Abstract
BackgroundThe effectiveness of community-based primary health care (CBPHC) interventions in low- and middle-income countries (LMICs), especially for maternal, neonatal and child health, is well established. However, there has not been a systematic review of the literature on the effectiveness of CBPHC on HIV outcomes derived from rigorous assessments of primary studies. Using peer-reviewed studies of randomized interventions or those containing a specified control group and directly measuring clinical HIV outcomes, we provide evidence for the effectiveness of CBPHC on HIV outcomes for mothers and children in low- and middle-income countries (LMICs).MethodsEligibility criteria included studies assessing the effectiveness of community-based HIV interventions with or without a facility-based component, or multiple integrated projects, with outcome measures defining an aspect of HIV health status such as the utilization of prevention or health care services, nutritional status, serious morbidity (including clinical measures of HIV progression) or mortality of children aged five or younger and pregnant women. Articles published through June 3, 2020 were identified by searching four databases. The type of community-based projects implemented, the implementors, and the implementation strategies of each program were identified and the impact on HIV-related outcomes assessed.ResultsThe search yielded 10 537 articles; 4881 underwent title and abstract screening after removing duplicates. Of these, 117 studies qualified for full-text screening; only 22 were included in the final analysis. Most studies showed that community-based interventions improved HIV prevention and treatment outcomes compared to facility-based approaches alone. Each study had at least one statistically significant HIV-related outcome; the non-significant outcomes found in six of the 22 studies were mostly not related to HIV programming. Most interventions were implemented by community health workers; other implementers were government workers, community members, or research staff. Strategies used included peer-to-peer education, psychosocial support, training of community champions, community-based follow-up care, home-based care, and integrated care.ConclusionsCBPHC strategies are effective in improving population-based, HIV-related health outcomes for mothers and children, especially in combination with facility-based approaches. However, there is a need to assess the scalability of such interventions and integrate them into existing health systems to assess their impact on the HIV pandemic in more routine settings.
Highlights
All but two of the studies were from sub-Saharan Africa, with one study from Guatemala and another from India
The most common HIV outcomes assessed included proportion of women screened for HIV, proportion of HIV-infected women initiating ART, proportion of HIV-infected infants retained on treatment, and proportion infants on ART that were virally suppressed
Most of the interventions were implemented by paid CHWs working exclusively on MNCH or HIV, while other interventions were implemented by CHWs integrated into other programs
Summary
Eligibility criteria included studies assessing the effectiveness of community-based HIV interventions with or without a facility-based component, or multiple integrated projects, with outcome measures defining an aspect of HIV health status such as the utilization of prevention or health care services, nutritional status, serious morbidity (including clinical measures of HIV progression) or mortality of children aged five or younger and pregnant women. Articles published through June 3, 2020 were identified by searching four databases. The type of community-based projects implemented, the implementors, and the implementation strategies of each program were identified and the impact on HIV-related outcomes assessed. Community-based primary health care for improving HIV/AIDS outcomes for mothers and children “community health,” “developing countries,” and related terms were identified to create a search query (see Appendix S1 in the Online Supplementary Document). We searched the above-mentioned databases for any articles published in peer-reviewed journals any time through June 3, 2020. Covidence software blindly assessed inter-rater agreement between reviewers at each stage of the review process. All procedures were conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines [25,26,27,28]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have