurocentric design undermines comfort, stability, and visual performance in African populations, whose craniofacial dimensions often differ significantly.

Limited Market Research

Major eyewear manufacturers have historically invested minimal resources in understanding African consumer needs. Unlike the Asian market—where extensive anthropometric research has led to tailored frame designs—African populations remain underrepresented in global design strategies. Naude and Campbell³ highlight that African-specific research and development are scarce, with limited local data informing global product lines.

Supply Chain Challenges

The distribution of eyewear in many African markets faces significant logistical hurdles. Key issues include poor transportation infrastructure:

• Transportation Infrastructure Limitations: Poor road conditions, long lead times due to border delays, and security concerns (including theft during transit) severely impact the timely and safe delivery of eyewear products. Studies in South Africa highlight how defective roads cause damage to transport fleets and products, while border congestion and customs delays further extend delivery times, increasing costs and risks.³⁶ Additionally, congestion in urban centres can cause delays of days, complicating distribution planning.
• Impact on Manufacturers: These logistical challenges disincentivise major eyewear manufacturers from investing in Africa-specific product lines because the cost and complexity of distribution reduce profitability and market predictability.^36,37

Price Sensitivity

African markets are highly price-sensitive, which creates tension between the need for specialised, culturally appropriate eyewear designs and affordability:

• Willingness to Pay: Research indicates that low- and middle-income consumers in low- and middle-income countries (LMIC), including many African markets, are willing to pay no more than about 10% of their monthly income for spectacle, often equating to just a few dollars (eg, around $3.80). This price sensitivity is driven by limited disposable income and competing priorities.
• Premium Pricing for Specialised Designs: Spectacle frames designed specifically for African facial features tend to command premium prices, which limits accessibility for the majority of consumers. The high cost is often due to smaller production volumes, import costs, and a lack of local manufacturing capacity. This premium pricing conflicts with the affordability needs of the market.

Fragmented Retail Environments

The optical retail landscape in Africa is highly fragmented, ranging from sophisticated urban optical shops to basic rural dispensing services:

• Diverse Retail Formats: While urban centres may have modern optical shops, the majority of eyewear sales occur through informal or small-scale outlets such as mom-and-pop shops, kiosks, or rural clinics. This fragmentation complicates distribution and market penetration for specialized frame designs.
• Distribution Challenges: Serving a widely dispersed and fragmented retail base is costly and logistically complex. Small retail outlets often have limited cash flow and storage capacity, requiring intermediaries to break bulk and adding layers to the supply chain.
• Supply Chain Visibility and Technology: Limited visibility across the supply chain and the high cost of technology solutions hinder efficient distribution. Companies often rely on third-party logistics providers (3PLs) familiar with local customs and regulations, but last-mile delivery remains a challenge.
• Market Entry Barriers: The fragmentation and diversity of retail environments create significant barriers for new entrants and specialised product lines, requiring tailored distribution strategies and local partnerships.

Clinical Implications of Poor Frame Fit

The mismatch between available frame designs and African facial anthropometry creates several clinical challenges with direct impact on vision care outcomes:

Optical Misalignment

When frames do not properly align with the face, the optical centres of lenses may be displaced from the pupillary axis. Research by Moodley et al² demonstrated that a majority of the participants were found not to be looking through the optical centres of their lenses, compromising corrective outcomes.

Reduced Compliance

Discomfort from poorly fitting frames directly impacts wearer compliance.^2,38 Omolase and Mahmoud³⁹ found that among Nigerian patients prescribed spectacles, 28% of the participants reported non-compliance due to ill-fitting frames.

Vertex Distance Variations

Misfit frames—particularly those with poorly aligned nose bridges or temples—alter the vertex distance unpredictably. This is especially problematic for higher prescriptions, where optical performance is sensitive to this variable.¹⁸

Limited Options for Speciality Needs

Specific clinical needs, such as frames for children, sports eyewear, safety glasses, and low vision devices, are particularly underserved. Kumaran and Periakaruppan⁴⁰ expressed that in a majority of cases, spectacle frames for children are a reduced version of adult frames, lacking consideration for paediatric craniofacial dimensions and activity levels.

These clinical implications extend beyond mere discomfort, directly affecting the efficacy of vision correction and potentially compromising clinical outcomes in vision care programs.

Socio-Cultural Factors Affecting Eyewear Adoption

Beyond technical and clinical considerations, several socio-cultural factors influence eyewear adoption and preferences in African contexts:

Aesthetic Preferences

Cultural aesthetics and beauty standards influence frame style preferences. Research by Naude and Campbell³ indicated that frame designs popular in Western markets often failed to align with local aesthetic preferences in multiple African countries, adding another dimension to design considerations beyond anatomical fit.

Stigma and Social Perception

In some communities, eyewear continues to carry social stigma or specific associations. In certain communities, spectacle wear was associated with ageing or disability, creating social barriers to adoption that compound technical fit issues.^41,42

Gender Considerations

Gender roles and expectations influence eyewear preferences and adoption patterns. Research has found significant gender differences in frame style preferences and comfort priorities, with women more frequently reporting concerns about aesthetic impact and men more frequently prioritising durability.^41,43

Traditional Healing Perspectives

In communities where traditional healing practices remain prominent, the adoption of corrective eyewear may interact with existing health belief systems. Understanding these interactions is essential for culturally appropriate design and distribution approaches.^44,45

Climate Adaptations

Environmental factors including heat, humidity, and dust affect frame performance requirements. Some spectacle frame materials performing well in temperate climates may fail prematurely in tropical African environments, necessitating different material selection priorities.⁴⁶

Addressing these socio-cultural dimensions alongside technical fit considerations represents a critical challenge for improving spectacle frame design for African consumers. Naude and Campbell³ argue that these considerations should not be treated as peripheral but as foundational to creating equitable and contextually appropriate eyewear solutions.

Innovations and Solutions

Anthropometric Research and Databases

Recent efforts to address the gap in African anthropometric data include:

Digital Anthropometric Mapping

The use of 3D scanning technologies has significantly enhanced the precision and scale of facial anthropometry studies. Adekunle et al⁴⁷ determined normative facial anthropometry measurement among 452 Nigerians using a 3D stereophotogrammetry analysis, which showed that there was a significant difference in the facial dimensions of males compared to females across all age groups included in the study.

Mobile Measurement Technologies

Innovations in smartphone-based anthropometric measurement tools show promise for expanding data collection capacity. Hartmann et al⁴⁸ validated a smartphone application capable of measuring key facial dimensions with accuracy comparable to traditional anthropometric tools, potentially enabling wider-scale data collection.

These research initiatives provide essential foundations for improved frame design, though significant gaps remain, particularly regarding systematic data collection across diverse African populations and age groups.

Frame Design Adaptations

Several design approaches have emerged to better accommodate African facial anthropometry:

Adjustable Bridge Systems

Innovative bridge designs including articulated, adjustable, and floating bridge systems allow for customization to different nasal bridge heights and widths. Thermoplastic materials like cellulose acetate allow heat-adjustable bridges to accommodate wider nasal measurements common in sub-Saharan populations.⁴⁶

Modified Pad Arms and Positioning

Specialized pad arm geometries and positioning accommodate lower nasal bridge heights while maintaining frame stability. Replace traditional rigid pads with flexible silicone versions that conform to diverse nasal bridge heights and widths, reducing pressure points.⁴⁹

Temple Design Modifications

Temples with adjusted length-to-curve ratios better accommodate head circumference variations. African populations show wider head widths, for example, Zimbabwean and Ghanaian males, when compared to their Asian averages of 136–140 mm, requiring temples up to 150 mm with graduated curvature.^11,27 The use of cable temples is also recommended; the curved riding bow designs prevent slippage in active wearers, particularly beneficial for rural populations engaged in physical labour.⁴⁹

Frame Front Curvature Adaptations

Modified frame front curvatures better accommodate wider facial measurements.

