Background:
Task-shifting to lay community health providers is increasingly suggested as a potentialstrategy to overcome the barriers to sustainable antiretroviral treatment (ART) scale-up inhigh-HIV-prevalence, resource-limited settings. The dearth of systematic scientific evidenceon the contributory role and function of these forms of community mobilisation has rendereda formal evaluation of the published results of existing community support programmes aresearch priority.
Methods:
We reviewed the relevant published work for the period from November 2003 to December2011 in accordance with the guidelines for a synthetic review. ISI Web of Knowledge,Science Direct, BioMed Central, OVID Medline, PubMed, Social Services Abstracts, andSociological Abstracts and a number of relevant websites were searched.
Results:
The reviewed literature reported an unambiguous positive impact of community support on awide range of aspects, including access, coverage, adherence, virological and immunologicaloutcomes, patient retention and survival. Looking at the mechanisms through whichcommunity support can impact ART programmes, the review indicates that communitysupport initiatives are a promising strategy to address five often cited challenges to ARTscale-up, namely (1) the lack of integration of ART services into the general health system;(2) the growing need for comprehensive care, (3) patient empowerment, (4) and defaultertracing; and (5) the crippling shortage in human resources for health. The literature indicatesthat by linking HIV/AIDS-care to other primary health care programmes, by providingpsychosocial care in addition to the technical-medical care from nurses and doctors, byempowering patients towards self-management and by tracing defaulters, well-organisedcommunity support initiatives are a vital part of any sustainable public-sector ARTprogramme.
Conclusions:
The review demonstrates that community support initiatives are a potentially effectivestrategy to address the growing shortage of health workers, and to broaden care toaccommodate the needs associated with chronic HIV/AIDS. The existing evidence suggeststhat community support programmes, although not necessarily cheap or easy, remain a goodinvestment to improve coverage of communities with much needed health services, such asART. For this reason, health policy makers, managers, and providers must acknowledge andstrengthen the role of community support in the fight against HIV/AIDS.