Role and outcomes of community health workers in HIV care in sub-saharan Africa: a systematic review

Mwai, Grace W; Mburu, Gitau; Torpey, Kwasi; Frost, Peter; Ford, Nathan; Seeley, Janet

doi:10.7448/ias.16.1.18586

Cited by 372HIV/AIDS Research and InterventionsHIV/AIDS Impact and ResponsesGlobal Health Workforce Issues

Role and outcomes of community health workers in HIV care in sub-saharan Africa: a systematic review

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Mwai, Grace W, Mburu, Gitau, Torpey, Kwasi, Frost, Peter, Ford, Nathan, Seeley, Janet·2013·Journal of the International AIDS Society

DOI 10.7448/ias.16.1.18586PMC PMC3772323

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Abstract

INTRODUCTION: The provision of HIV treatment and care in sub-Saharan Africa faces multiple challenges, including weak health systems and attrition of trained health workers. One potential response to overcome these challenges has been to engage community health workers (CHWs). METHODOLOGY: A systematic literature search for quantitative and qualitative studies describing the role and outcomes of CHWs in HIV care between inception and December 2012 in sub-Saharan Africa was performed in the following databases: PubMed, PsychINFO, Embase, Web of Science, JSTOR, WHOLIS, Google Scholar and SAGE journals online. Bibliographies of included articles were also searched. A narrative synthesis approach was used to analyze common emerging themes on the role and outcomes of CHWs in HIV care in sub-Saharan Africa. RESULTS: In total, 21 studies met the inclusion criteria, documenting a range of tasks performed by CHWs. These included patient support (counselling, home-based care, education, adherence support and livelihood support) and health service support (screening, referral and health service organization and surveillance). CHWs were reported to enhance the reach, uptake and quality of HIV services, as well as the dignity, quality of life and retention in care of people living with HIV. The presence of CHWs in clinics was reported to reduce waiting times, streamline patient flow and reduce the workload of health workers. Clinical outcomes appeared not to be compromised, with no differences in virologic failure and mortality comparing patients under community-based and those under facility-based care. Despite these benefits, CHWs faced challenges related to lack of recognition, remuneration and involvement in decision making. CONCLUSIONS: CHWs can clearly contribute to HIV services delivery and strengthen human resource capacity in sub-Saharan Africa. For their contribution to be sustained, CHWs need to be recognized, remunerated and integrated in wider health systems. Further research focusing on comparative costs of CHW interventions and successful models for mainstreaming CHWs into wider health systems is needed.

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Unlike Mwai et al. (2013), who reported a more even distribution of research efforts across SSA, this review indicates comparatively fewer SWD studies from West and Central Africa.
“However, unlike Mwai et al. (2013) (111), who reported a more even distribution of research efforts across SSA, our review indicates comparatively fewer SWD studies from West and Central Africa.”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [111]
The Results (Characteristics of included studies) place all 21 studies in nine countries in east and southern Africa. The Discussion (Limitations of the review) explicitly says no papers from West Africa were found, contrary to the attributed claim that Mwai et al. reported a more even distribution across sub-Saharan Africa. This verdict concerns only the claim about Mwai et al., not the citing review's SWD findings. (LLM, conf=0.91)
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Human resource aspects of antiretroviral treatment delivery models: current practices and recommendations
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Understanding the linkages between informal and formal care for people living with HIV in sub-Saharan Africa
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Effectiveness of a community intervention on malaria in rural Tanzania - a randomised controlled trial.
Eriksen, J., Mujinja, P. G. M., Warsame, M., Nsimba, S. E. D., Kouyaté, B. A., Gustafsson, L. L., Jahn, A., Müller, O., Sauerborn, R., & Tomson, G. B. (2010) · PubMed Central · Cited by 19 · see citing works
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The Experience of Being a Traditional Midwife: Living and Working in Relationship With Women
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Expansion of the Health Workforce and the HIV Epidemic
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Costs and cost–effectiveness of HIV community services: quantity and quality of studies published 1986–2011
Beck, E. J., Fasawe, O., Ongpin, P., Ghys, P. D., Avilla, C., & Lay, P. R. D. (2013) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.13.28 · Cited by 6 · see citing works
Impact of Community-Based HIV/AIDS Treatment on Household Incomes in Uganda
Feulefack, J., Luckert, M. K., Mohapatra, S., Cash, S. B., Alibhai, A., & Kipp, W. E. (2013) · PLoS ONE · doi:10.1371/journal.pone.0065625 · Cited by 5 · see citing works

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Research works printed but not linked: 2

[75]World Health Organization Strengthening the performance of community health workers in primary health care 1989 Geneva WHO 2497585
[80]World Health Organization Global experience of community health workers for delivery of health related millennium development goals: a systematic review, country case studies, and recommendations for integration into national health systems 2010 Geneva WHO

