Barriers and facilitators of rendering HIV services by community health workers in sub-Saharan Africa: a meta-synthesis

Abstract

ObjectivesTo synthesise qualitative studies that address the barriers to and facilitators of providing HIV services by community health workers (CHWs) in sub-Saharan Africa (SSA).DesignThis meta-synthesis was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We included studies that were published between 2009 and 2019. The Ritchie and Spencer framework and the Supporting the Use of Research Evidence framework were used for thematic analysis and framework analysis, respectively. The Qualitative Assessment and Review Instrument was used to assess the quality of selected studies.Eligibility criteriaQualitative studies published between 2009 and 2019, that included CHWs linked directly or indirectly to the Ministry of Health and providing HIV services in the communities.Information sourcesAn extensive search was conducted on the following databases: EBSCOhost- (ERIC; Health Source-Nursing/Academic Edition; MEDLINE Full Text), Google Scholar and PubMed.ResultsBarriers to rendering of HIV services by CHWs were community HIV stigma; lack of CHW respect, CHWs’ poor education and training; poor stakeholders’ involvement; poor access to the communities; shortage of CHWs; unsatisfactory incentives; lack of CHW support and supervision, lack of equipment and supplies and social barriers due to culture, language and political structures. The altruistic behaviour of CHWs and the availability of job facilitated the provision of HIV services.ConclusionThe delivery of HIV services by CHWs in SSA is faced by more lingering barriers than facilitators. Planners and policymakers can minimise the barriers by investing in both CHW and community training regarding HIV services. Furthermore, sufficient funding should be allocated to the programme to ensure its efficiency.PROSPERO registration numberCRD42020160012.

Feasibility and Acceptability of the Adherence Connection Counseling, Education, and Support (ACCESS) Proof of Concept: A Peer-Led, Mobile Health (mHealth) Cognitive Behavioral Antiretroviral Therapy (ART) Adherence Intervention for HIV-Infected (HIV+) Adolescents and Young Adults (AYA)

“…In resource limited countries, there is greater availability of CHWs for HIV care, and research is being directed to developing, testing, and establishing community based models for support of adherence and retention in care [ 86 ]. However, recommendations to optimize the CHW role for HIV support in LMICs calls for improved training and supervision, better care coordination, integration of patient centered mHealth approaches, and increased funding [ 87 , 88 ]. In the US, the CHW role in HIV care and research continues to evolve, and best practices for training, retaining and integrating CHWs into clinical and research teams remain to be determined.…”

Stigma and Discrimination of HIV/AIDs Recipients of Care in Western Uganda: Experiences and Roles of Expert Clients

“…23 Expert clients were faced with lack of respect, poor education and training, poor stakeholders' involvement; poor access to the communities, unsatisfactory incentives; lack of support and supervision, lack of equipment and supplies and social barriers due to culture, language, and political structures. 24 Certain conditions must be observed if expert clients are to contribute to sustainable service delivery, such as collaborative planning, definition of scope of practice, selection and educational requirements, registration, licensure and certification, recruitment and deployment, adequate and sustainable remuneration, as well as mentoring and supervision.…”

The implementation and effectiveness of multi-tasked, paid community health workers on maternal and child health: A cluster-randomized pragmatic trial and qualitative process evaluation in Tanzania

“…Indeed, studies on the implementation of CHW programs have noted that support for CHW, their performance and integration into communities and health systems is uneven across and within countries (37,38). Frequently, evidence-based recommendations are not effectively applied as CHW programs are designed and implemented (30,35,39), and many CHW programs are fraught with challenges including poor planning; unclear or fragmented roles; inadequate training; weak supervision; lapses in logistical processes; tenuous accountability linkages; ineffective incentive structures; poor selection processes and dissatisfaction of communities (40)(41)(42)(43).…”