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

Authors Koduah Owusu K, Adu-Gyamfi R, Ahmed Z

Received 18 May 2019

Accepted for publication 5 September 2019

Published 2 December 2019 Volume 2019:11 Pages 321—332


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Bassel Sawaya

Kwadwo Koduah Owusu,1 Raphael Adu-Gyamfi,2 Zamzam Ahmed1

1School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK; 2National AIDS/STI Control Programme, Ghana Health Service, Korle-Bu, Accra, Ghana

Correspondence: Raphael Adu-Gyamfi
National AIDS/STI Control Programme, Ghana Health Service, Korle-bu, Accra, Ghana
Tel +233267075458

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.

Keywords: linkage to care, human immunodeficiency virus, acquired immune deficiency syndrome, urban, sub-Saharan Africa, adults

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