Weight Distribution Engineering

Innovative approaches to frame weight distribution compensate for lower nasal bridge support.

These design adaptations demonstrate potential for improving frame fit for African wearers, though their availability remains limited in most markets.

Material Innovations

Novel materials offer potential solutions to specific challenges in frame fit for African populations:

• Variable Flexibility Materials: New polymer blends providing graduated flexibility allow frames to conform to diverse facial structures.
• Climate-Appropriate Materials: Materials engineered for performance in tropical climates address durability and comfort challenges.
• Biocompatible Materials: Advanced biocompatible materials reduce skin reactions and irritation, particularly important in humid climates.
• Memory Materials: Shape-memory alloys and polymers enable frames to maintain custom adjustments while providing flexibility. Research found that frames incorporating these materials required re-adjustment less frequently than conventional frames.^19,50
• Lightweight Composites: Ultra-lightweight composite materials reduce pressure concerns related to lower nasal bridge support.

While promising, many of these material innovations remain at premium price points, limiting their accessibility in price-sensitive markets. However, they demonstrate pathways for addressing specific fit challenges through material selection and engineering.

Digital Manufacturing and Customization

Emerging digital technologies offer new approaches to frame customization:

• 3D Scanning and Printing: Digital facial scanning paired with 3D printing enables truly customized frame production.
• Parametric Design Systems: Software utilizing parametric design principles allows semi-customization based on key measurements.
• Virtual Try-On Technologies: Advanced virtual try-on systems incorporate anthropometric analysis to recommend appropriate frame styles.
• Mass Customization Approaches: Modified Production Systems Enable Cost-Effective Customization at Scale.
• Modular Frame Systems: Component-based frames allowing interchange of bridges, temples, and fronts offer practical customisation options.

These technological approaches show particular promise for addressing the diversity of anthropometric needs within African populations, though implementation challenges, including equipment costs, technical training, and infrastructure requirements, remain significant barriers to widespread adoption.

Conclusion

This narrative review has examined the critical relationship between African facial anthropometry and spectacle frame design, revealing persistent challenges in providing appropriately fitting eyewear to diverse African populations. The literature clearly demonstrates that facial measurements common across various African populations often differ significantly from the European and East Asian standards that inform most commercial frame designs. These differences, particularly in nasal bridge structure, facial width, and orbital characteristics, create fundamental fit challenges affecting comfort, stability, and optical performance.

The implications extend beyond mere comfort, impacting clinical outcomes through reduced compliance, optical misalignment, and limited options for specialized needs. Socio-cultural dimensions further complicate eyewear adoption, with aesthetic preferences, social perceptions, and environmental factors influencing successful frame design and selection.

Emerging solutions offer promising directions for improvement. Expanded anthropometric research provides essential foundations for evidence-based design, while innovations in adjustable frame systems, appropriate materials, and digital customisation technologies demonstrate pathways to better-fitting eyewear. Case studies from various African contexts illustrate both successful approaches and implementation challenges in translating anthropometric knowledge into practical improvements.

Looking forward, priorities include expanded research representation across Africa’s diverse populations, industry adaptation through broader size ranges and region-appropriate designs, clinical practice improvements through measurement protocols and fitting expertise, and technological innovation enabling greater customization and accessibility.

The development of spectacle frames truly appropriate for African facial anthropometry represents not merely a technical challenge but an essential component of equitable global eye care. As vision correction programs expand across Africa, addressing this fundamental aspect of appropriate eyewear becomes increasingly critical for sustainable impact. The evidence suggests that through combined efforts in research, design innovation, clinical practice, and technology development, significant improvements in spectacle frame fit for African populations are both possible and necessary.

Disclosure

The authors report no conflicts of interest in this work.

References

1. WHO. Promising progress on eye health in African region, but challenges remain Brazzaville 2024. Available from: https://www.afro.who.int/news/promising-progress-eye-health-african-region-challenges-remain#:~:text=In%20addition%2C%20only%2012%25%20of,unhealthy%20lifestyles%2C%20and%20noncommunicable%20diseases. Accessed October 3, 2025.

2. Moodley VR, Kadwa F, Nxumalo B, Penceliah S, Ramkalam B, Zama A. Induced prismatic effects due to poorly fitting spectacle frames. Afr Vision Eye Health. 2011;70.

3. Naude M, Campbell AD. Not the “regular” fit: a socio-technical systems approach to designing eyewear in South Africa. In: Trimble J, Osman A, Stephenson B, Kadoda G, editors. 9th International Conference on Appropriate Technology; Pretoria: Tshwane University of Technology; 2020.

4. Thompson AJ. Paediatric Facial Anthropometry Applied to Spectacle Frame Design [Doctoral Thesis] Aston University; 2021.

5. Insights FB. Eyewear market to hit USD 178.95 billion by 2026; COVID-19 scare to propel the demand exponentially owing to deteriorating eye health: fortune business insights 2020. Available from: https://www.globenewswire.com/news-release/2020/05/22/2037705/0/en/Eyewear-Market-to-Hit-USD-178-95-Billion-by-2026-COVID-19-Scare-to-Propel-the-Demand-Exponentially-Owing-to-Deteriorating-Eye-Health-Fortune-Business-Insights.html. Accessed October 3, 2025.

6. van Staden D, Munsamy A. Integrated, people-centred eye care: why South Africa needs to prioritise. South Afr Med J. 2021;111(10):924. doi:10.7196/SAMJ.2021.v111i10.15918

7. Gomez F, Hirbo J, Tishkoff SA. Genetic variation and adaptation in Africa: implications for human evolution and disease. Cold Spring Harbor Perspect Biol. 2014;6:a008524.

8. Mhaleni V, Maponya M, Ramakatsa L, Mahlakwana L, Mathebula SD. Interpupillary distance measurements for the African population of Polokwane in Limpopo province, South Africa. Afr Vision Eye Health. 2021;80(1). doi:10.4102/aveh.v80i1.582

9. Wilson S, Medapati V, Segwapa K. Facial anthropometric norms of the Young Black South African woman. Plastic Reconstruct Surg Global Open. 2023;11(4).

10. Buthelezi LM, van Staden D. Integrating eye health into policy: evidence for health systems strengthening in KwaZulu-Natal. Afr Vision Eye Health. 2020;79.

11. Halladay AC, Thandiwe M, Ayerakwah P, Dennis S, Manjariwa J, George K. Ophthalmic anthropometry of an urban malawian population. Cogent Med. 2019;6(1):1614287. doi:10.1080/2331205X.2019.1614287

12. Tang CY, Tang N, Stewart MC. Facial measurements for frame design. Optometry Vision Sci. 1998;75(4):288–292. doi:10.1097/00006324-199804000-00027

13. Gowing J. Paediatric eye care – Part 1. Optician. 2017;2017(11):6837. doi:10.12968/opti.2017.11.6837

14. Greening D. Eyeglass frame size: a comprehensive guide 2023. Available from: https://www.astorinoeyecare.com/blog/eyeglass-frame-size-a-comprehensive-guide. Accessed October 3, 2025.

