Costs and cost-effectiveness of community health worker programs focussed on HIV, TB and malaria infectious diseases in low- and middle-income countries (2015–2024): A scoping literature review

Abstract

Infectious diseases remain a significant public health challenge in low- and middle-income countries (LMICs), with HIV, tuberculosis (TB), and malaria contributing significantly to morbidity and mortality. Community Health Workers (CHWs) play a pivotal role in addressing these diseases, yet evidence on the costs and cost-effectiveness of CHW-led interventions remains fragmented. We performed a scoping review, searching ten databases and the grey literature for original studies published between August 2015 and July 2024. Recognized search terms related to "Community Health Workers" and "Economic Evaluation(s)" in LMICs were utilized. Covidence software was employed to screen studies based on inclusion and exclusion criteria. Data on study methodology, costs and cost-related outcomes were then extracted, tabulated in a data-extraction form, and analysed using Microsoft Excel. Thirty-three studies representing 106 scenarios were included, predominantly from sub-Saharan Africa (61%). Over half the scenarios provide evidence about malaria (n = 59), followed by HIV (n = 31) and TB (n = 24). CHWs performed diverse roles, including delivering preventive education, case finding, diagnosis, treatment adherence support, counselling and referrals. The majority demonstrated that CHW programs were cost-effective compared to alternative service delivery models, most commonly facility-based care. These programs were particularly effective in improving treatment adherence and targeting high-priority populations. Costs per beneficiary ranged widely, from $1.20 to $26,556. This review highlights significant heterogeneity in methodologies and reporting, impeding comprehensive comparisons. Future research should emphasize standardized reporting, assess affordability, explore integrated CHW roles across multiple disease groups, and focus on generating evidence that supports priority-setting and resource allocation at the health system level.