Skip to main content

Advertisement

SpringerLink
Log in

A Systematic Review of Linkage-to-Care and Antiretroviral Initiation Implementation Strategies in Low- and Middle-Income Countries Across Sub-Saharan Africa

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Linkage to care (LTC) and initiation of antiretroviral therapy (ART) are key components in the longitudinal care cascade for people living with HIV. Many strategies to optimize these stages of HIV care have been implemented, though there is a paucity of analyses comparing the outcomes of these efforts in low- and middle-income countries. We conducted a systematic review of studies assessing interventions along all stages of the HIV care continuum published between 2008 and 2020. A comprehensive search strategy reviewed five electronic databases to capture studies assessing HIV testing, LTC, ART initiation, ART adherence, and viral suppression. Of the 388 articles that met the inclusion criteria, 78 described interventions for improving LTC/ART initiation. Efforts focused on empowering patients through integrative approaches generally yielded more substantive results compared to provider-initiated non-adaptive LTC interventions or cash incentives. Specifically, tailoring care and incorporating ART initiation into existing infrastructures, such as maternal clinics, had a high impact across settings. Moreover, strategies such as home-based HIV counseling and testing (HBHCT) appear to be most effective when implemented in tandem with other approaches including motivational counseling and point-of-care CD4 testing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

Systematic search was conducted to identify selected search terms was completed in PubMed, Embase, Scopus, Wed of Science, and the Cochrane Library.

Code Availability

Not applicable.

References

  1. Kranzer K, Govindasamy D, Ford N, Johnston V, Lawn SD. Quantifying and addressing losses along the continuum of care for people living with HIV infection in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2012;15(2):17383.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rosen S, Fox MP. Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review. PLoS Med. 2011;8(7):e1001056.

    Article  PubMed  PubMed Central  Google Scholar 

  3. HIV/AIDS UJUNPo. Fast track: ending the AIDS epidemic by 2030. UNAIDS; 2014. Report No.: 978-92-9253-063-1.

  4. Seizing The Moment: Tackling entrenched inequalities to end epidemics. Special analysis by Avenir Health using UNAIDS epidemiological estimates. 2020. https://aidsinfo.unaids.org/.

  5. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kay ES, Batey DS, Mugavero MJ. The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future. AIDS Res Ther. 2016;13:35.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sabapathy K, Hensen B, Varsaneux O, Floyd S, Fidler S, Hayes R. The cascade of care following community-based detection of HIV in sub-Saharan Africa: a systematic review with 90–90–90 targets in sight. PLoS ONE. 2018;13(7):e0200737.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Naik R, Zembe W, Adigun F, Jackson E, Tabana H, Jackson D, et al. What influences linkage to care after home-based HIV counseling and testing? AIDS Behav. 2018;22:722–32.

    Article  PubMed  Google Scholar 

  9. HIV/AIDS: WHO. 2020. https://www.afro.who.int/health-topics/hivaids.

  10. Govindasamy D, Ford N, Kranzer K. Risk factors, barriers and facilitators for linkage to antir : AIDS. AIDS. 2012;26(16):2059–67.

    Article  CAS  PubMed  Google Scholar 

  11. Group BMJP. Grading quality of evidence and strength of recommendations. 2004.

  12. Jenson A, Hansoti B, Rothman R, de Ramirez SS, Lobner K, Wallis L. Reliability and validity of emergency department triage tools in low- and middle-income countries: a systematic review. Eur J Emerg Med. 2018;25(3):154–60.

    Article  PubMed  Google Scholar 

  13. Bronfenbrenner U, Morris P. The bioecological model of human development. Handbook of child psychology. Theoretical models of human development. Amsterdam: Elsevier; 2007.

    Google Scholar 

  14. Sutton R. Feasibility and acceptability of health communication interventions within a combination intervention strategy for improving linkage and retention in HIV care in Mozambique. J Acquir Immune Defic Syndr. 2017;74:S29.

    Article  PubMed  Google Scholar 

  15. Myer L, Zulliger R, Black S, Pienaar D, Bekker LG. Pilot programme for the rapid initiation of antiretroviral therapy in pregnancy in Cape Town South Africa. AIDS Care. 2012;24(8):986–92.

