Background
Support groups for people
living with HIV (PLHIV) are integrated into Human Immunodeficiency Virus (HIV)
care and treatment programs as a modality for increasing patient literacy and
as an intervention to address the psychosocial needs of patients. However, the
impact of support groups on key health outcomes has not been fully determined.
Methods
We searched electronic
databases from January 1995 through May 2014 and reviewed relevant literature
on the impact of support groups on mortality, morbidity, retention in HIV care,
quality of life, and ongoing HIV transmission, as well as their cost
effectiveness.
Results
Of 1809 citations
identified, 20 met inclusion criteria. One reported on mortality, seven on
morbidity, five on retention in care, seven on quality of life, and seven on
ongoing HIV transmission. Eighteen (90%) of the articles reported largely
positive results on the impact of support group interventions on key outcomes.
Support groups were associated with reduced mortality and morbidity, increased retention
in care and improved quality of life. Due to study limitations, the overall
quality of evidence was rated as fair for mortality, morbidity, retention in
care, and quality of life, and poor for HIV transmission.
Conclusions
Implementing support groups
as an intervention is expected to have a high impact on morbidity and retention
in care and a moderate impact on mortality and quality of life of PLHIV.
Support groups improve disclosure with potential prevention benefits but the
impact on ongoing transmission is uncertain. It is unclear if this intervention
is cost-effective given the paucity of studies in this area.
...The review found largely positive results. Although limited
by the quality of the included studies, the data suggest potential benefit of
support groups on key health outcomes. We rated the expected impact of support
groups as an intervention in PLHIV as high in terms of reducing morbidity and
improving retention in care. Support groups also have the potential to
influence mortality, quality of life and prevention of ongoing HIV
transmission. Specific positive benefits associated with support group
membership include enhancing treatment success and improving the quality of
life through equipping PLHIV with coping skills.
With development of community-based care models in
some settings, support groups could provide an opportunity for PLHIV to share
experiences and become more engaged in their care. Given the severe human
resource challenges in sub-Saharan Africa, specifically the shortage of trained
health care providers38, support groups can play an
increasingly larger role in care models, particularly with regard to retaining
HIV-infected persons in care. Based on success of the pilot program developed
by Médecins Sans Frontières (MSF) and provincial health officials in Mozambique
reported in this review 16, 17, the
Mozambique Ministry of Health is scaling up CAGs nationally.
We did not specifically search for adherence as an
outcome in this review. However five studies reported increased adherence to
ART 15, 23, 24, 32 associated
with support group participation. In Wouters et al., 89.9% of support group members
reported that support group meetings helped create a forum for sharing
knowledge and experiences, some of which related to taking medications. In
Mozambique PLHIV enrolled in support groups reported increased adherence. 16
Two studies described negative outcomes. In a South
Africa study, male participants in support groups felt under pressure to
conform to a lifestyle that was not consistent with established gender roles 32,
while a large mixed methods study with participants from Burkina Faso, Kenya,
Malawi and Uganda showed that membership in a support group was associated with
non-disclosure to partners. 19 These
issues will need to be addressed to maximize the potential of support groups as
an intervention...
Full article at: http://goo.gl/HNJv2T
By:
1Division of Global AIDS, Centers for
Disease Control and Prevention (CDC), Atlanta, Georgia
2Office of HIV and AIDS, United States
Agency for International Development
§Corresponding author: Moses H Bateganya, MBChB,
MMed, MPH, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd
NE, MS E-04, Atlanta, GA 30333, USA ; Email: vog.cdc@aynagetaBM ; phone: 404-639-3220, fax: 404-639-8114
More at: https://twitter.com/hiv
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