<p>Strategies To Improve Linkage To HIV Care In Urban Areas Of Sub-Saharan Africa: A Systematic Review</p>

Abstract

Of the 37 million people estimated to be living with HIV globally in 2017, about 24.7 million were in the sub-Saharan Africa region, which has been and remains worst affected by the epidemic. Enrolment of newly diagnosed individuals into care in the region, however, remains poor with up to 54% not being linked to care. Linkage to care is a very important step in the HIV cascade as it is the precursor to initiating antiretroviral therapy (ART), retention in care, and viral suppression. A systematic review was conducted to gather information regarding the strategies that have been documented to increase linkage to care of Persons living with HIV(PLHIV) in urban areas of sub-Saharan Africa. An electronic search was conducted on Scopus, Cochrane central, CINAHL Plus, PubMed and OpenGrey for linkage strategies implemented from 2006. A total of 189 potentially relevant citations were identified, of which 7 were eligible for inclusion. The identified strategies were categorized using themes from literature. The most common strategies included: health system interventions (i.e. comprehensive care, task shifting); patient convenience and accessibility (i.e. immediate CD4 count testing, immediate ART initiation, community HIV testing); behavior interventions and peer support (i.e. assisted partner services, care facilitation, mobile phone appointment reminders, health education) and incentives (i.e. non-cash financial incentives and transport reimbursement). Several strategies showed favorable outcomes: comprehensive care, immediate CD4 count testing, immediate ART initiation, and assisted partner services. Assisted partner services, same day home-based ART initiation, combination intervention strategies and point-of-care CD4 testing significantly improved linkage to care in urban settings of sub-Saharan African region. They can be delivered either in a health facility or in the community but should be facilitated by health workers. There is, however, the need to conduct more linkage-specific studies in the sub-region.

Ethical and practical considerations in HIV drug trial closure: perspectives of research staff in Uganda

“…Participants in the current study reported using referral for linking participants to post-trial care which they considered passive and unreliable in facilitating successful linkage. Although established international research institutions (Rennie & Sugarman, 2009; UNAIDS, 2012; UNCST, 2014) consider referral as an acceptable approach to post-trial care, this approach has been criticised by various authors who confirm this study’s finding that a more practical, proactive and staff-facilitated approach to HIV care linkage is required (Koduah Owusu, Adu-Gyamfi, & Ahmed, 2019). A more proactive approach has been successfully used to link HIV positive individuals to care following HIV testing and research has demonstrated higher rates of linkage to, and retention in, HIV care (Elul et al, 2017).…”

“…Such an approach could be adapted for HIV trial closure. Currently, data on linkage to care following research participation is lacking (Koduah Owusu et al, 2019) and this is an important research gap.…”

“…Such an approach could be adapted for HIV trial closure. Currently, data on linkage to care following research participation is lacking (Koduah Owusu et al, 2019) and this is an important research gap. The possibility of negative side effects occurring after trial closure was a major concern for researchers in this study.…”

Does peer-navigated linkage to care work? A cross-sectional study of active linkage to care within an integrated non-communicable disease-HIV testing centre for adults in Soweto, South Africa

“…Client linkage to care and treatment initiation . For the purposes of the study, successful linkage to care followed the Centers for Disease Control and Prevention (CDC) definition of, a newly-identified HIV-infected person engaging with a health care provider within 30 days of diagnosis (at the ZAZI HTS centre) [ 16 ]. This definition was adopted for linkage to care for all conditions–communicable and NCDs, alike–and for successful treatment initiation , which was additionally defined as an initiation of pharmacological treatment within 30 days of diagnosis.…”

“…Active referral is a more facilitated approach, assisting the patient to remain engaged within the healthcare system, and in this context, reach care and initiate treatment. A systematic review of literature aiming to increase linkage of PLHIV among urban areas of SSA to care and treatment reported four common, active approaches: health system interventions, patient convenience and accessibility, behaviour-related interventions and peer support, and incentives [ 16 ]. These active referral methods combat different patient barriers to care and treatment (i.e.…”