    Article  PubMed  Google Scholar 

  16. Aliyu MH, Blevins M, Audet CM, Kalish M, Gebi UI, Onwujekwe O, et al. Integrated prevention of mother-to-child HIV transmission services, antiretroviral therapy initiation, and maternal and infant retention in care in rural north-central Nigeria: a cluster-randomised controlled trial. Lancet HIV. 2016;3(5):e202–11.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jani IV, Meggi B, Loquiha O, Tobaiwa O, Mudenyanga C, Zitha A, et al. Effect of point-of-care early infant diagnosis on antiretroviral therapy initiation and retention of patients. AIDS. 2018;32(11):1453–63.

    Article  PubMed  Google Scholar 

  18. Barnabas RV, van Rooyen H, Tumwesigye E, Brantley J, Baeten JM, van Heerden A, et al. Uptake of antiretroviral therapy and male circumcision after community-based HIV testing and strategies for linkage to care versus standard clinic referral: a multisite, open-label, randomised controlled trial in South Africa and Uganda. Lancet HIV. 2016;3(5):e212–20.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hoffmann CJ, Mabuto T, Ginindza S, Fielding KL, Kubeka G, Dowdy DW, et al. Strategies to accelerate HIV care and antiretroviral therapy initiation after HIV diagnosis: a randomized trial. J Acquir Immune Defic Syndr. 2017;75(5):540–7.

    Article  PubMed  Google Scholar 

  20. Larson BA. Same-day CD4 testing to improve uptake of HIV care and treatment in South Africa: point-of-care is not enough. AIDS Res Treat. 2013. https://doi.org/10.1155/2013/941493.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Eakle R, Gomez GB, Naicker N, Bothma R, Mbogua J, Cabrera Escobar MA, et al. HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: results from a prospective observational demonstration project. PLoS Med. 2017;14(11):e1002444.

    Article  PubMed  PubMed Central  Google Scholar 

  22. MacKellar D, Maruyama H, Rwabiyago OE, Steiner C, Cham H, Msumi O, et al. Implementing the package of CDC and WHO recommended linkage services: methods, outcomes, and costs of the Bukoba Tanzania combination prevention evaluation peer-delivered, linkage case management program, 2014–2017. PLoS ONE. 2018;13(12):e0208919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Boyer S. Factors associated with antiretroviral treatment initiation amongst HIV-positive individuals linked to care within a universal test and treat programme: early findings of the ANRS 12249 TasP trial in rural South Africa. AIDS Care. 2016;28:39.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Labhardt ND. Effect of offering same-day ART vs usual health facility referral during home-based HIV testing on linkage to care and viral suppression among adults with HIV in Lesotho: the CASCADE Randomized Clinical Trial. JAMA. 2018;319:1103.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Iwuji CC. Uptake of home-based HIV testing, linkage to care, and community attitudes about ART in Rural KwaZulu-Natal, South Africa: descriptive results from the first phase of the ANRS 12249 TasP Cluster-Randomised Trial. PLoS Med. 2016;13:e1002107.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sabapathy K. Predictors of timely linkage-to-ART within universal test and treat in the HPTN 071 (PopART) trial in Zambia and South Africa: findings from a nested case-control study. J Int AIDS Soc. 2017;20:e25037.

    Article  PubMed Central  CAS  Google Scholar 

  27. Elul B, Lamb MR, Lahuerta M, Abacassamo F, Ahoua L, Kujawski SA, et al. A combination intervention strategy to improve linkage to and retention in HIV care following diagnosis in Mozambique: a cluster-randomized study. PLoS Med. 2017;14(11):e1002433.

    Article  PubMed  PubMed Central  Google Scholar 

  28. McNairy ML, Lamb MR, Gachuhi AB, Nuwagaba-Biribonwoha H, Burke S, Mazibuko S, et al. Effectiveness of a combination strategy for linkage and retention in adult HIV care in Swaziland: the Link4Health cluster randomized trial. PLoS Med. 2017;14(11):e1002420.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Franse CB. Linkage to HIV care before and after the introduction of provider-initiated testing and counselling in six Rwandan health facilities. AIDS Care. 2017;29:326.