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Trends in task shifting in HIV treatment in Africa: Effectiveness, challenges and acceptability to the health professions
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The Impact of Structured Mentor Mother Programs on 6-Month Postpartum Retention and Viral Suppression among HIV-Positive Women in Rural Nigeria: A Prospective Paired Cohort Study
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A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil
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Assessing glomerular filtration rate in healthy Indian adults: A comparison of various prediction equations
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The Impact of Mentor Mother Programs on PMTCT Service Uptake and Retention-in-Care at Primary Health Care Facilities in Nigeria
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Harmonization of community health worker programs for HIV: A four-country qualitative study in Southern Africa
Neve, J. D., Garrison‐Desany, H. M., Andrews, K. G., Sharara, N., Boudreaux, C., Gill, R. K., Geldsetzer, P., Vaikath, M., Bärnighausen, T., & Bossert, T. J. (2017) · PLoS Medicine · doi:10.1371/journal.pmed.1002374 · Cited by 55 · see citing works
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Trained lay health workers reduce common mental disorder symptoms of adults with suicidal ideation in Zimbabwe: a cohort study
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The Training and Fieldwork Experiences of Community Health Workers Conducting Population-Based, Noninvasive Screening for CVD in LMIC
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Sustaining the future of HIV counselling to reach 90‐90‐90: a regional country analysis
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HIV/AIDS Competent Households: Interaction between a Health-Enabling Environment and Community-Based Treatment Adherence Support for People Living with HIV/AIDS in South Africa
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Workload and emerging challenges of community health workers in low- and middle-income countries: A mixed-methods systematic review
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High prevalence of non-communicable diseases and associated risk factors amongst adults living with HIV in Cambodia
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Retention in care prior to antiretroviral treatment eligibility in sub-Saharan Africa: a systematic review of the literature
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Brief Report: Decentralizing ART Supply for Stable HIV Patients to Community-Based Distribution Centers: Program Outcomes From an Urban Context in Kinshasa, DRC
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Prevalence, incidence and predictors of volunteer community health worker attrition in Kwale County, Kenya
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Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach
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Retention in Care of Adult HIV Patients Initiating Antiretroviral Therapy in Tigray, Ethiopia: A Prospective Observational Cohort Study
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The roles, training and knowledge of community health workers about diabetes and hypertension in Khayelitsha, Cape Town
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Continuum in HIV care from entry to ART initiation in rural K wa Z ulu‐ N atal, S outh A frica
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A Role for Health Communication in the Continuum of HIV Care, Treatment, and Prevention
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Outcomes of community-based differentiated models of multi-month dispensing of antiretroviral medication among stable HIV-infected patients in Lesotho: a cluster randomised non-inferiority trial protocol
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Review article Role and outcomes of community health workers in HIV care in sub-Saharan Africa: a systematic review
Mwai, G. W., Mburu, G., Torpey, K., Frost, P., Ford, N., & Seeley, J. (2016)
Self-citation
The Impact of Community Health Workers on HIV Therapy Outcome in Sub-Saharan Africa
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“I Have to Push Him with a Wheelbarrow to the Clinic”: Community Health Workers' Roles, Needs, and Strategies to Improve HIV Care in Rural South Africa
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Roles, barriers, and recommendations for community health workers providing community-based HIV care in Sub-Saharan Africa: A review
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Authors: Mwai, G. W., Mburu, G., Torpey, K., Frost, P., Ford, N., & Seeley, J.
Affiliations: Brighton and Sussex Medical School (GB)
International HIV/AIDS Alliance (GB)
University of Cape Town (ZA)
University of East Anglia (GB)
Corresponding author: Mwai, Grace W
ORCID: Mburu, Gitau
Torpey, Kwasi
Ford, Nathan
Seeley, Janet
Venue: Journal of the International AIDS Society
Publisher: Wiley
Published: 2013-01
Volume: 16
Issue: 1
Pages: 18586-18586
ISSN: 1758-2652 (ISSN-L)
DOI: 10.7448/ias.16.1.18586
PMC: PMC3772323
OpenAlex: W2100664910
Cited by: 372
References: 85
Citations by year: 2026: 11 · 2025: 27 · 2024: 31 · 2023: 25 · 2022: 29 · 2021: 46 · 2020: 37 · 2019: 27 · 2018: 43 · 2017: 36 · 2016: 23 · 2015: 24 · 2014: 11
FWCI: 2.50
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/3.0/ (vor, 252 d)
Locations: Journal of the International AIDS Society (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Lancaster EPrints (Lancaster University) (acceptedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
UEA Digital Repository (University of East Anglia) (submittedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
Keywords: community health workers, HIV care, sub-Saharan Africa, patient support, home care, retention in care, health workforce capacity, community-based care
MeSH terms: Africa, Community Health Workers, Health Services Research, Humans, HIV Infections, Africa South of the Sahara

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Role and outcomes of community health workers in HIV care in sub-saharan Africa: a systematic review

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