Page 240 - HIVMED_v21_i1.indb

Page 2 of 9 Review Article

systematic reviews and meta-analyses include community- BOX 1: PubMed search string.
based HIV testing, facilitated referrals for ART initiation, #1 ‘community-based’ OR ‘home initiation’ OR ‘home-based’ OR ‘community
models’ OR ‘home models’ OR ‘home care services’ OR ‘facility-based’ OR
education, treatment supporters and active adherence ‘health facility’ OR ‘hospital’ OR ‘clinic’ OR ‘referral and consultation*’
reminder devices such as mobile phone text messages. #2 ‘retention in care’ OR ‘retention’ OR ‘loss to follow up’ OR ‘patient
However, these have shown mixed results, with each compliance’ OR ‘patient adherence’ OR ‘viral suppression’ OR ‘viral load’
OR ‘clinical outcomes’ OR ‘Kaplan-Meier estimate’ OR ‘attrition’
intervention also being found not to produce significant #3 HIV OR ‘hiv seropositivity/diagnosis’ OR ‘hiv infections/diagnosis’ OR
effects in some settings. Despite this, interest is increasing in ‘hiv infections/virology’ OR ‘AIDS’
5
the role of out-of-facility or community-based ART initiation #4 ‘antiretroviral’ OR ‘antiretroviral therapy’ OR ‘antiretrovir*’ OR ‘ART’ OR
(CB-ARTi) as an essential approach for universal access to ‘anti-HIV agents’ OR ‘therapeutics’ OR ‘initiation’
HIV care. #5 ‘sub-Saharan Africa’ OR ‘Africa south of the Sahara’
HIV, human immunodeficiency virus; AIDS, acquired immune deficiency syndrome;
Community-based ART initiation has the potential to reduce ART, antiretroviral therapy.
attrition by increasing access to care, reducing patient costs,
decongesting clinics and ensuring improved uptake of ‘loss to follow-up’; ‘attrition’; and ‘HIV’. The search strategy
ART. 3,6,7 There is a need for the updating of the status of was limited to studies conducted in SSA and published in
evidence that supports the implementation of CB-ARTi English from January 2009 through July 2019. The PubMed
models. Such evidence should include its impact on the search strategy is summarised in Box 1.
clinical and behavioural outcomes such as retention in care
and viral suppression amongst patients initiating ART in We also conducted a grey literature search that was limited to
SSA. The objective of this article is to review and describe the abstracts from the following major HIV-related conferences:
evidence of the effectiveness of CB-ARTi programmes that Conference on Retroviruses and Opportunistic Infections
start ART in communities in comparison with the current
standard of care in SSA, namely the initiation of ART in (CROI), the International AIDS Conference, International
traditional facility-based hospitals and clinics. Conference on AIDS and STDs in Africa (ICASA), Southern
African HIV Clinicians’ Society Conference and the South
Methodology African AIDS Conference. In addition, we searched clinical
trial databases for planned or ongoing research via the U.S.
This rapid review used a streamlined systematic method to National Library of Medicine Register of Clinical Trials
capture the evidence from current community-based (clinicaltrials.gov) and the WHO (World Health Organisation)
approaches to the initiation of ART in SSA. There were two International Clinical Trials Registry Platform (ICTRP). Three
research questions. (1) What are the essential elements of technical experts on HIV care and treatment were also
evidence-based models of CB-ARTi that inform policy in contacted by e-mail for comment on the appropriateness of
SSA? (2) How do the reported clinical outcomes, for example, the identified literature and additional articles.
retention in care and viral suppression, amongst patients
initiating ART in community-based settings compare with Study inclusion criteria
traditional standards of care in SSA?
Studies were included in the review if they: (1) reported on
The rapid review approach streamlines traditional community-based models of ART initiation; (2) measured
systematic review methods to gain efficiency and accelerate clinical outcomes (e.g. linkage to care, adherence, reported
the review process, whilst still aiming to produce valid stigma, retention in care and virologic suppression) of
conclusions. We focussed on a narrow topic, used a limited patients initiated on ART in the community compared with
8
rather than an exhaustive range of search terms and patients receiving the current standard of care; and (3) used
restricted the analysis and synthesis. We also restricted the observational and experimental methods with primary
search of grey literature (material written for professionals data within randomised controlled trials (RCTs), cross-
and disseminated outside of peer-reviewed journals) to sectional or cohort (prospective and retrospective) designs.
key websites and only considered studies published in We excluded articles that did not meet all three criteria
English since January 2009. Furthermore, we performed from the review.
single (vs. dual) screening of titles and abstracts by using
Rayyan, a web-based semi-automated screening software Study selection and data extraction
(https://rayyan.qcri.org/welcome).
All references captured by the search engine were uploaded
Search strategy to Rayyan and duplicates were identified and removed. The
eligibility of the articles was assessed in two steps, the first
Studies were identified through bibliographic searches of entailing all titles and abstracts being assessed by the primary
PubMed and PDQ-Evidence publication databases by using reviewer. In the second step, full texts for all the articles
the following terms and variations: ‘community based’; deemed relevant to the research questions were read in full
‘home initiation’; ‘community models’; ‘home care services’; and analysed to confirm their eligibility. The primary
‘health facility’; ‘clinic’; ‘antiretroviral therapy’; ‘antiretroviral’; reviewer extracted data from all eligible articles by using a
‘clinical outcomes’; ‘patient adherence’; ‘patient compliance’; standard data collection form to collect information about
‘viral load’; ‘viral suppression’; ‘retention’; ‘retention in care’; the publication date, study setting, design and interventions,

http://www.sajhivmed.org.za 232 Open Access