Background
Methods
Search strategy
Selection criteria
Study selection
Study | Country | Research design | N | Period | Title of lay providers | Results | Study limitations |
---|---|---|---|---|---|---|---|
Abaasa | Uganda | Retrospective cohort study | 897 | 18 mo | Field officers | The AIDS Support Organization (TASO) ART programme displays good adherence and survival | - Retrospective design: not all potential confounders included |
(2008) | |||||||
- Self-reported adherence and the risk of social desirability bias | |||||||
Assefa | Ethiopia | Descriptive study | NA | >36 mo | Health extension workers | Substantial expansion of HIV/AIDS and ART services in resource-limited context | - Descriptive study design: no causal relationships |
(2009) | |||||||
- No measurement of the extent of the impact of community support | |||||||
- Secondary and incomplete data | |||||||
Bedelu | South Africa | Descriptive study | 1025 | 20 mo | HIV/AIDS counsellors & CHWs | MSF programme using task-shifting and community support achieved near universal coverage without compromising quality of care | - Descriptive study design: no causal relationships |
(2007) | |||||||
- No measurement of the extent of the impact of community support | |||||||
Benavides | Uganda | Descriptive report | 5854 | NC | Field officers | Field officers encourage adherence, refill medications and promote family support contributing to TASO’s ART program’s outcomes (adherence rates > 95% , reducing mortality by almost 90% ) | - Descriptive study design: no causal relationships |
(2006) | |||||||
- No measurement of the extent of the impact of community support | |||||||
Celletti | Brazil, Ethiopia, Malawi, Namibia, and Uganda | Desk review, observation & key informant interviews | NA | NA | CHWs | Under certain conditions, the delegation of specific tasks to CHWs can increase access to HIV services and improve quality of care. | - No clear literature search strategy |
(2010) | - No clear qualitative methodology (selection of informants, data collection & analysis) | ||||||
Chang | Uganda | Retrospective cohort study | 360 | 24 mo | Peer health workers | Good adherence and survival in community- and faith-based HIV/AIDS care programme | - Retrospective study design |
(2009) | |||||||
- Reliance on clinical and programmatic records | |||||||
- Underestimation of survival because of lost-to-follow-up rates | |||||||
- Outcome measurements not measured at exact time intervals | |||||||
Chang | Uganda | Cluster-randomized trial | 1336 | >22 mo | Peer health workers | A peer health worker intervention was associated with decreased virologic failure, but did not affect cumulative risk of virologic failure, adherence measures or short-term virologic outcomes | - Limited generalisability: mobile clinic setting |
(2010) | |||||||
- Weakness of design: imbalances between clusters | |||||||
- Limited statistical power | |||||||
Cohen | Lesotho | Descriptive study | 5376 | 40 mo | HIV/AIDS counsellors | Lay counsellor-supported testing and counselling, adherence and case management produced favourable outcomes | - Descriptive study design: no causal relationships |
(2009) | |||||||
- No measurement of the extent of the impact of community support | |||||||
Etienne | Kenya, Rwanda, Uganda, Tanzania, Zambia, Nigeria, Haiti, and Guyana | Descriptive study | 13391 | 12 mo | Adherence supporters | Adherence counselling, structured treatment preparation, community home visits, and supportive supervision by community nurse significantly reduced the loss to follow up. | - Descriptive study design: no causal relationships |
(2010) | |||||||
- Potential selection bias at the facility level | |||||||
Gusdal | Ethiopia & Uganda | Qualitative study | 118 | NA | (peer) HIV/AIDS counsellors | Peer counsellors served as facilitators of adherence, role models and bridges to the health system | - Selection bias: no information on patients lost-to-follow-up |
(2011) | - Saturation of data not achieved | ||||||
Hermann | Ethiopia, Malawi, and Uganda | Desk review & descriptive field research | NA | NA | CHWs | Present CHW programmes are essential for ART scale-up and comprehensive care but have insufficient attention to quality supervision, continuous training,and the life experience of PLWHA | - No clear literature search strategy |
(2009) | |||||||
- No clear methodology for the literature analysis | |||||||
Idoko | Nigeria | Quasi-experiment | 175 | 12 mo | DOT ART supporters | Patients accessing treatment support (daily/ twice weekly/weekly observed therapy) demonstrated better treatment outcomes compared to control group | - Limited genralisability: one facility |
(2007) | |||||||
- Small sample size: limited statistical power | |||||||
- No statistically significant differences | |||||||
Igumbor | South Africa | Retrospective patient record review | 540 | 9 mo | adherence supporters | Patients with community adherence support maintained a suppressed VL and remainedin care for a longer period as opposed to patients lacking this support | - Retrospective study design (no causal relationships) |
(2011) | |||||||
- No measurement of the extent of the impact of community support | |||||||
Jaffar | Uganda | Cluster-randomised equivalence trial | 1453 | 42 mo | Field officers | Home-based HIV care was as effective as facility-based care: similar virological failure and mortality rates | - Refusals and withdrawals can create selection bias |
(2009) | |||||||
- Weakness of design: imbalances between clusters | |||||||
Kabore | Lesotho, South Africa, Namibia, and Botswana | Observational cohort study | 377 | 18 mo | CHWs, HBC volunteers & adherence supporters | Community support was associated with more rapid and greater CD4 increase and higher levels of adherence. Home-based care and/or food support was associated with greater improvements in HRQoL. | - Observational study design: patients select to receive support |
