A rapid review and synthesis of the effectiveness of programmes initiating community-based antiretroviral therapy in sub-Saharan Africa

Abstract

Background: Community-based antiretroviral therapy initiation (CB-ARTi) has the potential to reduce attrition by increasing access to care, reducing patient costs, decongesting clinics and ensuring improved uptake of ART. There is a paucity of research that identifies successful implementation of CB-ARTi in sub-Saharan Africa (SSA).Objectives: The aim of the study was to review and describe the evidence on the effectiveness of CB-ARTi programmes that start ART in communities in comparison with the current standards of care in SSA.Methods: A rapid review of grey and published peer-reviewed literature between January 2009 and July 2019, by using PubMed, PDQ-Evidence, Google Scholar, clinical trial databases and major HIV (human immunodeficiency virus) conference websites, was conducted. Search terms used included ‘community-based’, ‘home initiation community models’, ‘antiretroviral therapy’, ‘clinical outcomes’, ‘viral suppression’, ‘retention in care’, ‘loss to follow-up’, ‘HIV’ and ‘sub-Saharan Africa’.Results: The search yielded 90 articles and reports following the removal of duplicates. After initial screening and full-text screening, six articles remained and were included in the qualitative narrative synthesis. This included four randomised control trials and two cohort studies of specific interventions comparing CB-ARTi with the standard of care in SSA. There is evidence that CB-ARTi can increase access to HIV-testing services, linkage to ART, retention in care and viral suppression rates and is possibly not inferior to facility-based healthcare.Conclusion: CB-ARTi has the potential to increase access to HIV services to people living with HIV in SSA. The results mentioned previously suggest that CB-ARTi models could prove to be equal and possibly not inferior to facility-based ones and warrant further investigation.

Examining barriers to antiretroviral therapy initiation in infants living with HIV in sub‐Saharan Africa despite the availability of point‐of‐care diagnostic testing: a narrative systematic review

“…Furthermore, we stress the importance of training healthcare professionals in managing infants living with HIV. Some of our findings align with recent literature related to the topic, validating our approach [28–31].…”

Barriers and facilitators for interventions to improve ART adherence in Sub-Saharan African countries: A systematic review and meta-analysis

“…It is also noteworthy that some specific groups, like pregnant and lactating women, show heightened adherence when given targeted interventions [88]. Community-based ART delivery, as observed in other reviews, also emerges as a potent strategy, enhancing patient retention, accessibility to HIV services, and overall treatment engagement [89][90][91].…”

Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study

“…The objective of this study was to leverage recent outcomes from the DO ART study to parameterise a mathematical model and project population health impact, budget impact, and cost-effectiveness of scaling up community delivery of ART in KwaZulu-Natal, South Africa. This study fills a key gap in the health economics literature on DSD models and community-based ART in particular [ 12 ].…”