15. Rosyidi C, Riyanti N, Iftadi I. Head and facial anthropometry for determining the critical glasses frame dimensions. J Eng Sci Technol. 2016;11(11).

16. Oladipo GS, Okoh PD, Akande PA, Oyakhire MO. Anthropometric study of some craniofacial parameters: head circumference, nasal height, nasal width and nasal index of adult Omoku indigenes of Nigeria. Ame J Sci Indust Res. 2010;2(1).

17. Gupta V, Sodhi P, Pandey R. Normal values for inner intercanthal, interpupillary, and outer intercanthal distances in the Indian population. Int J Clin Pract. 2003;57(1):25–29. doi:10.1111/j.1742-1241.2003.tb11392.x

18. Costa Neto A, Guedes J, Mora-Perez DJ, et al. Vertex distance variability of the Vision-S 700 refractors in normal population. Rev Bras Oftalmol. 2024;83.

19. Tian Y, Ball R. Parametric design for custom-fit eyewear frames. Heliyon. 2023;9(9):e19946. doi:10.1016/j.heliyon.2023.e19946

20. Farkas LG, Katic MJ, Forrest CR. International anthropometric study of facial morphology in various ethnic groups/races. J Craniofac Surg. 2005;16(4):615–646. doi:10.1097/01.scs.0000171847.58031.9e

21. Pivnick E, Rivas M, Tolley E, Smith S, Presbury G. Interpupillary distance in a black population. Clin Genet. 1999;55(3):182–191. doi:10.1034/j.1399-0004.1999.550306.x

22. Butler MA, Jowell ME, Clarke-Farr PC. Analysis of readymade readers and near-interpupillary distance for presbyopic patients in optometric practice in Cape Town, South Africa. Afr Vision Eye Health. 2016;75(1). doi:10.4102/aveh.v75i1.316

23. Madrolu VSK, Male SR, Bhardwaj R. Influence of prismatic effect due to decentration of optical center in ophthalmic lens. Health Sci Rep. 2023;6.

24. Ofodile F, Bhokari F. The African-American Nose (Part II). Ann Plastic Surgery. 1995;34(2):123–129. doi:10.1097/00000637-199502000-00003

25. Barretto RL, Mathog RH. Orbital Measurement in Black and White Populations. Laryngoscope. 1999;109(7):1051–1054. doi:10.1097/00005537-199907000-00007

26. Jilani SK, Ugail H, Logan A. Inter-ethnic and demic-group variations in craniofacial anthropometry: a review. PSM Biolog Res. 2019;4(1).

27. Kyei S, Tagoh S, Kwarteng M, Aboagye E. Ophthalmic anthropometry among rural dwellers in Mashonaland Central Province, Zimbabwe. Rwanda J Med Health Sci. 2021;4(1):99–111. doi:10.4314/rjmhs.v4i1.8

28. Aghaji A, Udeh N, Okoye O, et al. Spectacle design preferences among school children in Enugu State, Nigeria. Niger J Clin Pract. 2021;24.

29. Ilechie AA, Asiaku J. Ophthalmic anthropometry for Ghanaian adults. J Health Visual Sci. 2010;12(1).

30. Sarna K, Sonigra K, Ngeow WC. A cross-sectional study to determine and compare the craniofacial anthropometric norms in a selected Kenyan and Chinese population. Plastic Surg. 2023;31(1):84–90. doi:10.1177/22925503211024763

31. Shah R, Frank-Ito DO. The role of normal nasal morphological variations from race and gender differences on respiratory physiology. Respir Physiol Neurobiol. 2023;297.

32. McDowell JL, Kenyhercz MW, L’ Abbe ENL. An evaluation of nasal bone and aperture shape among three South African populations. Forensic Sci Int. 2015;252.

33. Bouhadana G, Gornitsky J, Saleh E, Oliveira Trabelsi N, Borsuk DE. Expanding the classic facial canons: quantifying intercanthal distance in a diverse patient population. Plastic Reconstruct Surg Global Open. 2022;10(4):e4268. doi:10.1097/GOX.0000000000004268

34. Karnani A, Garrette B, Kassalow J, Lee M. Better vision for the poor: Stanford Social Innovation Review; 2011. Available from: https://ssir.org/articles/entry/better_vision_for_the_poor#. Accessed October 3, 2025.

35. Tagoh S, Kyei S, Kwarteng M, Aboagye E. Prevalence of refractive error and visual impairment among rural dwellers in Mashonaland Central Province, Zimbabwe. J Curr Ophthalmol. 2020;32(4):402–407. doi:10.4103/JOCO.JOCO_224_20

36. Jaqueta SD, Mashilo EN, Mocke K, Agigi AFA. Physical distribution challenges and adaptations: a qualitative study of South Africa-based organisations operating in emerging African markets. J Transport Supply Chain Manage. 2020;14.

37. Mbekeani K. Understanding the Barriers to Regional Trade Integration in Africa. Tunisia: African Development Bank; 2013.

38. Farmer M. Spectacle Wear Compliance 2012. Available from: https://www.opticianonline.net/content/features/spectacle-wear-compliance/. Accessed October 3, 2025.

39. Omolase CO, Mahmoud AO. Factors associated with non-compliance with spectacle wear in an adult Nigerian population. Afr J Biomed Res. 2009;12(1).

40. Kumaran SL, Periakaruppan SP. Ophthalmic anthropometry versus spectacle frame measurements: is spectacle fit in children compromised? Asian J Pharmace Res Health Care. 2022;14.

41. Ezinne NE, Mashige KP, Akano OF, Ilechie AA, Ekemiri KK. Spectacle utilisation rate and reasons for non-compliance with wearing of spectacles amongst primary school children in Onitsha, Anambra State, Nigeria. Afr Vision Eye Health. 2020;79(1). doi:10.4102/aveh.v79i1.544

42. Zulu NL, van Staden D. Experiences and perceptions of South African optometry students toward public eye care services. Afr Vision Eye Health. 2023;82(1). doi:10.4102/aveh.v82i1.726

43. Ramlagun K. Aesthetics and Spectacle Wear: Investigating Perceived Harmony Between Face Shape and Spectacle Frame Shape [PhD Thesis]. Anglia Ruskin University; 2024.

44. Enimah E, Nirghin U, Boadi-Kusi SB, Ntodie M. Determinants of traditional eye practices amongst rural dwellers in the Asikuma Odoben Brakwa District, Ghana. Afr Vision Eye Health. 2022;81(1). doi:10.4102/aveh.v81i1.678

45. Buthelezi S, Gerber B. Cultural Competence in ophthalmic dispensing education: a qualitative study. Adv Med Educ Prac. 2024;15(585):–94. doi:10.2147/AMEP.S438707

46. Hansraj R, Govender B, Joosab M, Magubane S, Rawat Z, Bissessur A. Spectacle frames: disposal practices, biodegradability and biocompatibility – a pilot study. Afr Vision Eye Health. 2021;80(1). doi:10.4102/aveh.v80i1.621

47. Adekunle AA, Olowo AY, James O, et al. Facial anthropometry measurement using 3D stereophotogrammetry analysis among Nigerians. J Craniofacial Surg. 2022;33(4):1178–1181. doi:10.1097/SCS.0000000000008036

48. Hartmann R, Nieberle F, Palm C, et al. Utility of smartphone-based three-dimensional surface imaging for digital facial anthropometry. JPRAS Open. 2024;39.

