Effect of Female Sex Work Targeted Community-based Interventions Along the HIV Treatment Cascade in Sub-Saharan Africa: A Systematic Review and Meta-analysis

Abstract

Background: Female Sex Workers are extremely vulnerable and highly susceptibility to being infected with human immunodeficiency virus. As a result, community based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. However little is known about the specific community intervention packages that have optimal effect on FSWs access and retention in HIV care. This paper synthesized evidence on the effectiveness of community-based interventions that provided HIV services to FSWs across all stages of HIV care cascade.Methods: We defined the 5 steps that make up the HIV care cascade and categorized them as outcomes, namely HIV testing, HIV diagnosis, linkage to care, ART use and viral suppression. We conducted a systematic search of randomized controlled trials, cohort and cross sectional studies done in sub-Saharan African countries and published from 2004 to 2020. We reviewed studies with data on the implementation of community interventions for any of the HIV care cascade stage. The data were analyzed using random effects meta-analysis where possible and for the rest of the studies, data were synthesized using summary statistics. Results: The significant impact of the community interventions was observed on HIV testing, HIV diagnosis and ART use. However, for HIV testing and ART use, the improvement was not sustained for the entire period of implementation. There were minimal interventions that had impact on HIV diagnosis, with only one community service delivery model showing significance. Generally, the interventions that had reasonable impact are those that implemented targeted and comprehensive package of HIV services provided at one location, and with unique strategies specific to each cascade stage.Conclusions: The effect of community-based interventions varies across the different stages of HIV care cascade with impact observed in specific strategies with features unique to each cascade stage. Moreover, positive effects of these strategies were short term and with small-scale implementation. As such, the information on long-term treatment outcomes, and the extent to which FSWs remain engaged in care is sparse. There is need to conduct a further research to deepen the assessment of the effectiveness of community-based interventions on HIV care cascade for FSWs. This will enhance identification of evidence based optimal interventions that will guide effective allocation of scarce resources for strategies that would have a significant impact on HIV service delivery.Systematic review registration: PROSPERO CRD42020157623.

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

“…Findings from this scoping review on the effect of KP-CBART on outcomes along the HIV care continuum ranging from HIV testing to viral load suppression and retention in care including ART delivery, showed that outcomes in KP-CBART were at least as good as in facility-based care. Our conclusion is coherent with the conclusion from a recent review on CBART for FSW, even though most of the included studies did not overlap, as different inclusion criteria were used [ 13 ]. Our review only included studies for which ART delivery was part of the intervention, and studies in which KP had a role in KP-CBART delivery.…”

“…However, this review only focussed on FSW, included studies regardless of the level of involvement of FSW in care provision, and included studies regardless of whether ART was provided within the communities. Moreover, the modalities used for KP-CBART were not summarized [ 13 ]. In our review, we explored the effect of CBART along the continuum of HIV care on clinical outcomes among KP in sub-Saharan Africa.…”

Long-term retention and predictors of attrition for key populations receiving antiretroviral treatment through community-based ART in Benue State Nigeria: A retrospective cohort study

“…A trial and a prospective study in Tanzania showed high retention rates in ART care among FSW receiving ART through a community-based ART programme for Key populations (KP-CBART) [ 13 , 14 ] However, there are only few studies on how this evidence is translated to less-resourced routine care [ 9 , 15 ]. These studies reported retention rate in KP-CBART models between 6–12 months on ART.…”