title: Community-based antiretroviral therapy programs can overcome barriers to retention of patients and decongest health services in sub-Saharan Africa: a systematic review.
abstract: In sub-Saharan Africa models of care need to adapt to support continued scale up of antiretroviral therapy (ART) and retain millions in care. Task shifting, coupled with community participation has the potential to address the workforce gap, decongest health services, improve ART coverage, and to sustain retention of patients on ART over the long-term. The evidence supporting different models of community participation for ART care, or community-based ART, in sub-Saharan Africa, was reviewed. In Uganda and Kenya community health workers or volunteers delivered ART at home. In Mozambique people living with HIV/AIDS (PLWHA) self-formed community-based ART groups to deliver ART in the community. These examples of community ART programs made treatment more accessible and affordable. However, to achieve success some major challenges need to be overcome: first, community programs need to be driven, owned by and embedded in the communities. Second, an enabling and supportive environment is needed to ensure that task shifting to lay staff and PLWHA is effective and quality services are provided. Finally, a long term vision and commitment from national governments and international donors is required. Exploration of the cost, effectiveness, and sustainability of the different community-based ART models in different contexts will be needed.
authors.affiliation: Médecins Sans Frontières, Av. Eduardo Mondlane 38 - CP 262, Tete, Mozambique.
authors.forename: Tom
authors.initials: T
authors.lastname: Decroo
authors.forename: Freya
authors.initials: F
authors.lastname: Rasschaert
authors.forename: Barbara
authors.initials: B
authors.lastname: Telfer
authors.forename: Daniel
authors.initials: D
authors.lastname: Remartinez
authors.forename: Marie
authors.initials: M
authors.lastname: Laga
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
mesh_terms: D017954:Africa South of the Sahara; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003153:Community Health Services; D003150:Community Health Workers; D015658:HIV Infections / Q000188:drug therapy*; D006296:Health Services; D006699:Home Care Services; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D010349:Patient Compliance; D012111:Residence Characteristics; D014838:Volunteers
chemical_list: D044966:Anti-Retroviral Agents; D007093:Imidazoles; C009695:xylometazoline
keywords: Antiretroviral therapy; Community participation; HIV; Health services accessibility; Highly active; Task shifting