49. Aravind Eye Care System A. Optical Sales and Dispensing – a Practical Guide. First ed. Tamilnadu: Aravind Eye Hospital; 2007.

50. Walsh G, Wilkinson M. Materials and allergens within spectacle frames: a review. Contact Dermatitis. 2006;55(3):130–139. doi:10.1111/j.1600-0536.2006.00791.x

Introduction

The global response to HIV, which has spanned several decades,^1,2 is currently at an inflection point. By 2023, the number of individuals receiving life-saving antiretroviral therapy had reached nearly 31 million, while the number of those living with HIV who were not receiving such therapy stood at 9.3 million. This public health success has led to a significant reduction in the number of AIDS-related deaths, which have now reached their lowest level since the peak in 2004.¹

In the Democratic Republic of Congo, the epidemic is considered generalized (with a low prevalence of 1.2%, a seroprevalence rate of 1.6% in women aged 15 to 49 years and 0.6% in men of the same age), with epidemic foci in mining communities (Haut-Katanga and Lualaba) and urban centers of Kinshasa.³

The international community’s commitment to the Sustainable Development Goals (SDGs) has led to significant progress in the fight against HIV, with the eradication of HIV as a public health threat being considered a realistic possibility by 2030. However, the accession to power of the new US administration has led to a setback in these efforts, jeopardising the progression of HIV as a public health threat.^4,5 However, the continued provision of “life-saving humanitarian assistance” has been facilitated by UNAIDS, which has obtained an exemption, thus ensuring the continuation or resumption of essential medicines and medical services, including HIV treatment, as well as the necessary supplies for this assistance. Furthermore, UNAIDS has committed to the continuation of its efforts in favour of other essential components of the PEPFAR (Emergency Programme of Health and HIV Prevention Services, Care and Support for Orphans and Vulnerable Children) initiatives.⁴

In this context of uncertainty, it becomes imperative to explore ways to improve the psychosocial and economic support provided to these Children people in a country facing aggression from armed groups. HIV/AIDS is now considered a chronic disease, causing not only physical health complications.⁶

This situation also affects Children people living with HIV, and is accompanied by a large number of children entering adolescence and adulthood with a chronic infectious disease, thanks in particular to psychosocial and economic support services.⁷

However, existing research reveals a lack of psychosocial and economic support for children and young people living with HIV (CPLHIV). Existing research shows that young people living with HIV do not receive sufficient psychosocial and economic support^7–11. A review demonstrated that treatment adherence, disclosure of HIV status, gender-related issues and lack of support networks are problems faced by CPLHIV across the world.

In the DRC, particularly in Lubumbashi, health and community professionals play a key role in providing holistic care and treatment for people living with HIV, especially young people. As front-line workers, they have a comprehensive understanding of the challenges faced by children living with HIV and how these challenges are perceived and experienced, including those not expressed by the children themselves. This perception of the psychosocial and economic challenges faced by children living with HIV can therefore inform the design of viable policies and programmes.^12–17 Our study also includes community members, such as adolescent and adult peer educators, providing a broader view of the situation.¹⁸

This study therefore aims to determine the challenges requiring psychosocial and economic support faced by Children living with HIV, to describe the interventions in place and to explore the experience of professionals providing psychosocial support to Children people living with HIV in Lubumbashi, in the current context of uncertainty.

Methods

Study Framework

Katuba health zone (Figure 1),¹⁹ in the city of Lubumbashi, capital of the Haut-Katanga province in the Democratic Republic of Congo. It involved eight structures in this zone: the KATUBA General Reference Hospital, the BUKAMA Reference Health Center, the POLY BARAKA, the CDTI Health Center, the AVE MARIA Health Center, the MASAIDIANO Health Center, the LWIZI Health Center and the MANE CACHEE Health Center (Table 1). All these health care establishments (ESS) were targeted because they have an HIV/AIDS care service.

Table 1 List of ESS

Figure 1 Health map of the city of Lubumbashi, DRC, subdivided into health zone and Katuba health zone surrounded by a red frame.

Study Design

The present study adopted a descriptive case study approach,²⁰ employing a phenomenological qualitative method, in order to ascertain the psychosocial and economic support care provided to persons living with HIV (PLHIV).^21,22 In order to achieve the objectives of the study, the views of providers and community workers (case managers and peer educators) were canvassed. The research took place over an eight-month period, from June 1, 2024 to February 8, 2025, with data collection between July 1 and August 1, 2024.

Sampling

The study covered all staff working in the field of CPLHIV care in health facilities in the Katuba Health Zone. The study population was organized into three hierarchical levels: the focal points of each health facility, then the peer educators and the case managers. In order to ensure optimal representativeness of the study population, targeted (or purposive) sampling was methodically applied for the recruitment of participants. They have been grouped according to the department in which they work: Appui Psychosocial (APS) and Orphelin et Enfants Vulnerables (OVC)., in order to ensure the homogeneity of the sample; without distinction of sex (mixture of men and women).

Inclusion Criteria

We included in the study only those who had at least six months of direct experience with CPLHIV (Table 2). All participants were over 18 years old. According to the DRC Constitution, as amended, a child is any person under the age of 18.²³

Table 2 Study Participants

Recruitment of Study Participants

Before the start of each in-depth, face-to-face, semi-structured interview with providers and peer educators, or each non-directive focus group session with case managers, participants were contacted and given an information sheet and an informed consent form. Due to the locations of the participants and the configuration of their workplaces, semi-structured interviews were conducted with all participants, while focus groups were conducted with case managers only. Participants who consented to participate in the study were instructed to not limit themselves to the list of questions and to iterate until information saturation was reached.

The in-depth, semi-structured interviews lasted between 45 and 60 minutes, while the focus groups lasted between 75 and 90 minutes. All interviews were conducted in French, although the participants spoke Swahili. We moderated the sessions and took notes. Our mission was to obtain consent for participation in the study, explain the theme and how the focus groups would be conducted, initiate and encourage discussion, and ensure that participants’ comments were not misinterpreted.

Instruments

The tools used were the interview guide, the Focus Group Guide in French and the Android phone recorder application for recording sounds on themes such as: Challenges that require psychosocial and economic support faced by Children people living with HIV/AIDS, psychosocial and economic interventions, the experience of community caregivers providing psychosocial support to Children people living with HIV/AIDS, psychosocial and economic support and collaboration within the team. These interview guides were developed by reviewing existing literature^12,13 and the socio-ecological model^14,15 which aims to explore psychosocial and economic support systems among CPLHIV and recognizes that health experiences and outcomes are often influenced by factors intrinsic and extrinsic to the individual.^16–18

Data Analysis

The audio recordings were listened to several times before being faithfully transcribed into Microsoft Word and translated (three authors) into French for the Swahili interventions. Before analyzing the data in ATLAS.ti (version 12), the transcripts were imported into the software for content analysis to identify emerging themes associated with the APSC in Lubumbashi.

Reliability

To ensure scientific rigor, we employed criteria of credibility, dependability, transferability, and confirmability^19. The audio files were audited several times before being carefully transcribed into Microsoft Word and translated into French by three authors for the Swahili interventions. The supervisory team received the audio recordings, transcriptions, and coding, as well as the themes, to conduct a cross-analysis to ensure the credibility of the results. The lead author (CKD) reviewed the results with other members of the research team (MMM and LNM) as well as his supervisor (CKM). This was made possible through the triangular analysis conducted by the first and fourth authors (CKD and BKP).

