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Abstract
BackgroundTask-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment (ART) scale-up in high-HIV-prevalence, resource-limited settings. The dearth of systematic scientific evidence on the contributory role and function of these forms of community mobilisation has rendered a formal evaluation of the published results of existing community support programmes a research priority.MethodsWe reviewed the relevant published work for the period from November 2003 to December 2011 in accordance with the guidelines for a synthetic review. ISI Web of Knowledge, Science Direct, BioMed Central, OVID Medline, PubMed, Social Services s, and Sociological s and a number of relevant websites were searched.ResultsThe reviewed literature reported an unambiguous positive impact of community support on a wide range of aspects, including access, coverage, adherence, virological and immunological outcomes, patient retention and survival. Looking at the mechanisms through which community support can impact ART programmes, the review indicates that community support initiatives are a promising strategy to address five often cited challenges to ART scale-up, namely (1) the lack of integration of ART services into the general health system; (2) the growing need for comprehensive care, (3) patient empowerment, (4) and defaulter tracing; and (5) the crippling shortage in human resources for health. The literature indicates that by linking HIV/AIDS-care to other primary health care programmes, by providing psychosocial care in addition to the technical-medical care from nurses and doctors, by empowering patients towards self-management and by tracing defaulters, well-organised community support initiatives are a vital part of any sustainable public-sector ART programme.ConclusionsThe review demonstrates that community support initiatives are a potentially effective strategy to address the growing shortage of health workers, and to broaden care to accommodate the needs associated with chronic HIV/AIDS. The existing evidence suggests that community support programmes, although not necessarily cheap or easy, remain a good investment to improve coverage of communities with much needed health services, such as ART. For this reason, health policy makers, managers, and providers must acknowledge and strengthen the role of community support in the fight against HIV/AIDS.
Highlights
Task-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment (ART) scale-up in high-HIV-prevalence, resource-limited settings
The total number of people accessing ART in sub-Saharan Africa masks wide variation in the progress made towards universal access in these countries, with Botswana and Namibia leading the path by reportedly having in excess of 85% of those in need of ART, while Mozambique, Zimbabwe, and South Africa close up the ranks with only 51–56% of those in need of access to treatment [1,3,4,5,6]
As a result of the limited number of studies that have assessed the potential contribution of community support to ART programme outcomes, we decided to expand their geographical scope to all resource-limited countries
Summary
Task-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment (ART) scale-up in high-HIV-prevalence, resource-limited settings. Sub-Saharan Africa remains the region most heavily affected by HIV, and accounted for 68% of all people living with the virus and for 72% of AIDS deaths in 2009 [1]. A recent review by Barth and colleagues [2] has demonstrated that the proportions of patients with on-treatment success after 2 years of firstline therapy are comparable to those from developed countries. These preliminary outcomes do not warrant complacency. Long-term retention of patients in treatment programmes is a prerequisite for achieving any adherence at all and conditional to durable ART success
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