(2010) | |||||||
- Potential selection bias | |||||||
- High rate of patients who were lost-to-follow-up | |||||||
Koenig | Haiti | Descriptive study | 1050 | 12 mo | CHWs | DOT-HAART using CHWs resulted in good viral suppression and high survival rates | - Descriptive study design: no causal relationships |
(2004) | |||||||
- No measurement of the extent of the impact of community support | |||||||
Kunutsor | Uganda | Randomized controlled trial | 174 | 7 mo | Adherence supporter | Patients with an adherence supporter had over 4 times the odds of achieving optimal adherence and were more l ikely to be on time for their clinical appointments | - Limited genralisability: one facility |
(2011) | |||||||
- Potential selection bias (of highly motivated patients) | |||||||
- Limited statistical power (adherence measurement method) | |||||||
Morris | Zambia | Descriptive study | NA | 36 mo | Peer health workers | Improved clinical care quality despite growing patient volumes | - Descriptive study design: no causal relationships |
(2009) | |||||||
- No measurement of the extent of the impact of community support | |||||||
- Programme’s intensive use of resources | |||||||
Mukherjee | Haiti | Descriptive study | 1500 | 12 mo | CHWs | Home-based adherence support from a network of CHWs produces low rates of treatment failure | - Descriptive study design: no causal relationships |
(2006) | |||||||
- No measurement of the extent of the impact of community support | |||||||
Mukherjee | Haiti | Descriptive study | NA | NA | CHWs | CHWs facilitate the uptake of PHC services, including by the most vulnerable households | - Descriptive study design: no causal relationships |
(2007) | |||||||
- No measurement of the extent of the impact of community support | |||||||
- Limited representativeness of qualitative results | |||||||
Muñoz | Peru | Quasi-experiment | 120 | 12 mo | CHWs & DOT ART supporters | CASA (community-based accompaniment with supervised antiretroviral) participants reported better clinical and psychosocial outcomes compared to control group | - Small sample size |
(2010) | |||||||
- Potential selection bias (confounding differences) | |||||||
- Limited generalisability | |||||||
Nachega | South Africa | Randomized controlled trial | 274 | 24 mo | DOT ART supporter | DOT-ART was associated with greater median CD4-cell count and better survival rates, but not with improved virological outcomes | - Limited genralisability |
(2010) | |||||||
- Limited time frame of the intervention | |||||||
- Relatively low incidence of AIDS-defining illness and death | |||||||
Pearson | Mozambique | Randomized controlled trial | 350 | 12 mo | Peer DOT ART supporters | Intervention participants demonstrated significantly higher ART adherence | - Initial phase of ART programme (highly motivated patients) |
(2007) | |||||||
- No blinding of the participants and the study personnel | |||||||
- Self-reported adherence measure | |||||||
- Limited generalisability: one facility | |||||||
Rich et al. | Rwanda | Retrospective medical record review | 1041 | 24 mo | CHWs | Community based ART produced very high levels of retention and large increases in CD4 cell count. However, the relative impact of the different components of the program could not be determined. | - Descriptive study design: no causal relationships |
(2012) | |||||||
- No measurement of the extent of the impact of community support | |||||||
- Low data completeness for key variables | |||||||
- Potential selection bias | |||||||
Selke | Kenya | Randomized controlled trial | 208 | 12 mo | CCCs | Community-based care by PLWAs resulted in similar clinical outcomes as standard care but with half the number of clinical visits | - Limited generalisability |
(2010) | |||||||
- Selection bias: different sublocations & only adherent patients included | |||||||
- Small sample size (limited statistical power) | |||||||
Weidle | Uganda | Nested randomised trial | 987 | 12 mo | HIV/AIDS counsellors & Field officers | Group education, personal adherence plans, a medicine companion and home-delivery of ARVs by lay counsellors achieved good ART adherence and reponse | - Selection bias: participants selected from a community AIDS organisation |
(2006) | |||||||
- Limited statistical power | |||||||
- No measurement of the extent of the impact of community support | |||||||
Wools-Kaloustian | Kenya | Quasi experiment | NA | 24 mo | CCCs | An ART delivery model that shifts patient monitoring and ARV dispensing to CCCs is both acceptable and feasible | - Limited generalisability: one facility |
- Programme’s intensive use of resources (PDAs & training) | |||||||
(2009) | |||||||
Wouters | South Africa | Retrospective cohort study | 371 | 24 mo | CHWs & adherence supporters | Community support predicted better viral suppression and immunological restoration | - Study design: patients select to receive support |
(2009) | |||||||
- Potential selection bias (confounding differences) | |||||||
- Underestimation of survival because of lost-to-follow-up rates | |||||||
Wouters | South Africa | Retrospective cohort study | 371 | 24 mo | CHWs & adherence supporters | Community support initiatives (CHWs and support groups) positively impacted disclosure to family members | - Study design: patients select to receive support |
(2009) | |||||||
- Potential selection bias (confounding differences) | |||||||
Zachariah | Malawi | Quasi-experiment | 1634 | 20 mo | HBC volunteers. | Community support was associated with significantly lower death rate and better ART outcomes | - Study design: not possible to know the exact reasons for the observed differences |
(2007) |