Review Article

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

Raymond Chimatira, Andrew Ross
Southern African Journal of HIV Medicine | Vol 21, No 1 | a1153 | DOI: https://doi.org/10.4102/sajhivmed.v21i1.1153 | © 2020 Raymond Chimatira, Andrew Ross | This work is licensed under CC Attribution 4.0
Submitted: 16 August 2020 | Published: 05 November 2020

About the author(s)

Raymond Chimatira, Department of Public Health, School of Public Health and Nursing, University of KwaZulu-Natal, Durban, South Africa
Andrew Ross, Department of Family Medicine, School of Public Health and Nursing, University of KwaZulu-Natal, Durban, South Africa


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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.


Keywords

community-based ART; HIV; interventions; ART initiation; retention; attrition; viral suppression; sub-Saharan Africa

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