Efficacy of HIV interventions in African fishing communities: A systematic review and qualitative synthesis

OBJECTIVES: This systematic review aims to qualitatively synthesise existing evidence on the efficacy of HIV interventions in African fishing communities. METHODS: Five databases (NCBI PubMed, EMBASE, Web of Science Core Collection, The Cochrane Library and CABI Global Health Database) were searched in March 2019 for eligible studies. All peer reviewed papers with a defined HIV intervention explicitly mentioning African fishing communities were included. Outcomes included any measure of the efficacy of HIV interventions. RESULTS: Of 22,289 search results, data was extracted from 25 eligible studies that passed critical appraisal. Seven involved HIV prevention, six HIV testing and counselling, three treatment, and nine combinations of more than one intervention. Findings include a high coverage of safe male circumcision (SMC) but low condom use among fisher folk, and a preference for PrEP over other HIV prevention services. Uptake of HIV testing and coverage of ART are below levels required to reach UNAIDS 90-90-90 targets, and there is high demand for ART and HIV self-testing kits. CONCLUSIONS: Further provision of services to combat HIV specifically amongst fishing communities are required; there is limited information on how to retain fisher folk in care and achieve an undetectable viral load. Interventions tailored to individual fishing populations, offered in parallel to education or counselling services are likely to be most effective. Use of innovations including mobile health and medical drones could assist these hard to reach populations. Our findings will inform future HIV service provision in fishing communities

• Population(s)
  • General HIV+ population
  • General HIV- population
• Engagement and Care Cascade
  • Linkage/engagement in care
  • Retention in care
• Prevention
  • Biomedical interventions
  • Education/media campaigns
• Testing
  • Testing