Abstract
In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported. Community-based interventions (CBIs) for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk, or already infected with, HIV. This paper evaluates the impact of CBIs on HIV knowledge, attitudes, and transmission. We included 39 studies on educational activities, counseling sessions, home visits, mentoring, women’s groups, peer leadership, and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence. Our review findings suggest that CBIs to increase HIV awareness and risk reduction are effective in improving knowledge, attitudes, and practice outcomes as evidenced by the increased knowledge scores for HIV/AIDS (SMD: 0.66, 95% CI: 0.25, 1.07), protected sexual encounters (RR: 1.19, 95% CI: 1.13, 1.25), condom use (SMD: 0.96, 95% CI: 0.03, 1.58), and decreased frequency of sexual intercourse (RR: 0.76, 95% CI: 0.61, 0.96). Analysis shows that CBIs did not have any significant impact on scores for self-efficacy and communication. We found very limited evidence on community-based management for HIV infected population and prevention of mother- to-child transmission (MTCT) for HIV-infected pregnant women. Qualitative synthesis suggests that establishment of community support at the onset of HIV prevention programs leads to community acceptance and engagement. School-based delivery of HIV prevention education and contraceptive distribution have also been advocated as potential strategies to target high-risk youth group. Future studies should focus on evaluating the effectiveness of community delivery platforms for prevention of MTCT, and various emerging models of care to improve morbidity and mortality outcomes.
Highlights
In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported globally; a 33% decline in the number of new infections as compared to 2001 [1]
We systematically reviewed literature published before July 2013 to identify randomized controlled trials (RCTs), quasi-experimental, and before-and-after studies on Community-Based Intervention (CBI) for the prevention and management of HIV
Pooled statistics were reported as relative risk (RR) for categorical variables and standard mean difference (SMD) for continuous variables between the experimental and control groups with 95% confidence intervals (CIs)
Summary
In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported globally; a 33% decline in the number of new infections as compared to 2001 [1]. Community-based interventions (CBIs) are built on shared values and norms, and belief systems and social practices, and permit culturally sensitive discussions of HIV, and sexual and reproductive health. They allow increased access and ease availability of medical care to population potentially at risk of, or already infected with HIV by reaching individuals in homes, schools, or community centres. In low-prevalence countries and concentrated epidemics, CBIs should focus on reaching those groups that are most at risk [6]
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