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

Figures & data

Table 1 The Key Search Terms

Stage	Key Terms
Population	Adults HIV positive Urban Sub-Saharan Africa
Intervention	Strategies to improve linkage to care
Outcome	Improved linkage rates
Types Of Study	Randomized controlled trials Retrospective cohort studies Prospective cohort studies

Figure 1 Flowchart of the study selection process.

Table 2 The Characteristics Of Studies Included In The Review (listed Alphabetically By Country)

Lead Author	Peter Cherutich, 2016^Citation39	Niklaus D. Labhardt, 2018^Citation44	Batya Elul, 2017^Citation42	Christopher J. Hoffmann, 2017^Citation40	Margaret L. McNairy, 2017^Citation38	Erica Samson Sanga, 2017^Citation41	Sian Floyd, 2014^Citation43
Country	Kenya	Lesotho	Mozambique	South Africa	Swaziland	Tanzania	Zambia
Type of study	Cluster randomized controlled trial	Randomized clinical trial	Cluster randomized trial	Randomized trial	Cluster randomized trial	Prospective mixed -method cohort study	Cluster randomized controlled trial
Participants	Non-pregnant adults aged ≥ 18 years with newly or recently diagnosed HIV without a recent history of intimate partner violence who had not yet or had only recently linked to HIV care from 18 HIV testing services clinics in Kenya.	PLHIV diagnosed during home-based HIV testing in 6,655 households from 60 rural villages and 17 urban areas in Lesotho	Newly diagnosed HIV patients in 10 primary health facilities in Maputo, Mozambique	Adults testing HIV positive and not currently in HIV care at 7 mobile HIV counseling and testing units in urban, peri-urban, and rural South Africa	Newly diagnosed HIV patients in 10 clusters of HIV clinics in Swaziland	Newly diagnosed HIV positive adults from 16 testing facilities in four districts of Mbeya Region, Tanzania	Four POPART Intervention Communities in Zambia
Strategies	Assisted partner services involving health advisors initiating confidential efforts to contact named sex partners of consenting index patients, informing them of their potential exposure to HIV, offering to test them for HIV at home, the workplace, or other convenient venue and, for those testing HIV positive, referring them to an HIV clinic.	Same-day home-based ART initiation	A combination intervention strategy involving 1. Point-of-care CD4 testing at the time of diagnosis, 2. Accelerated ART initiation, 3. Short message service (SMS) health messages and appointment reminders	Point-of-care CD4 plus longitudinal strengths-based counseling	A combination intervention, including 1. Point-of-care CD4+ testing at the time of an HIV-positive test, 2. Accelerated antiretroviral therapy (ART) initiation for treatment-eligible participants, 3. Mobile phone appointment reminders 4. Health educational packages, 5.Non-cash financial incentives	Community Testing	HIVST
Control	Waiting list	Counseling and referral	Counseling and referral	Standard care (Counseling and referral)	Counseling and referral	Facility testing	RDT, non-HIVST
Number of participants	1,305	268	2,004	2,558	2,106	1,012	15,557
Number of interventions	1	1	3	1	5	1	1
Site of intervention	Community	Community	Facility	Community	Facility	Community	Community
Follow up (months)	1.5	3	12	3	12	6	3
Facilitator(s)	HCW Supported HIV patient	HCW	HCW	Health worker	Health worker	HCW	CHiP
Primary measure	Linkage at 6 weeks	Linkage at 3 months	Linkage at 1 month	Verified linkage at 3 months	Linkage at 1 month months	Linkage at 6 months	Linkage at 3 months
Primary outcome	SD+	SD+	SD+	SD+	NSD	SD-	NSD
Other outcomes	–	Viral suppression at 12 months SD+	Retention at 12 months	–	Retention SD+	Time to linkage SD-	Time to linkage NSD

Abbreviations: RDT, rapid diagnostic test kits; HIVST, HIV self-testing; HCW, healthcare worker; CHiP, community HIV care provider; SD, significant difference; NSD, non-significant difference; +, in favor of the intervention group; -, in favor of the control group.

Cherutich P, Golden MR, Wamuti B, et al. Assisted partner services for HIV in Kenya: a cluster randomised controlled trial. Lancet HIV. 2017;4(2):e74–e82. doi:10.1016/S2352-3018(16)30214-427913227

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Labhardt ND, Ringera I, Lejone TI, et al. Effect of offering same-day ART vs usual health facility referral during home-based HIV testing on linkage to care and viral suppression among adults with HIV in Lesotho: the CASCADE randomized clinical trial. JAMA. 2018;319(11):1103–1112. doi:10.1001/jama.2018.181829509839

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Elul B, Lamb MR, Lahuerta M, et al. A combination intervention strategy to improve linkage to and retention in HIV care following diagnosis in Mozambique: a cluster-randomized study. Lewin SR, ed. PLoS Med. 2017;14(11):e1002433. doi:10.1371/journal.pmed.100243329136001

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Hoffmann CJ, Mabuto T, Ginindza S, et al. Strategies to accelerate HIV care and antiretroviral therapy initiation after HIV diagnosis. J Acquir Immune Defic Syndr. 2017;75(5):540–547. doi:10.1097/QAI.000000000000142828471840

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McNairy ML, Lamb MR, Gachuhi AB, et al. Effectiveness of a combination strategy for linkage and retention in adult HIV care in Swaziland: the Link4Health cluster randomized trial. Deeks SG, ed. PLoS Med. 2017;14(11):e1002420. doi:10.1371/journal.pmed.100242029112963

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Sanga ES, Lerebo W, Mushi AK, et al. Linkage into care among newly diagnosed HIV-positive individuals tested through outreach and facility-based HIV testing models in Mbeya, Tanzania: a prospective mixed-method cohort study. BMJ Open. 2017;7(4):e013733. doi:10.1136/bmjopen-2016-013733

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Floyd S, Shanaube K, Schaap A, et al. Linkage to HIV care following HIV self-testing: results from a cluster-randomised trial of community-based distribution of oral HIV self-test kits nested in four HPTN 071 (PopART) communities in Zambia. https://programme.aids2018.org//PAGMaterial/eposters/7432.pdf Accessed 128, 2018.

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