Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Sep 10;16(1):18586.
doi: 10.7448/IAS.16.1.18586.

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

Grace W Mwai  1 , Gitau Mburu, Kwasi Torpey, Peter Frost, Nathan Ford, Janet Seeley
Affiliations

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

Grace W Mwai et al. J Int AIDS Soc. .

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.

Keywords: HIV; care; community health workers; sub-Saharan Africa; systematic review.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Schematic representation of study selection.
See this image and copyright information in PMC

References

    1. UNAIDS. Report on the global AIDS epidemic. Geneva: UNAIDS; 2012.
    1. Seeley J, Dercon S, Barnett T. The effects of HIV/AIDS on rural communities in East Africa: a 20-year perspective. Trop Med Int Health. 2010;15(3):329–35. - PubMed
    1. Johnson LF, Mossong J, Dorrington RE, Schomaker M, Hoffmann CJ, Keiser O, et al. Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med. 2013;10(4):e1001418. - PMC - PubMed
    1. Hontelez JA, de Vlas SJ, Baltussen R, Newell ML, Bakker R, Tanser F, et al. The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS. 2012;26(Suppl 1):S19–30. - PMC - PubMed
    1. Myer L, Carter RJ, Katyal M, Toro P, El-Sadr WM, Abrams EJ. Impact of antiretroviral therapy on incidence of pregnancy among HIV-infected women in sub-Saharan Africa: a cohort study. PLoS Med. 2010;7(2):e1000229. - PMC - PubMed

Publication types