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

Raymond Chimatira,Andrew Ross

doi:10.4102/sajhivmed.v21i1.1153

Abstract

BackgroundCommunity-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).ObjectivesThe 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.MethodsA 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’.ResultsThe 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.ConclusionCB-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.

Highlights

Sustainable human immunodeficiency virus (HIV) epidemic control requires that a large percentage of people living with HIV (PLHIV) must initiate antiretroviral therapy (ART) early, regardless of their CD4 T-cell count or clinical stage, and remain in care, adhere to treatment and achieve viral suppression.[1]
The results reached earlier suggest that Community-based antiretroviral therapy initiation (CB-ARTi) models could http://www.sajhivmed.org.za prove to be equal and possibly not inferior to facilitybased ones and warrant further investigation
The apparent promise and pitfalls of CB-ARTi and the increasing interest of policymakers in its potential as a strategy to increase linkage to care and ART uptake in the era of UTT indicate that careful monitoring of the evidence base is warranted

Summary

Introduction

Sustainable human immunodeficiency virus (HIV) epidemic control requires that a large percentage of people living with HIV (PLHIV) must initiate antiretroviral therapy (ART) early, regardless of their CD4 T-cell count or clinical stage, and remain in care, adhere to treatment and achieve viral suppression.[1]. Successful strategies to address the high rates of patient attrition at every stage of the HIV care cascade include rapid ART initiation and differentiated care models with community ART distribution for stable patients on ART. Community-based HIV programmes that include dispensing ART have contributed significantly to decongesting the traditional healthcare services, and improved adherence and retention in care.[2,3,4] Other interventions identified through http://www.sajhivmed.org.za. 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

Results

Discussion

Conclusion