Ethical Considerations

This study was conducted in accordance with the Declaration of Helsinki (1964). Participants gave written informed consent prior to taking part, including consent for the publication of anonymised responses and direct quotes. Authorisation for the research was provided by the faculty. This was for reasons of confidentiality and anonymity. Appropriate data management was ensured in three stages: First, recordings, transcripts and field notes were deleted from the original devices. Second, they were saved in password-protected files on a computer and external hard drive. Finally, they were anonymised. The study obtained research certificate No. 0050/2024 from the Faculty of Medicine at the University of Lubumbashi.

Results

Participant Characteristics

Table 3 presents the sociodemographic characteristics of the respondents. The largest groups were full-time nurses, followed by case managers (28.57%) with an average experience of 15.5 ± 11.43 years (4–34) years. The respondents included were women (57%) and 43% men, with an average age of 44.21 ± 9.40 years.

Table 3 Sociodemographic Characteristics of Respondents

Themes Emergent

Data from eight (8) interviews and one (1) focus group were summarized into three (3) themes which emerged as: Challenges that require psychosocial and economic support faced by Children People Living with HIV/AIDS (i), Psychosocial and Economic Interventions among CPLHIV (ii) and Experience of Community Caregivers Providing Psychosocial Support to CPLHIV (iii). These themes are developed in the following lines (Table 4):

Table 4 Overview of the Main Themes and Their Sub-Themes Relating to Challenges and Interventions in Psychosocial and Economic Support for Children People Living with HIV/AIDS Among Health and Community Workers in the Katuba Health Zone in Lubumbashi, DRC

Theme 1: Challenges That Require Psychosocial and Economic Support Faced by Children People Living with HIV/AIDS

Situation of Children People Living with HIV

Participants shared their experiences of the current challenges faced by Children people living with HIV, which included the burden of treatment and daily adherence to treatment, stigma, and discrimination. Participants also stated that some Children people, in the absence of visible symptoms, struggle to recognize the need for their treatment, which compromises their treatment adherence, and Children people living with HIV experience ridicule, isolation, and discriminatory attitudes from those around them, including those in their families and schools. Participants stated:

[…] Their problem is first of all the effect of taking the medication every day and for an indefinite period. They think that they are not useful to society, that they cannot have children, that they cannot work in life and that they cannot get married, so there are a lot of problems like that […] KAT004

[…] The big problem with these children is adherence to treatment. Physically they don’t feel sick. Their appearance says they’re not sick and they themselves say they’re not sick. So it’s difficult for these children to adhere to treatment and the other problem is that they are mostly orphans so they are mistreated and rejected at times. […] KAT002

The testimonies collected from participants highlight other psychosocial and relational challenges, including the impact of HIV on schooling and socio-professional integration, financial difficulties and access to care, increased vulnerability to abuse and violence, lack of information and fear of disclosure. One participant said:

[…] Children people living with HIV/AIDS, regardless of their age, face multiple and complex challenges. Academic problems: The disease can lead to frequent absences, difficulty concentrating, and decreased academic performance. Relationship difficulties: Children people may have difficulty forming friendships and intimate relationships, due to fear of rejection or transmission of the virus. Uncertainty about the future: The future may seem uncertain, which can generate anxiety and depression. Financial difficulties: Families of Children people living with HIV/AIDS may face financial difficulties related to treatment costs, which can limit access to quality care and essential resources. […] KAT006

Prevention and Psychosocial Support Intervention for Children People Living with HIV/AIDS

Prevention and psychosocial support intervention are a priority, declared all participants, for several reasons justifying this priority: Impact on overall health, prevention of transmission, improvement of life expectancy and reduction of inequalities in all health establishments integrating HIV/AIDS care services. According to them, if these Children people are well prepared, mentally, they will protect themselves and protect others, so it is really a priority. A focal point stated:

[…] If it is an absolute priority, because we must disclose HIV status to Children people and this will allow Children people to know themselves and know how to behave, not to have sex in a disorderly manner, because that could contribute to increasing the number of HIV infections. So, it is also an economic priority, because these Children people living with HIV must be educated and we must prepare them for future life […] KAT002

Awareness of the Psychosocial and Economic Problems of Children People Living with HIV

Participants’ testimonies divide psychosocial and economic problems into two categories: those living with HIV who are aware of the problem and those who are not. This varies depending on their age, social environment, and level of information. Others minimize or deny them. Two focal points summarize this sentiment:

[…] Yes, but well! It depends on the age group. A Children person over 10 is more aware than a Children person under 10. Yes, they consider it an important problem, because they want to know if they will need to get married one day and work like everyone else […] KAT003

[…] Indeed, yes, they are aware because we teach them and they are taught for that. Yes, they consider it as a problem, already the effect of taking the treatment every day while other children their age do not take it and the effect that they live mostly in foster families or in orphanages. Yes, they consider it as a major problem […] KAT006

Questions from Children People Living with HIV

All participants stated that all Children people living with HIV/AIDS face psychosocial and economic challenges. One participant said:

[…] Yes, Children people living with HIV regularly ask questions about psychosocial and economic issues. These questions often concern the future: ‘Will I be able to have a normal life?’ Relationships: ‘Will I be able to find love?’ Work: ‘Will I be able to find a job?’ Education: ‘Will I be able to continue my education?’ […] KAT007

Regarding economic concerns alone, participants stated that community members are more familiar with this concept, and they stated that Children people living with HIV/AIDS require economic support. The most urgent need is access to vocational training. Many of our Children people do not have a diploma and struggle to find employment.

Case Manager 3_FG:

[…] The most urgent need is access to vocational training. Many of our Children people do not have a diploma and have difficulty finding a job. […]

Theme 2: Psychosocial and Economic Interventions for Children People Living with HIV/AIDS

Advice and Management of Children People Living with HIV

Participants stated that the management and counseling of Children people living with HIV/AIDS is done in collaboration with psychosocial workers, other providers do it alone to avoid falls and some entrust this task to social workers, who are there for this situation.

[…] We provide individual and group counseling: Mental health professionals provide a safe space for Children people to express their emotions, concerns, and challenges. Peer support groups: Children people can connect with other Children people living with HIV and share their experiences. Socio-educational activities: Workshops are organized to develop Children people’s social, emotional, and career skills […] KAT006

Children people living with HIV also receive several types of psychosocial support:

[…] We offer active listening, personalized advice, group activities (sharing experiences, self-esteem building workshops) and individualized support. These interventions are effective because they allow Children people to feel supported, develop coping strategies and strengthen their resilience […].CASE MANAGER_3_FG_BKM

Assessment of Psychosocial Risk in Children People Living with HIV

Psychosocial risk assessments for Children people living with providers are conducted by psychosocial workers (case managers and peer educators) and other care providers conduct them alone.

[…] We leave this task to the agents of a non-governmental organization (case manager, peer educators), these social agents have assessment protocols and this allows them to see if they can strengthen psychosocial support […] KAT004

[…] We have a framework, questionnaires that help us to talk with them and to get to the bottom of the problem […] KAT003

Economic Risk Assessment Among Children People Living with HIV

The economic risk assessment is carried out by case managers who are psychosocial agents.

[…] This assessment is done by social workers. For example, there are Children people who have financial difficulties in their family and who need to go to school, they go on site to assess the vulnerability of the family, these agents will judge if the Children people can benefit from the transfer cache. […] KAT003

Effectiveness and Efficiency of Current Psychosocial and Economic Support Assessment and Intervention Services

Current services provided to Children people living with HIV appear efficient and effective for most participants and ineffective for some.

