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Table 2 A summary table showing impact of community HIV intervention on continuation in HIV care across the treatment cascade, extracted from the included studies

From: Effect of community-based interventions targeting female sex workers along the HIV care cascade in sub-Saharan Africa: a systematic review and meta-analysis

Cascade step Combined interventions that showed significant impact Evidence
HIV testing • Partnership with KP NGOs/CBOs based in the community/hotspots to deliver HTS services on behalf of national programs
• Peer educator direct distribution of HIV self-test kits
• Repeated use of text messaging and communication on what’s up by peers informing FSW about the availability of testing services in the community
• Adapted health care: creation of FSW safe spaces and integration of targeted FSW HIV services in the general health care (e.g., STI screening and treatment, lubricants and condoms, direct escort by FSW peers within a public facility)
• Provision of testing through night clinics (bars, brothels, DICs)
• Full time provision of testing at clinics based in hotspots
• Strengthening support networks FSW CSOs to encourage health-promoting behavior
• Venue-based peer education, free condom distribution, and HIV counseling and testing;
Chanda et al. [29]
Kelvin et al. [34]
Aho et al. [28]
Lafort et al. [38]
Pande et al. [42]
HIV diagnosis Enhanced peer outreach approach:
• Use of paid outreach peers that have not worked as peers before to find new FSWs from their network
• Use of short-term incentivized peer support to reach their hard to reach contacts-FSWs
Lillie et al. [37]
Linkage to care None  
ART use: • NGO-initiated FSW-targeted mobile clinical services
• Provision of services at a community-led drop-in center
• Training of health workers in FSW-friendly approaches
• Provision of HIV services in the community clinic by a professional health provider
• Extending operating days at community based clinics with flex working hours
• Provision of broad package of HIV service offered in clinics based in hotspots
• Provision of on call services where FSW can consult anytime
• Police sensitivity trainings, violence prevention, and campaigns for anti-stigma and discrimination
Kerrigan et al. [35]
Cowan et al. [32] Napierala et al. [40]
Pande et al. [42]
Viral suppression None  
Interventions that showed a positive effect but with non-significant impact
 Linkage to • Enhancing referral mechanisms to the neighboring public health facilities by paying stipend for peers.
• Financial facilitation of FSW focal persons based at public health facilities
• Establishment and incentivized peer referrals to the DICs
• Creation of a safe space at a public health facility in a community without a FSW DIC
• Conducting sensitivity trainings to all service providers including the non-professional staff within the clinics
• Peer referrals and linkages at the clinics based in hotspots
• Behavior change communication to educate and improve health-seeking behaviors
• Extended hours of work to evenings, night, and weekends
• Mobile HIV services to mitigate transport issues
Chanda et al. [29]
Kerrigan et al. [35] Pande et al. [42]
Lafort et al. [36]
 Viral suppression: • Usual HIV services augmented with additional community mobilization activities aimed at raising awareness of the benefits of ART.
• Building leadership skills among FSW groups
• Participation of FSW groups in selecting their fellow FSW adherence supporters
• Adherence training sessions for the FSW adherence supporters
• Mobile telephone messaging reminders for ART adherence
• SMS and follow-up phone to support clinic attendance.
• Empowering FSW to improve retention in care by targeting improved individual client-oriented practices
Cowan et al. [32]
Kerrigan et al. [35]
Napierala et al. [40]