Community-Based ART Service Delivery for Key Populations in Sub-Saharan Africa: Scoping Review of Outcomes Along the Continuum of HIV Care

• Published in: AIDS and behavior 2022-07, Vol.26 (7), p.2314-2337
• Main Authors: Ibiloye, Olujuwon, Masquillier, Caroline, Jwanle, Plang, Van Belle, Sara, van Olmen, Josefien, Lynen, Lut, Decroo, Tom
• Format: Article
• Language: English
• Subjects: Africa South of the Sahara - epidemiology; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Clinical outcomes; Community; Community health care; Community Health Services; Community involvement; Counseling; Drop-in centers; Drug abuse; Drug Users; Gays & lesbians; Health care facilities; Health Psychology; Health risks; Health services; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - prevention & control; Homosexuality, Male; Human immunodeficiency virus; Humans; Infectious Diseases; Male; Medical treatment; Medicine; Medicine & Public Health; Men who have sex with men; Mens health; Prisoners; Prisons; Prostitution; Public Health; Retention; Sex industry; Sex workers; Sexual and Gender Minorities; Sexually transmitted diseases; STD; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - drug therapy; Substance Abuse, Intravenous - epidemiology; Substantive Review; Tests; Transgender persons; Womens health
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-021-03568-3

HIV positive key population (KP) often face health system and social barriers to HIV care. KP include sex workers, men who have sex with men, persons who inject drugs, transgender people, and people in prisons and other closed settings. Community-based ART service delivery (CBART) has the potential to increase access to antiretroviral treatment (ART) and enhance retention in care. This scoping review summarized the evidence on the effect of CBART along the continuum of HIV care among KP in sub-Saharan Africa. We searched Pubmed, Web of Science, Google scholar, and NGO websites for articles published between 2010 and April 2020. We synthesized the involvement of KP community members or lay providers in medical task provision, and outcomes along the continuum of HIV care. Of 3,330 records identified, 66 were eligible for full test screening, out of which 12 were included in the review. CBART for KP was provided through: (a) community drop-in-centres, (b) community drop-in-centres plus mobile team, or (c) community-based health centres. KP were engaged as peer educators and they provided services such as community mobilisation activities for HIV testing and ART, ART adherence counselling, and referral for ART initiation. Across the KP-CBART studies, outcomes in terms of ART uptake, adherence to ART, retention in care and viral suppression were at least as good as those obtained for KP attending facility-based care. KP-CBART was as effective as facility-based care. To achieve the UNAIDS 95–95–95 target in sub-Saharan Africa, national programmes should scale-up KP-CBART to complement facility-based care.