[…] These interventions are effective because they allow Children people to feel supported, develop coping strategies and strengthen their resilience […]. ALL CASE MANAGERS_FG_BKM

[…] It’s not really effective, because the budget we had planned beforehand is not the one we are using today, it’s not working as it should because there are patients who have not received anything until today and we are still waiting, however, the psychosocial support seems to be working […] KAT006

Theme 3: Experience of Community Caregivers Providing Psychosocial Support to Children People Living with HIV

Constraints in Psychosocial and Economic Support Services

Regarding constraints from a psychosocial and economic perspective, the participants’ interview accounts reveal two sides: those who encounter them and those who do not. Among those service providers who encounter obstacles.

[…] Yes, there are constraints, the number of providers is not sufficient, so coverage on the ground seems a little difficult and also the financial subsidy is not sufficient […] KAT003

[…] Here at home, there are no constraints since we started in 2016, in any case, there are no constraints […] KAT008

Recommendations for Improving Psychosocial and Economic Support Services for Children People Living with HIV

All participants made recommendations and challenges to overcome to contribute to better psycho-social and economic support for Children people living with HIV. The strengthening of human and material resources appears first as a first recommendation with the following challenges: the shortage of care providers, the increased need for community workers (case managers and peer educators) and strengthening the training of health professionals. One participant said:

[…] Increase the number of healthcare providers (doctors, nurses, case managers and peer educators) because they are insufficient. For good psychological support, we need a lot of peer educators and a lot of case managers. We also need to increase a lot of efforts because this will allow for good monitoring of Children people living with HIV. For economic support, we only need to increase the budget and then we can improve a lot of things […] KAT004

The second recommendation from the participants concerns increased funding and economic support for JVHIV, better partner funding to ensure business continuity and financial involvement from the government. One participant said:

[…] We must continue to support them. There is also the bad faith of our leaders because the country does not lack the means if we only have to wait for the partners to act; it will not be enough so we ask that the government can help us with funding so that all Children people living with HIV can be cared for, because if the partner left you can imagine what would happen next? […].KAT002

The third recommendation made by the participants was prevention and awareness activities with several challenges. One participant said:

[…] Strengthening prevention: By focusing on primary and secondary prevention, including strengthening sex education and facilitating access to condoms. Combating stigma: By organizing awareness campaigns and involving communities […]. KAT001

The fourth and final recommendation from the interviews was to improve Access to Care and Psychosocial Support, with challenges such as geographical and financial access to care and increased support for families of Children people living with HIV.

[…] Improving access to care: By facilitating geographical and financial access to care, and by strengthening the quality of services offered. Supporting families: By providing psychosocial support to families and involving them in the care of their children. By working together, we can improve the quality of life of Children people living with HIV and empower them to achieve their goals. […] KAT001

Discussion

The present study explores the psychosocial and economic support for CPLHIV as perceived by health workers and community workers in the Katuba health zone. The study identifies the main findings as follows: It is evident that children encounter a multitude of distinctive challenges that exert a detrimental influence on their physical, mental, emotional and social health. The early identification and management of psychosocial and economic issues appear to be pivotal in enhancing their overall well-being. While the efficacy of current psychosocial and economic interventions is acknowledged, there is a consensus that their effectiveness could be enhanced. The recommendations made by the service providers surveyed underscore the necessity to fortify the support system in its entirety, encompassing both human resources and organisational arrangements.

CPLHIV face a multitude of specific challenges that influence their physical, mental, emotional and social health. These challenges vary depending on the social environment, population, culture and the broader socio-economic and political context.²⁴ As reported by the participants in our study who reported as challenges the burden of treatment, daily therapeutic adherence, stigma and discrimination, including social and academic rejection. Other participants also mentioned various situations that CPLHIV may face, such as the effect of HIV on education and professional integration, economic problems and access to care, increased susceptibility to abuse and violence, information deficit and fear of exposure^24–28. The results of this study are consistent with those of several research studies that have highlighted issues such as personal stigma, isolation and adjustment problems. These issues can significantly impact people’s ability to adhere to antiretroviral therapy, their independence, and their ability to establish and maintain healthy social relationships^24–27. For example, it has been reported that some people, in the absence of visible symptoms, struggle to recognize the need for treatment, which compromises their treatment adherence. Some CPLHIV avoid social interactions and do not seek the necessary social support, believing that they do not deserve respect or attention. This dynamic can lead to a state of hopelessness and a constant fear of rejection, without the social support they desperately need.^24–27

The findings of this study, supported by,²⁹ highlight the critical importance of comprehensive psychosocial and economic interventions to provide CPLHIV with more tailored coping strategies and support systems in light of the challenges identified. Psychosocial support is an essential component of holistic care for these CPLHIV. Indeed, it has been shown that this support enables Children people to cope with the emotional, social and economic challenges related to their diagnosis, to improve their self-esteem and to develop life skills.

However, in low-resource settings, health systems often face challenges in supporting populations in managing these multifaceted challenges. These difficulties are exacerbated by various factors compounded by the suspension of PEPFAR assistance, including limited government attention, armed conflict in the case of the DRC, population displacement, and political instability.^30,31

Regarding psychosocial and economic interventions for CPLHIV, stakeholders highlighted that support and guidance, as well as assessment of psychosocial and economic risks for these individuals, are primarily carried out in collaboration with community members. Psychosocial and economic interventions can be effectively deployed to improve adherence to antiretroviral therapy among HIV-positive adolescents and Children adults in resource-limited settings,^32–34 as demonstrated by several studies, including ours. These findings are consistent with several studies that have demonstrated increased retention and adherence to antiretroviral therapy (ART) among adolescents and Children people following the application of a psychosocial method.^9,32,34–42

Early identification and intervention of psychosocial and economic problems are crucial. The data collected reveal a variety of circumstances associated with the challenges encountered in implementing psychosocial and economic support services for people living with HIV. On the one hand, various participants reported problems related to insufficient human and financial resources. On the other hand, others reported not encountering any major obstacles.

Research has shown that initiatives aimed at strengthening support networks, improving the training of health professionals and promoting community actions can have a decisive influence on improving the quality of life of people living with HIV and their caregivers.^43–45

Strasser et al⁴⁶ argue that evidence-based psychosocial and economic support services for CPLHIV are currently underdeveloped and underfunded. They state that this situation needs to be addressed and improved, as some participants attested. The sudden interruption of current development assistance or future reduction of PEPFAR funding may negate efforts made so far towards the elimination of HIV/AIDS as a health problem^36. The goal of ending the AIDS pandemic by 2030 is within reach, urgent action is needed from world leaders^20, particularly in sub-Saharan Africa, which concentrated more than 90% of the funding and was home to two-thirds of all people living with HIV.^37,38

Strength and Limits

The primary strength of this study lies in the diversity of the participants, encompassing various genders, age ranges, and roles, thereby facilitating an in-depth exploration of the realities experienced by CPLHIV. Notwithstanding, this study is not without its limitations. Primarily, the research design, employing a case study approach guided by a phenomenological method, renders the findings inherently bound to the context of the Katuba health zone. It is acknowledged that each health zone possesses its own unique characteristics, which serve to distinguish it from other health zones. Consequently, it is posited that the results of this research may only be applicable to other zones that exhibit similar contexts. Secondly, the study of the challenges faced by young people can only be better understood through the application of socio-ecological approaches, which emphasise the interaction between the different levels (individual, family, community, institutional).⁴⁷ This study did not achieve this.

