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SUBSTANTIAL: evidence documents the benefits of peer support provided by community health workers, lay health advisors, promotores de salud, and others. The papers in this supplement, all supported by the Peers for Progress program of the American Academy of Family Physicians Foundation, contribute to the growing body of literature addressing the efficacy, effectiveness, feasibility, reach, sustainability, and adoption of peer support for diabetes self-management. They and additional papers supported by Peers for Progress contribute to understanding how peer support can be implemented in real world settings. Topics include examination of the peers who provide peer support, reaching the hardly reached, success factors in peer support interventions, proactive approaches, attention to emotions, peer support in behavioral health, dissemination models and their application in China, peer support in the patient-centered medical home, research challenges, and policy implications.

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.

Objective this paper is a report of a systematic review and meta-ethnography to explore the impact of peer support in the context of perinatal mental illness (PMI). Method systematic review methods identified five qualitative studies about women's experiences of PMI, and the impact peer support has on their journey towards emotional well-being. Findings from the identified studies were synthesised into themes, using meta-ethnography. Synthesis and findings the meta-ethnography produced four themes; ‘Isolation: the role of peer support', ‘Seeking validation through peer support', ‘The importance of social norms of motherhood', and ‘Finding affirmation/a way forward; the impact of peer support'. These themes represent women's experiences of PMI, their encounters with peer support groups within that context, and the impact of such encounters on their mental health status. Key conclusion recognising the risk of isolation and having pathways of referral to peer support networks is important, as are practitioners roles in nurturing peer support networks in perinatal care. More research is required to establish the most successful formats/structures of peer support. Practitioners should also recognise their individual and collective professional duty to challenge stereotypical depictions of motherhood wherever they arise, as this ‘gold standard' benchmark of good mothering engenders guilt about not being good enough, often leaving women feeling inadequate. Implications for practice isolation is a key factor in PMI. Practitioners should be instrumental in their acceptance and development of peer support for PMI, ensuring these networks are valued, nurtured and encouraged. This study illustrates the powerful effect of professional and social forces on how new mothers feel about themselves.