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Role and outcomes of community health workers in HIV care in sub-saharan Africa: a systematic review
Open accessAbstract
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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“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]
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Metadata
- 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
- Venue
- Journal of the International AIDS Society
- Publisher
- Wiley
- Published
- 2013-01
- Volume
- 16
- Issue
- 1
- Pages
- 18586-18586
- ISSN
- 1758-2652 (ISSN-L)
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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