Future research endeavours could concentrate on the challenges confronted by CPLVHIV. This could be achieved by investigating the perspectives of family members, young people themselves, community workers and healthcare staff.

Conclusion

This research highlights a series of challenges faced by children living with HIV that have a deleterious influence on their overall well-being. It highlights the need for early identification and management of these challenges, in order to significantly improve the quality of life of the individuals concerned. Although current interventions are considered effective, there is a consensus that their effectiveness could be improved. This could be achieved by strengthening the support system through recommendations from service providers, particularly in terms of human resources and organisation. As part of our recommendations for future interventions or the adjustment of existing interventions, we advocate the strengthening of human and material resources in order to meet the following challenges: the shortage of healthcare providers; the increased needs of community members and their training; increased funding, in particular the financial involvement of the national government; focusing on more prevention and awareness-raising activities; improving access to care and support for the families of children living with HIV. These strategies should be implemented to reduce the psychological and economic distress of children living with HIV. To achieve this, the various stakeholders should be involved with a view to “eliminating HIV/AIDS by 2030”. Further research could be carried out in all the health zones of the city of Lubumbashi, using qualitative or mixed methodologies as part of a socio-ecological approach.

Abbreviation

CPLHIV, Children people living with HIV/AIDS.

Data Sharing Statement

The original contributions to this study are presented in the article, and the transcripts and other supporting material for this manuscript are available from the corresponding authors and publishers.

Disclosure

No competing interests have been declared by the authors.

References

1. ONUSIDA Programme commun des Nations Unies sur le VIH/sida. 2024. Rapport Pour La Journée Mondiale Du Sida 2024-Suivons Le Chemin Du Droit. Version abrégée. Available from: https://www.unaids.org/sites/default/files/media_asset/take-the-rights-path-to-end-aids-short-version_fr.pdf. Accessed January 15, 2025.

2. ONUSIDA Programme commun des Nations Unies sur le VIH/sida. The urgency of now: AIDS at a crossroads. 2024. Available from: https://www.unaids.org/sites/default/files/media_asset/2024-unaids-global-aids-update_en.pdf. Accessed December 30, 2024.

3. Ministère du Plan et Suivi de la Mise en œuvre de la Révolution de la Modernité-MPSMRM/Congo. Ministère de la Santé Publique-MSP/Congo, ICF International. République Démocratique du Congo Enquête Démographique et de Santé (EDS-RDC) 2013–2014. 2014.

4. ONUSIDA Programme commun des Nations Unies sur le VIH/sida. L’ONUSIDA se félicite de la décision du Secrétaire d’État américain de poursuivre le traitement du VIH qui sauve des vies et convoque des partenaires pour évaluer et atténuer les impacts sur les services de VIH. 2025. Available from: https://www.unaids.org/fr/resources/presscentre/pressreleaseandstatementarchive/2025/january/20250129_us-waiver. Accessed January 30, 2025.

5. Lancet T. American chaos: standing up for health and medicine. Lancet. 2025;405(10477):439. doi:10.1016/S0140-6736(25)00237-5

6. Bravo P, Edwards A, Rollnick S, Elwyn G. Tough decisions faced by people living with HIV: a literature review of psychosocial problems. AIDS Rev. 2010;12(2):76–88.

7. Greifinger R, Dick B. Provision of psychosocial support for young people living with HIV: voices from the field. SAHARA-J J Soc Asp HIVAIDS. 2011;8(1):33–41. doi:10.1080/17290376.2011.9724982

8. Nyongesa MK, Nasambu C, Mapenzi R, et al. Psychosocial and mental health challenges faced by emerging adults living with HIV and support systems aiding their positive coping: a qualitative study from the Kenyan coast. BMC Public Health. 2022;22(1):76. doi:10.1186/s12889-021-12440-x

9. Petersen I, Bhana A, Myeza N, et al. Psychosocial challenges and protective influences for socio-emotional coping of HIV+ adolescents in South Africa: a qualitative investigation. AIDS Care. 2010;22(8):970–978. doi:10.1080/09540121003623693

10. Mutumba M, Bauermeister JA, Musiime V, et al. Psychosocial challenges and strategies for coping with HIV among adolescents in Uganda: a qualitative study. AIDS Patient Care STDs. 2015;29(2):86–94. doi:10.1089/apc.2014.0222

11. Ramaiya MK, Sullivan KA, Donnell KO, et al. A Qualitative Exploration of the Mental Health and Psychosocial Contexts of HIV-Positive Adolescents in Tanzania. PLoS One. 2016;11(11):e0165936. doi:10.1371/journal.pone.0165936

12. Pineault R. Comprendre Le Système de Santé Pour Mieux Le Gérer. Les Presses de l’Université de Montréal. 2013. Available from: https://books.google.com/books?hl=fr&lr=&id=m409DwAAQBAJ&oi=fnd&pg=PT4&dq=Comprendre+le+syst%C3%A8me+de+sant%C3%A9+pour+mieux+le+g%C3%A9rer+Raynald+Pineault&ots=oB9HPWhVuq&sig=qRo_SNmkL0JhdBAYYw8udrVY0VE. Accessed June 7, 2025.

13. Stevens A, Gabbay J. Needs assessment needs assessment. Health Trends. 1991;23(1):20–23.

14. Mulenga DM, Rosen JG, Banda L, et al. “I have to do it in secrecy”: provider Perspectives on HIV Service Delivery and Quality of Care for Key Populations in Zambia. J Assoc Nurses AIDS Care JANAC. 2024;35(1):27–39. doi:10.1097/JNC.0000000000000443

15. Igihozo G, Sichali JM, Medhe S, Wong R. Exploring the Perspectives of Healthcare Providers on Providing HIV Prevention and Treatment Services for Key Populations in Rwanda: a Qualitative Study. World J AIDS. 2022;12(2):120–139. doi:10.4236/wja.2022.122010

16. Yannessa JF, Reece M, Basta TB. HIV Provider Perspectives: the Impact of Stigma on Substance Abusers Living with HIV in a Rural Area of the United States. AIDS Patient Care STDs. 2008;22(8):669–675. doi:10.1089/apc.2007.0151

17. Mutambo C, Hlongwana K. Healthcare Workers’ Perspectives on the Barriers to Providing HIV Services to Children in Sub-Saharan Africa. AIDS Res Treat. 2019;2019:1–10. doi:10.1155/2019/8056382

18. Medley A, Kennedy C, O’Reilly K, Sweat M. Effectiveness of Peer Education Interventions for HIV Prevention in Developing Countries: a Systematic Review and Meta-Analysis. AIDS Educ Prev. 2009;21(3):181–206. doi:10.1521/aeap.2009.21.3.181

19. Chenge M, Van der Vennet J, Porignon D, Luboya N, Kabyla I, Criel B. La carte sanitaire de la ville de Lubumbashi, République Démocratique du Congo Partie I: problématique de la couverture sanitaire en milieu urbain congolais. Glob Health Promot. 2010;17(3):63–74. doi:10.1177/1757975910375173

20. Lucy G. Recherche Sur Les Politiques et Les Systèmes de Santé: Manuel de Méthodologie: Version Abrégée. Alliance pour la recherche sur le politiques et les systèmes de santé. Organisation mondiale de la Santé; 2013.

