Faith-based organisations in providing HIV services within low- and middle-income countries (LMICs): a systematic review.

BACKGROUND

To end the acquired immune deficiency syndrome (AIDS) epidemic by 2030, the Joint United Nations Programme on HIV/AIDS (UNAIDS) proposes that 95% of people living with HIV should be diagnosed, 95% of those with a diagnosis should be on treatment, and 95% of those on treatment should achieve viral suppression. To attain these targets, UNAIDS estimates that community-based HIV services should increase from 5% to 30%. Within low-and-middle-income countries (LMICs), faith-based organisations (FBOs) often possess broad societal influence and extensive reach. Thus, many major AIDS organisations expect the collaboration between health and faith sectors to strengthen community-based HIV services. However, limited research has been conducted to evaluate the effectiveness of existing FBO-based interventions in delivering HIV services.

OBJECTIVE

To assess and evaluate the role of FBOs in the provision of HIV services within LMICs, and the associated barriers and challenges they may face.

METHODS

This systematic review followed PRISMA 2020 guidelines. A literature search of EMBASE, PubMed, and MEDLINE for relevant English-language studies was conducted on 23rd October 2025. Studies were limited to empirical publications providing data on outcomes of HIV interventions by FBOs within LMICs. Data were extracted and all studies were assessed for quality and risk of bias using the Cochrane Risk of Bias 2 (ROB 2) tool, Risk of Bias In Non-randomised Studies-of Interventions (ROBINS-I) tool, the appraisal tool for Cross-Sectional Studies (AXIS) tool and the CASP qualitative checklist.

RESULTS

Sixteen studies were included in this review, including seven qualitative studies, six quantitative studies, and three studies of mixed methods. All studies were conducted within sub-Saharan Africa. FBO interventions were primarily behavioural and fell into four categories: (1) congregation-based teaching, (2) education of religious leaders, (3) comprehensive home-based care (HBC), and (4) bespoke interventions using FBO structures. Key challenges facing FBOs in HIV service provision included insufficient resources, cultural issues (e.g. stigma, traditional healing) and concerns regarding barrier contraception.

CONCLUSIONS

Despite cultural and resource-based challenges, FBO interventions showed significant potential for expanding community-based HIV care within LMICs in sub-Saharan Africa. This review discusses several recommendations to strengthen FBO activities, encourage effective partnerships with FBOs, and ultimately lead to better HIV outcomes within LMICs. However, given the heterogeneity and quality of studies included, recommendations should be interpreted with caution.