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

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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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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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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 › Medicine › Public Health, Environmental and Occupational Health › 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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