21. Corbiére M, Larivière N. Méthodes Qualitatives, Quantitatives et Mixtes, 2e Édition: Dans La Recherche En Sciences Humaines, Sociales et de La Santé. 2nd ed ed. Presses de l’Université du Québec. 2020. doi:10.2307/j.ctv1c29qz7

22. Creswell JW, Creswell JD. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 6th ed ed. Sage Publications, Inc; 2022.

23. Cabinet du Président de la République. Constitution de la République Démocratique du Congo telle que révisée par la Loi n° 11/002 du 20 janvier 2011 portant révision de la Constitution de la République Démocratique du Congo du 18. (Textes coordonnés). 2011. Available from: https://www.leganet.cd/Legislation/JO/2011/JOS.05.02.2011.pdf. Accessed June 9, 2025.

24. Adraro W, Abeshu G, Abamecha F. Physical and psychological impact of HIV/AIDS toward youths in Southwest Ethiopia: a phenomenological study. BMC Public Health. 2024;24(1):2963. doi:10.1186/s12889-024-20478-w

25. Getaye A, Cherie N, Bazie GW, Gebremeskel Aragie T. Proportion of Depression and Its Associated Factors Among Youth HIV/AIDS Clients Attending ART Clinic in Dessie Town Government Health Facilities, Northeast Ethiopia. J Multidiscip Healthc. 2021;14:197–205. doi:10.2147/JMDH.S296849

26. Tamirat KS, Tesema GA, Tessema ZT. Psychosocial Factors Associated with Suicidal Ideation Among HIV/AIDS Patients on Follow-Up at Dessie Referral Hospital, Northeast Ethiopia: a Cross-Sectional Study. HIV/AIDS – Research and Palliative Care. 2021;13:415–423. doi:10.2147/HIV.S299538

27. Duko B, Toma A, Asnake S, Abraham Y. Depression, anxiety and their correlates among patients with HIV in South Ethiopia: an institution-based cross-sectional study. Front Psychiatry. 2019;10:290. doi:10.3389/fpsyt.2019.00290

28. Mutumba M, Musiime V, Lepkwoski JM, et al. Examining the relationship between psychological distress and adherence to anti-retroviral therapy among Ugandan adolescents living with HIV. AIDS Care. 2016;28(7):807–815. doi:10.1080/09540121.2015.1131966

29. Parcesepe A, Tymejczyk O, Remien R, et al. HIV-Related Stigma, Social Support, and Psychological Distress Among Individuals Initiating ART in Ethiopia. AIDS Behav. 2018;22(12):3815–3825. doi:10.1007/s10461-018-2059-8

30. Mirkuzie AH, Ali S, Abate E, Worku A, Misganaw A. Progress towards the 2020 fast track HIV/AIDS reduction targets across ages in Ethiopia as compared to neighboring countries using global burden of diseases 2017 data. BMC Public Health. 2021;21(1):285. doi:10.1186/s12889-021-10269-y

31. Girum T, Wasie A, Worku A. Trend of HIV/AIDS for the last 26 years and predicting achievement of the 90–90-90 HIV prevention targets by 2020 in Ethiopia: a time series analysis. BMC Infect Dis. 2018;18(1):320. doi:10.1186/s12879-018-3214-6

32. Okonji EF, Mukumbang FC, Orth Z, Vickerman-Delport SA, Van Wyk B. Psychosocial support interventions for improved adherence and retention in ART care for young people living with HIV (10–24 years): a scoping review. BMC Public Health. 2020;20(1):1841. doi:10.1186/s12889-020-09717-y

33. Hudelson C, Cluver L. Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review. AIDS Care. 2015;27(7):805–816. doi:10.1080/09540121.2015.1011073

34. Bhana A, Mellins CA, Petersen I, et al. The VUKA family program: piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa. AIDS Care. 2014;26(1):1–11. doi:10.1080/09540121.2013.806770

35. Davila JA, Miertschin N, Sansgiry S, Schwarzwald H, Henley C, Giordano TP. Centralization of HIV services in HIV-positive African-American and Hispanic youth improves retention in care. AIDS Care. 2013;25(2):202–206. doi:10.1080/09540121.2012.689811

36. Ruria EC, Masaba R, Kose J, et al. Optimizing linkage to care and initiation and retention on treatment of adolescents with newly diagnosed HIV infection. Aids. 2017;31:S253–S260. doi:10.1097/QAD.0000000000001538

37. Wohl AR, Garland WH, Wu J, et al. A youth-focused case management intervention to engage and retain young gay men of color in HIV care. AIDS Care. 2011;23(8):988–997. doi:10.1080/09540121.2010.542125

38. Willis N, Milanzi A, Mawodzeke M, et al. Effectiveness of community adolescent treatment supporters (CATS) interventions in improving linkage and retention in care, adherence to ART and psychosocial well-being: a randomised trial among adolescents living with HIV in rural Zimbabwe. BMC Public Health. 2019;19(1):117. doi:10.1186/s12889-019-6447-4

39. Graves JC, Elyanu P, Schellack CJ, et al. Impact of a family clinic day intervention on paediatric and adolescent appointment adherence and retention in antiretroviral therapy: a cluster randomized controlled trial in Uganda. PLoS One. 2018;13(3):e0192068. doi:10.1371/journal.pone.0192068

40. Uusküla A, Laisaar KT, Raag M, et al. Effects of Counselling on Adherence to Antiretroviral Treatment Among People with HIV in Estonia: a Randomized Controlled Trial. AIDS Behav. 2018;22(1):224–233. doi:10.1007/s10461-017-1859-6

41. Tominari S, Nakakura T, Yasuo T, et al. Implementation of mental health service has an impact on retention in HIV care: a nested case-control study in a japanese HIV care facility. PLoS One. 2013;8(7):e69603. doi:10.1371/journal.pone.0069603

42. MacKenzie RK, Van Lettow M, Gondwe C, et al. Greater retention in care among adolescents on antiretroviral treatment accessing “Teen Club” an adolescent‐centred differentiated care model compared with standard of care: a nested case–control study at a tertiary referral hospital in Malawi. J Int AIDS Soc. 2017;20(3):e25028. doi:10.1002/jia2.25028

43. Baingana F, Thomas R, Comblain C. HIV/AIDS and mental health. The World Bank, Health Nutr Popul HNP Discuss Pap. 2005;2005;1–65.

44. World Health Organization. The World Health Report 2001: mental health: new understanding, new hope. 2001. Available from: https://books.google.com/books?hl=fr&lr=&id=GQEdA-VFSIgC&oi=fnd&pg=PR9&dq=Organization+WH.+The+World+Health+Report+2001:+Mental+health:+new+understanding,+new+hope.+2001.&ots=d3TzSG8dqE&sig=CRBAU6a3zESSj-RFKExMlQ0K9cQ. Accessed February 20, 2025.

45. Pagano L, Caira M, Offidani M, et al. Adherence to international guidelines for the treatment of invasive aspergillosis in acute myeloid leukaemia: feasibility and utility (SEIFEM-2008B study). J Antimicrob Chemother. 2010;65(9):2013–2018. doi:10.1093/jac/dkq240

46. Strasser S, Gibbons S. The development of HIV-related mental health and psychosocial services for children and adolescents in Zambia: the case for learning by doing. Child Youth Serv Rev. 2014;45:150–157. doi:10.1016/j.childyouth.2014.03.032

47. Richard L, Gauvin L, Raine K. Ecological Models Revisited: their Uses and Evolution in Health Promotion Over Two Decades. Annu Rev Public Health. 2011;32(2011):307–326. doi:10.1146/annurev-publhealth-031210-101141