The Impact of Community Health Workers on HIV Therapy Outcome in Sub-Saharan Africa

Abstract

In sub-Saharan Africa, the burden on HIV care givers is high. This resulted in renewed interest in community health worker (CHW) programs. We conducted a review of the literature to summarize CHWs' effects on HIV therapy outcome. We also investigated which CHW tasks might favorably impact treatment outcome.<br/> We conducted a comprehensive literature search in PubMed, Web of Science and Embase for papers published up to October 2018. The studies included were conducted on HIV-positive adults in sub-Saharan Africa and reported biological HIV outcomes. We systematically collected data on HIV therapy outcome and CHW tasks. We used Bayesian network modelling for the analysis of CHW tasks.<br/> We included 19 studies in total: 4 randomized controlled trials, 8 comparative cohort studies and 7 single arm interventions. In all studies, CHW interventions were beneficial or not inferior to standard of care (SOC). The more common tasks of CHWs involved an important human support component, with home visits being the most common task. Upon analysis we found indications that ART delivery, individual adherence support and frequent home visits were predictive of a successful CHW intervention, defined as improved therapy outcome compared to SOC or reaching 90% of treated patients being virally suppressed.<br/> We found that CHW interventions are not inferior to SOC and might even be beneficial. We hypothesize that ART delivery, individual adherence support and frequent home visits are predictive of a successful CHW intervention. Further research is needed to be able to judge whether any single task or a particular combination of tasks is significantly correlated with a successful CHW intervention, or whether such tasks are context specific.