    Article  PubMed  Google Scholar 

  30. Wanyenze RK, Hahn JA, Liechty CA, Ragland K, Ronald A, Mayanja-Kizza H, et al. Linkage to HIV care and survival following inpatient HIV counseling and testing. AIDS Behav. 2011;15(4):751–60.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Asiimwe S, Ross JM, Arinaitwe A, Tumusiime O, Turyamureeba B, Roberts DA, et al. Expanding HIV testing and linkage to care in southwestern Uganda with community health extension workers. J Int AIDS Soc. 2017;20(Suppl 4):21633.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Naik R, Doherty T, Jackson D, Tabana H, Swanevelder S, Thea DM, et al. Linkage to care following a home-based HIV counselling and testing intervention in rural South Africa. J Int AIDS Soc. 2015;18:19843.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ayieko J, Petersen ML, Charlebois ED, Brown LB, Clark TD, Kwarisiima D, et al. A patient-centered multicomponent strategy for accelerated linkage to care following community-wide HIV testing in Rural Uganda and Kenya. J Acquir Immune Defic Syndr. 2019;80(4):414–22.

    Article  PubMed  Google Scholar 

  34. Barnabas RV, van Rooyen H, Tumwesigye E, Murnane PM, Baeten JM, Humphries H, et al. Initiation of antiretroviral therapy and viral suppression after home HIV testing and counselling in KwaZulu-Natal, South Africa, and Mbarara district, Uganda: a prospective, observational intervention study. Lancet HIV. 2014;1(2):e68–76.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Desai MA, Okal DO, Rose CE, Ndivo R, Oyaro B, Otieno FO, et al. Effect of point-of-care CD4 cell count results on linkage to care and antiretroviral initiation during a home-based HIV testing campaign: a non-blinded, cluster-randomised trial. Lancet HIV. 2017;4(9):e393–401.

    Article  PubMed  Google Scholar 

  36. MacPherson P. Effect of optional home initiation of HIV care following HIV self-testing on antiretroviral therapy initiation among adults in Malawi: a randomized clinical trial. JAMA. 2014;312:372.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Ruzagira E, Grosskurth H, Kamali A, Baisley K. Brief counselling after home-based HIV counselling and testing strongly increases linkage to care: a cluster-randomized trial in Uganda. J Int AIDS Soc. 2017;20(2):e25014.

    Article  PubMed Central  CAS  Google Scholar 

  38. Bassett IV, Regan S, Luthuli P, Mbonambi H, Bearnot B, Pendleton A, et al. Linkage to care following community-based mobile HIV testing compared with clinic-based testing in Umlazi Township, Durban, South Africa. HIV Med. 2014;15(6):367–72.

    Article  CAS  PubMed  Google Scholar 

  39. Govindasamy D, van Schaik N, Kranzer K, Wood R, Mathews C, Bekker LG. Linkage to HIV care from a mobile testing unit in South Africa by different CD4 count strata. J Acquir Immune Defic Syndr. 2011;58(3):344–52.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Larson B. Rapid point-of-care CD4 testing at mobile HIV testing sites to increase linkage to care: an evaluation of a pilot program in South Africa. J Acquir Immune Defic Syndr. 2012;61:e13.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Zyl V. Using a call center to encourage linkage to care following mobile HIV counseling and testing. AIDS Care. 2015;27:921.

    Article  PubMed  Google Scholar 

  42. Ayieko J, Petersen ML, van Rie A, Wafula E, Opudo W, Clark TD, et al. Effect of a patient-centered phone call by a clinical officer at time of HIV testing on linkage to care in Rural Kenya. Open Forum Infect Dis. 2018;5(6):ofy126.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Tun W, Apicella L, Casalini C, Bikaru D, Mbita G, Jeremiah K, et al. Community-based antiretroviral therapy (ART) delivery for female sex workers in Tanzania: 6-month art initiation and adherence. AIDS Behav. 2019;23(2):142–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Hacking D, Mgengwana-Mbakaza Z, Cassidy T, Runeyi P, Duran LT, Mathys RH, et al. Peer mentorship via mobile phones for newly diagnosed HIV-positive youths in clinic care in Khayelitsha, South Africa: mixed methods study. J Med Internet Res. 2019;21(12):e14012.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Cowan FM, Davey C, Fearon E, Mushati P, Dirawo J, Chabata S, et al. Targeted combination prevention to support female sex workers in Zimbabwe accessing and adhering to antiretrovirals for treatment and prevention of HIV (SAPPH-IRe): a cluster-randomised trial. Lancet HIV. 2018;5(8):e417–26.

