mothers2mothers, Cape Town, South Africa.
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2019 Jan 31;14(1):e0211439. doi: 10.1371/journal.pone.0211439. eCollection 2019.
Increased demand for healthcare services in countries experiencing high HIV disease burden and often coupled with a shortage of health workers, has necessitated task shifting from professional health workers to Lay Health Workers (LHWs) in order to improve healthcare delivery. Maternal and Child Health (MCH) services particularly benefit from task-shifting to LHWs or similar cadres. However, evidence on the roles and usefulness of LHWs in MCH service delivery in Sub-Saharan Africa (SSA) is not fully known.
To examine evidence of the roles and impact of lay health worker programmes focusing on Women Living with HIV (WLH) and their HIV-exposed infants (HEIs).
A scoping review approach based on Arksey and O'Malley's guiding principles was used to retrieve, review and analyse existing literature. We searched for articles published between January 2008 and July 2018 in seven (7) databases, including: MEDLINE, Embase, PsycINFO, Joanna Briggs, The Cochrane Library, EBM reviews and Web of Science. The critical constructs used for the literature search were "lay health worker", "community health worker", "peer mentor", "mentor mother," "Maternal and Child health worker", "HIV positive mothers", "HIV exposed infants" and PMTCT.
Thirty-three (33) full-text articles meeting the eligibility criteria were identified and included in the final analysis. Most (n = 13, 39.4%) of the included studies were conducted in South Africa and used a cluster RCT design (n = 13, 39.4%). The most commonly performed roles of LHWs in HIV specific MCH programmes included: community engagement and sensitisation, psychosocial support, linkage to care, encouraging women to bring their infants back for HIV testing and supporting default tracing. Community awareness on Mother to Child Transmission of HIV (MTCT), proper and consistent use of condoms, clinic attendance and timely HIV testing of HEIs, as well as retention in care for infected persons, have all improved because of LHW programmes.
LHWs play significant roles in the management of WLH and their HEIs, improving MCH outcomes in the process. LHW interventions are beneficial in increasing access to PMTCT services and reducing MTCT of HIV, though their impact on improving adherence to ART remains scanty. Further research is needed to evaluate ART adherence in LHW interventions targeted at WLH. LHW programmes can be enhanced by increasing supportive supervision and remuneration of LHWs.
在艾滋病毒疾病负担高的国家，医疗保健服务的需求不断增加，而卫生工作者往往短缺，这使得从专业卫生工作者向初级卫生保健工作者（LHWs）转移任务成为必要，以改善医疗服务的提供。孕产妇和儿童保健（MCH）服务特别受益于向 LHWs 或类似干部转移任务。然而，在撒哈拉以南非洲（SSA），关于 LHWs 在 MCH 服务提供中的作用和有效性的证据并不完全清楚。
研究针对艾滋病毒感染者妇女及其艾滋病毒暴露婴儿（HEIs）的初级卫生保健工作者方案的作用和影响的证据。
我们采用基于 Arksey 和 O'Malley 的指导原则的范围审查方法来检索、审查和分析现有文献。我们在七个数据库（包括 MEDLINE、Embase、PsycINFO、Joanna Briggs、The Cochrane Library、EBM 评论和 Web of Science）中搜索了 2008 年 1 月至 2018 年 7 月期间发表的文章。文献检索使用的关键构建包括“初级卫生保健工作者”、“社区卫生工作者”、“同伴导师”、“导师母亲”、“孕产妇和儿童保健工作者”、“艾滋病毒阳性母亲”、“艾滋病毒暴露婴儿”和 PMTCT。
符合入选标准的 33 篇全文文章被确定并纳入最终分析。纳入的研究大多（n=13，39.4%）来自南非，采用聚类 RCT 设计（n=13，39.4%）。LHWs 在艾滋病毒特定的 MCH 方案中最常执行的角色包括：社区参与和宣传、心理社会支持、护理联系、鼓励妇女带婴儿回来进行艾滋病毒检测以及支持失访追踪。由于 LHW 方案，社区对艾滋病毒母婴传播（MTCT）、正确和持续使用避孕套、诊所就诊和及时检测 HEIs 的艾滋病毒、以及感染者的护理保留等方面的认识都有所提高。
LHWs 在管理艾滋病毒感染者妇女及其 HEIs 方面发挥着重要作用，从而改善了母婴保健的结果。LHW 干预措施有利于增加获得 PMTCT 服务的机会，并减少艾滋病毒母婴传播，但它们对提高抗逆转录病毒治疗的依从性的影响仍然很少。需要进一步研究评估针对艾滋病毒感染者妇女的 LHW 干预措施中的抗逆转录病毒治疗依从性。可以通过增加对 LHW 的支持性监督和报酬来增强 LHW 方案。
