This systematic review aims to qualitatively synthesize existing evidence on the efficacy of HIV interventions in African fishing communities. Methods: Five databases (NCBI PubMed, EMBASE, Web of Science Core Collection, The Cochrane Library, and CABI Global Health Database) were searched in March 2019 for eligible studies. All peer-reviewed papers with a defined HIV intervention explicitly mentioning African fishing communities were included. Outcomes included any measure of the efficacy of HIV interventions. Results: Of 22,289 search results, data was extracted from 25 eligible studies that passed critical appraisal; seven involved HIV prevention, six HIV testing and counseling, three treatment, and nine combinations of more than one intervention. Findings include a high coverage of safe male circumcision (SMC) but low condom use among fisher folk, and a preference for PrEP over other HIV prevention services. Uptake of HIV testing and ART coverage are below levels required to reach UNAIDS 90-90-90 targets, and there is a high demand for ART and HIV self-testing kits. Conclusions: Greater provision of services to combat HIV, specifically amongst fishing communities, is required; there is limited information on retaining fisher folk in care and achieving an undetectable viral load. Interventions tailored to individual fishing populations, offered in parallel to education or counseling services are likely to be most effective. Use of innovations, including mobile health and medical drones, could assist these hard-to-reach populations. Our findings will inform future HIV service provision in fishing communities.

Introduction: Significant advances in combination anti-retroviral therapy have been instrumental in improving the quality of lives and life expectancy for people living with HIV. However, in the absence of a cure, sustained investment and innovation is required to improve adherence and quality of life for people living with HIV. We developed ARTAccess, a web-based application that links patient information on anti-retroviral therapy and viral load to an algorithm that guides a private community pharmacist on anti-retroviral therapy refills without the need for an additional nurse in the pharmacy. The aim of this paper is to describe the present the development process of the ARTAccess application and the exploration of the perceptions about its use by end users. Methods: Between October–December 2018, we conducted a qualitative observational study to document the processes of the ART-Access™ application development. Using theoretical frameworks of participatory action research and human-centred design, we undertook structured and unstructured observations of the application development review meetings. We observed and had interactions in 12 stakeholder meetings. Three observers attended each development meeting and independently drafted a reflective narration of the transcript and separately conducted their own analyses. ARTAccess was launched in January 2019 and in March 2019, three in-depth interviews were conducted with the nurse dispensers running the refill program at the three pharmacies where ARTAccess was piloted. Results: The ARTAccess application development meetings generated emerging themes. Introduction of a mHealth application for efficiency introduced job insecurity fears of health workers which needed to be addressed, to allow for increased engagement by health worker stakeholders. Stakeholder meetings provided important perceived gaps and needs for improvement at each stage of the ARTAccess application development. The user-centred design process led to five application versions; three more than the two originally planned; the feedback on the ARTAccess application became more positive as later versions were presented to stakeholders. Conclusions: The study provides evidence that participatory action research in a human-centred design approach enhanced the application development process of a new technology for health. In resource limited settings, where digital technologies may be used to support overstretched health systems, health workers need re-assurance that digital tools being developed will not threaten their employment.