    Article  PubMed  Google Scholar 

  46. Muhamadi L, Tumwesigye NM, Kadobera D, Marrone G, Wabwire-Mangen F, Pariyo G, et al. A single-blind randomized controlled trial to evaluate the effect of extended counseling on uptake of pre-antiretroviral care in Eastern Uganda. Trials. 2011;12:184.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Siedner MJ. Rethinking the pre in pre-therapy counseling: no benefit of additional visits prior to therapy on adherence or Viremia in Ugandans initiating ARVs. PLoS ONE. 2012;7:e39894.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Bassett IV, Coleman SM, Giddy J, Bogart LM, Chaisson CE, Ross D, et al. Sizanani: a Randomized trial of health system navigators to improve linkage to HIV and TB care in South Africa. J Acquir Immune Defic Syndr. 2016;73(2):154–60.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Venter WDF, Fischer A, Lalla-Edward ST, Coleman J, Lau Chan V, Shubber Z, et al. Improving linkage to and retention in care in newly diagnosed HIV-positive patients using smartphones in South Africa: randomized controlled trial. JMIR Mhealth Uhealth. 2019;7(4):e12652.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Boeke CE, Nabitaka V, Rowan A, Guerra K, Nawaggi P, Mulema V, et al. Results from a proactive follow-up intervention to improve linkage and retention among people living with HIV in Uganda: a pre-/post- study. BMC Health Serv Res. 2018;18(1):949.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Kiragga AN. Implementation and operational research: impact of nurse-targeted care on HIV outcomes among immunocompromised persons: a before-after study in Uganda. J Acquir Immune Defic Syndr. 2016;72:e32.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Burtle D. Introduction and evaluation of a “pre-ART care” service in Swaziland: an operational research study. BMJ Open. 2012;2:e000195.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Maughan-Brown B. A conditional economic incentive fails to improve linkage to care and antiretroviral therapy initiation among HIV-positive adults in Cape Town, South Africa. AIDS Patient Care STDs. 2018;32:70.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Stinson K. Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study. PLoS ONE. 2013;8:e63328.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Burnett SM, Zawedde-Muyanja S, Hermans SM, Weaver MR, Colebunders R, Manabe YC. Effect of TB/HIV integration on TB and HIV indicators in rural Ugandan health facilities. J Acquir Immune Defic Syndr. 2018;79(5):605–11.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Kerschberger B, Schomaker M, Ciglenecki I, Pasipamire L, Mabhena E, Telnov A, et al. Programmatic outcomes and impact of rapid public sector antiretroviral therapy expansion in adults prior to introduction of the WHO treat-all approach in rural Eswatini. Trop Med Int Health. 2019;24(6):701–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Hassan S, Cooke A, Saleem H, Mushi D, Mbwambo J, Lambdin BH. Evaluating the integrated methadone and anti-retroviral therapy strategy in Tanzania using the RE-AIM framework. Int J Environ Res Public Health. 2019;16(5):728.

    Article  PubMed Central  Google Scholar 

  58. Barton GR, Fairall L, Bachmann MO, Uebel K, Timmerman V, Lombard C, et al. Cost-effectiveness of nurse-led versus doctor-led antiretroviral treatment in South Africa: pragmatic cluster randomised trial. Trop Med Int Health. 2013;18(6):769–77.

    Article  PubMed  Google Scholar 

  59. Cameron D, Gerber A, Mbatha M, Mutyabule J, Swart H. Nurse-initiation and maintenance of patients on antiretroviral therapy: are nurses in primary care clinics initiating ART after attending NIMART training? S Afr Med J. 2012;102(2):98–100.

    Article  PubMed  Google Scholar 

  60. Nyasulu JCY. NIMART rollout to primary healthcare facilities increases access to antiretrovirals in Johannesburg: an interrupted time series analysis. S Afr Med J. 2013;103:232.

    Article  Google Scholar 

  61. Oluoch T, Kwaro D, Ssempijja V, Katana A, Langat P, Okeyo N, et al. Better adherence to pre-antiretroviral therapy guidelines after implementing an electronic medical record system in rural Kenyan HIV clinics: a multicenter pre-post study. Int J Infect Dis. 2015;33:109–13.

