Background: The effectiveness of community-based primary health care (CBPHC) interventions in low- and middle-income countries, especially for maternal, neonatal and child health, is well established. However, there has not been a systematic review of the literature on the effectiveness of CBPHC on HIV outcomes derived from rigorous assessments of primary studies. Furthermore, HIV programming to date has been primarily at the facility level, limiting the experience of community-based approaches. Using peer-reviewed studies of randomized interventions or those containing a specified control group and directly measuring biological HIV outcomes, we provide evidence for the effectiveness of CBPHC on HIV outcomes for mothers and children in low- and middle-income countries.
Methods: Eligibility criteria included studies assessing effectiveness of community-based interventions or integrated projects, with outcome measures being population-based indicators that defined an aspect of HIV health status including nutritional status, serious morbidity and mortality of pregnant women and children < 5y. Articles published before April 2018 were identified by searching Pubmed, Embase, Scopus and Ovid Global Health databases. The kind of projects implemented, the outcomes, implementation strategies and implications of the findings were assessed. Two independent reviewers completed a data extraction form for each article and a third reviewer resolved any differences.
Results: Initial screening identified 9,827 articles; 4,241 articles underwent further title and abstract review after removing duplicates. Of these, 99 studies qualified for further screening and only 19 were included in the final analysis based on the eligibility criteria. Most of the studies showed that community-based interventions improved HIV/AIDS prevention and treatment outcomes compared to facility-based approaches alone. Most interventions were implemented by community health workers; other implementers were government workers, community members, or research staff. Strategies used included peer-to-peer education, community collaboration, psychosocial support, training of community champions, follow-up care, home-based care, integrated care, health systems strengthening, and utilization of mHealth tools.
Conclusions: CBPHC strategies are effective in improving population-based, HIV-related health outcomes for mothers and children, but there is a need to assess the scalability of such interventions and how to integrate them into existing health systems in order to assess their impact on the HIV epidemic in more routine settings.

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