2 support, and laboratory monitoring. Some of these functions can be standardized and simpliﬁed to involve less qualiﬁed health cadres and PLWHA in ART delivery [9]. Various care models showed the added value of involving PLWHA in psychosocial and adherence support [5, 10, 11]. However, we believe that more functions, including standardized medical functions such as ART provision could be shifted towards PLWHA to obtain a more demedicalized ART delivery mo- del, primarily based on the communities and expert patients, with professional backup when needed [8, 9]. This participa- tion of PLWHA as expert patients in standardized medical tasks is proposed to streamline the process to access ART, to improve adherent behaviour, psychosocial wellbeing and re- tention in care [6, 8, 9, 12]. The result is a modiﬁed patient- professional partnership, deﬁned by the paradigm of collabo- rative care. Both patients and healthcare workers can use their expertise, patients as experts about their lives and needs and healthcare workers as experts about diseases [13]. For the scope of this paper, we analysed how PLWHA can become expert patients and get involved in ART pro- vision. To do so, we developed a conceptual framework in which self-management can reinforce PLWHA to become expert patients. We reviewed the literature for examples of involvement of PLWHA in ART provision. We focused on the context of SSA, where staggering workforce shortages limit the response to the HIV epidemic, and where social support networks are an essential element of personhood [14]. 2. Methods Based on our own experience, working in an HIV program in Tete, Mozambique, where patients are involved in the ART provision through community ART groups, we wanted to analyse how PLWHA can become expert patients and get involved in ART provision. In order to structure our thinking about the involvement of PLWHA as expert patients, we developed a framework to illustrate the diﬀerent elements required to reinforce HIV self-management and to empower PLWHA to become engaged in the care for their condition as expert patients (Figure 1). To increase their level of self-management and to become expert patients, PLWHA need to be (1) adequately informed and capable of acquiring self-management skills, (2) moti- vated to take day to day responsibility for their own care, and (3) part of a peer support network [6]. In order to compare our own experience with other HIV care delivery models featuring involvement of PLWHA in ART provision in SSA, we searched the literature on PubMed, the Cochrane database, and Google Scholar from 2000 to 2011. In addition, we reviewed article reference lists and searched websites of WHO and international HIV agencies. A combination of key search terms “SSA”, “HIV”, “AIDS”, “delivery of health care”, “community networks”, “com- munity health services”, “peer support”, “self-help groups”, “expert patient”, “self-management”, “treatment outcomes,” and “retention in care” was used. The search was limited to English literature. All retrieved abstracts were reviewed by AIDS Research and Treatment FR and TD. We only selected articles that explicitly described PLWHA involvement in ART provision in SSA. Papers on psychosocial and adherence support and ART provision by lay providers, who were not explicitly PLWHA, were excluded, as the added value of these strategies is already extensively described in the literature. Also studies with PLWHA involvement during a short time period were not considered as we focused on long-term solutions to empower PLWHA. We applied the conceptual framework on the selected studies. 3. Results The literature search for involvement of PLWHA as expert patients in ART provision in SSA produced 50 articles. Twenty-four articles were excluded as they did not reveal information on PLWHA involvement in care or ART pro- vision. Of the 26 remaining articles, 6 were excluded as they described a nurse-based care model without an explicit involvement of PLWHA. Another 9 articles were excluded as lay providers were involved in psychosocial support and adherence support, but not in ART provision, and PLWHA were not involved or PLWHA involvement was not explicitly described. Three articles illustrated the positive impact of involve- ment of PLWHA in psychosocial and adherence support on adherence and treatment outcomes. But as these articles did not mention an involvement of PLWHA in ART provision, they were excluded for further analyses [5, 10, 11]. In addition, we excluded 4 articles from rural Uganda where community health care workers (CHWs) or volunteers provided ART at patients’ homes without involving PLWHA. The CHWs were trained, salaried, and equipped with a motorbike and mobile phone, whereas social recognition was the main motivation for the volunteers. Outcomes obtained were comparable with conventional care. It is hypothesized that these ART delivery models, primarily based on CHW and volunteers, could serve as a role model for further invol- vement of PLWHA in ART provision and care [15–18]. We only found four articles, including our own experi- ence in Tete, involving PLWHA in ART provision in SSA. One article described the increased medication adherence as a result of a peer-delivered direct observed treatment (DOT) strategy during the ﬁrst 6 treatment weeks of antiretro- viral treatment at a health facility in Mozambique [19]. This study was further discarded, as PLWHA were involved only in the initial 6 weeks of ART provision, and since to our under- standing DOT is not compatible with the proposed process of reinforced self-management for PLWHA to become expert patients. Figure 2 describes the research strategy and results. Table 1 summarizes the three articles retrieved describing PLWHA involvement in ART provision. We did not ﬁnd published examples of PLWHA involved in decision making of ART initiation. The ﬁrst two articles discuss the same cluster random- ized controlled trial in Kenya, comparing a community- based care model to a conventional-clinic-based care model.