    Article  PubMed  Google Scholar 

  62. Amoroso CL. Using electronic medical records for HIV care in rural Rwanda. Stud Health Technol Inform. 2010;160:337.

    PubMed  Google Scholar 

  63. Audet CM, Salato J, Blevins M, Amsalem D, Vermund SH, Gaspar F. Educational intervention increased referrals to allopathic care by traditional healers in three high HIV-prevalence rural districts in Mozambique. PLoS ONE. 2013;8(8):e70326.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Zwarenstein M, Fairall LR, Lombard C, Mayers P, Bheekie A, English RG, et al. Outreach education for integration of HIV/AIDS care, antiretroviral treatment, and tuberculosis care in primary care clinics in South Africa: PALSA PLUS pragmatic cluster randomised trial. BMJ. 2011;342:d2022.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Ngidi W. Using a campaign approach among health workers to increase access to antiretroviral therapy for pregnant HIV-infected women in South Africa. J Acquir Immune Defic Syndr. 2013;63:e133.

    Article  CAS  PubMed  Google Scholar 

  66. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:1–15.

    Article  Google Scholar 

  67. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Makofane K, van der Elst EM, Walimbwa J, Nemande S, Baral SD. From general to specific: moving past the general population in the HIV response across sub-Saharan Africa. J Int AIDS Soc. 2020;23(Suppl 6):e25605.

    PubMed  PubMed Central  Google Scholar 

  69. WHO. Consultation on HIV differentiated service delivery models for specific populations and settings: pregnant and breastfeeding women, children, adolescents and key populations. World Health Organization; 2016 2017-01-13 17:10:07; 2017.

  70. Chang LW. Effectiveness of peer support on care engagement and preventive care intervention utilization among pre-antiretroviral therapy, HIV-infected adults in Rakai, Uganda: a randomized trial. AIDS Behav. 2015;19:1742.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Geng E, Hargreaves J, Peterson M, Baral S. Implementation research to advance the global HIV response: introduction to the JAIDS supplement. J Acquir Immune Defic Syndr (1999). 2019;82(Suppl 3):S173.

    Article  Google Scholar 

Download references

Acknowledgements

Kate Lobner for her support in developing the search strategy, executing the search across platforms, removal of duplicate results and preparing the search for review.

Funding

The authors are grateful for the support of the National Institute of Mental Health (Award Number R01 MH110358) and the National Institute of Nursing Research of the National Institutes of Health (NIH) (Award Number R01 NR016650).

Author information

Author notes

  1. Nneoma E. Okonkwo and Alexander Blum contributed equally to this work.

Authors and Affiliations

  1. School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Nneoma E. Okonkwo & Alexander Blum

  2. Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Nikita Viswasam, Elizabeth Hahn, Sofia Ryan, Gnilane Turpin, Carrie E. Lyons & Stefan Baral

  3. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Suite 200, 5801 Smith Avenue, Baltimore, MD, 21209, USA

    Bhakti Hansoti

  4. Department of International Health, Bloomberg School of Public Health, Baltimore, MD, USA

    Bhakti Hansoti

Authors
  1. Nneoma E. Okonkwo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander Blum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nikita Viswasam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sofia Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gnilane Turpin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carrie E. Lyons
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stefan Baral
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bhakti Hansoti
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BH, SB and GT conceived the study; CL, GT, BH, EH, SR developed the initial search strategy and completed the initial search, NO, AB, NV completed data abstraction for the selected articles and updated the search; NO and AB completed the synthesis of the results and wrote the manuscript; all authors reviewed, edited and approved of the final version of the manuscript.

Corresponding author

Correspondence to Bhakti Hansoti.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical Approval

Not applicable.

Consent to Participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 323 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okonkwo, N.E., Blum, A., Viswasam, N. et al. A Systematic Review of Linkage-to-Care and Antiretroviral Initiation Implementation Strategies in Low- and Middle-Income Countries Across Sub-Saharan Africa. AIDS Behav 26, 2123–2134 (2022). https://doi.org/10.1007/s10461-021-03558-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03558-5

Keywords

Search

Navigation