Edinburgh Napier University

  Background: People living with HIV/AIDS (PLWHA) experience severe symptom burden and psychosocial problems irrespective of treatment status. There is evidence that person-centred approach used to care for PLWHA accessing ART, improved quality of life and psychosocial wellbeing. UNAIDS recommends a 30% increase in community-based care for PLWHA to improve retention in care. This review aimed to appraise the evidence for community and person-centred care models and their impact on outcomes for PLWHA.

Methods: Systematic review conducted in line with the PRISMA guidelines. Six databases (CINAHL, Embase, Global Health, Medline, PsycINFO and Web of Science), were searched from 1980 to February 2017, using predefined search terms. Community models of care were analysed by study location, model type, components of care, outcomes and data quality.

Results: 45 studies of community models of HIV/AIDS care were identified. 40% were from high income countries, 24.4% from upper middle income countries, 31.1% from low and middle income countries and 4.4% were from a mixture of low, middle and upper middle income countries. Community care was delivered in various ways, including outreach into community centres and individuals’ homes, with support by trained healthcare professionals, volunteers and/or peer workers. This review found that community models of HIV/AIDS care improved: treatment adherence; retention in care; viral suppression; mortality; quality of life, loss to follow-up and were cost effective. However, few of the models described included person-centred assessment and management of needs.

Conclusion: Community models of HIV/AIDS care had significant impact on the outcomes for PLWHA. However, few models included person-centred assessment and management of physical, psychological, social and spiritual problems of PLWHA. Therefore, there is a need for future studies to focus on inclusion of these four domains when developing person-centred community care for PLWHA.