Page 239 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 9 Review Article

A rapid review and synthesis of the effectiveness of

programmes initiating community-based antiretroviral

therapy in sub-Saharan Africa

Authors: Background: Community-based antiretroviral therapy initiation (CB-ARTi) has the
Raymond Chimatira 1 potential to reduce attrition by increasing access to care, reducing patient costs, decongesting
Andrew Ross 2
clinics and ensuring improved uptake of ART. There is a paucity of research that identifies
Affiliations: successful implementation of CB-ARTi in sub-Saharan Africa (SSA).
1 Department of Public
Health, School of Public Objectives: The aim of the study was to review and describe the evidence on the effectiveness
Health and Nursing, of CB-ARTi programmes that start ART in communities in comparison with the current
University of KwaZulu-Natal, standards of care in SSA.
Durban, South Africa
Methods: A rapid review of grey and published peer-reviewed literature between January
2 Department of Family 2009 and July 2019, by using PubMed, PDQ-Evidence, Google Scholar, clinical trial databases
Medicine, School of Public and major HIV (human immunodeficiency virus) conference websites, was conducted. Search
Health and Nursing,
University of KwaZulu-Natal, terms used included ‘community-based’, ‘home initiation community models’, ‘antiretroviral
Durban, South Africa therapy’, ‘clinical outcomes’, ‘viral suppression’, ‘retention in care’, ‘loss to follow-up’,
‘HIV’ and ‘sub-Saharan Africa’.
Corresponding author:
Raymond Chimatira, Results: The search yielded 90 articles and reports following the removal of duplicates. After
raymond.chimatira@gmail. initial screening and full-text screening, six articles remained and were included in the
com
qualitative narrative synthesis. This included four randomised control trials and two cohort
Dates: studies of specific interventions comparing CB-ARTi with the standard of care in SSA. There
Received: 16 Aug. 2020 is evidence that CB-ARTi can increase access to HIV-testing services, linkage to ART, retention
Accepted: 10 Sept. 2020 in care and viral suppression rates and is possibly not inferior to facility-based healthcare.
Published: 05 Nov. 2020
Conclusion: CB-ARTi has the potential to increase access to HIV services to people living with
How to cite this article: HIV in SSA. The results mentioned previously suggest that CB-ARTi models could prove to be
Chimatira R, Ross A. A rapid
review and synthesis of the equal and possibly not inferior to facility-based ones and warrant further investigation.
effectiveness of programmes
initiating community-based Keywords: community-based ART; HIV; interventions; ART initiation; retention; attrition;
antiretroviral therapy in viral suppression; sub-Saharan Africa.
sub-Saharan Africa. S Afr J
HIV Med. 2020;21(1), a1153.
https://doi.org/10.4102/ Introduction
sajhivmed.v21i1.1153
Sustainable human immunodeficiency virus (HIV) epidemic control requires that a large
Copyright: percentage of people living with HIV (PLHIV) must initiate antiretroviral therapy (ART) early,
© 2020. The Authors.
Licensee: AOSIS. This work regardless of their CD4 T-cell count or clinical stage, and remain in care, adhere to treatment
is licensed under the and achieve viral suppression. To this end, the Joint United Nations Programme on HIV and
1
Creative Commons AIDS (UNAIDS) set the ambitious 95–95–95 treatment targets that by 2030, 95% of all PLHIV will
Attribution License.
know their HIV status, 95% of all those diagnosed as HIV-positive will receive sustained ART
and 95% of all those receiving ART will achieve viral suppression. 1
However, the achievement of the 95-95-95 targets in sub-Saharan Africa (SSA) is challenged by a
weak HIV care cascade, with PLHIV being lost at each step as a result of barriers to getting tested,
linkage to and staying in care, and starting or adhering to ART. Many studies from SSA report
2
that rates of linkage to care and initiation of ART in individuals who tested HIV-positive are lower
than 50%.
2,3
Read online: Successful strategies to address the high rates of patient attrition at every stage of the HIV care
Read online:
Scan this QR
Scan this QR cascade include rapid ART initiation and differentiated care models with community
code with your
code with your
smart phone or ART distribution for stable patients on ART. Community-based HIV programmes that include
smart phone or
mobile device
mobile device dispensing ART have contributed significantly to decongesting the traditional healthcare services,
to read online.
to read online.
and improved adherence and retention in care. 2,3,4 Other interventions identified through
http://www.sajhivmed.org.za 231 Open Access