Roles, Barriers, and Recommendations for Community Health Workers Providing Community-Based HIV Care in Sub-Saharan Africa: A Review

Abstract

While the impact of Community Health Workers (CHWs) on home-based human immunodeficiency virus (HIV) care has been documented, barriers and recommendations have not been systematically reviewed. Following the reporting requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we used an aggregative narrative synthesis approach to summarize the results of qualitative studies published between January 1, 2000, and November 6, 2020 in the following databases: PubMed, CINAHL, PsychINFO, Web of Science, and Google Scholar. In total, 17 studies met the selection criteria and were included in the analysis. They reported on a range of roles played by CHWs in HIV care, including education and health promotion; HIV-specific care (HIV testing services; screening for opportunistic infections and acute illness); medication delivery; tracing persons who had defaulted from care; and support (treatment support; referral; home-based care; and psychosocial support). Many different barriers to community-based HIV care were reported and centered on the following themes: Stigma and nondisclosure; inadequate support (lack of resources, inadequate training, inadequate funding, and inadequate monitoring); and health system challenges (patients' preference for more frequent visits and poor integration of CHWs in the wider health care system). Recommendations to mitigate these barriers included: addressing HIV-related stigma; introducing updated and relevant CHW training; strengthening the supervision of CHWs; coordinating care between the home and facilities; incorporating patient-centered mHealth approaches; and committing to the funding and resources needed for successful community-based care. In summary, CHWs are providing a variety of important community-based HIV services but face challenges with regards to training, resources, and supervision.

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

“…Twelve (12) participants were purposively recruited into the study. All the participants were married aged between 32 and 68 years.…”

“…In other studies, it was reported that many different barriers to community-based HIV care were reported and they were stigma and nondisclosure; inadequate support (lack of resources, inadequate training, inadequate funding, and inadequate monitoring). 12,28 This greatly hindered the work of the expert clients. Significant efforts should be made to mitigate these barriers by addressing HIV-…”

“…Expert clients played an important role in health education and community awareness, HIV-specific education, such as information about living with HIV, ART, and its side effects, as well as HIV coinfections (Tuberculosis). 12 In their role, expert clients build on their knowledge acquired during facility-based HIV/ART workshops and trainings. To enhance their work, expert clients should be provided with monthly refresher training to keep them updated and provided with resources to use while conducting health education sessions in the communities.…”

“…The key role of expert clients was to work alongside the frontline health workers to address stigma and discrimination among PLWH. 12 However, staff shortages have led many health facilities to shift tasks to expert clients (ECs). In Uganda, stigma and discrimination against people with HIV/AIDs is high according to a survey by NAFOPHANU, 2015.…”