Integrating Human Immunodeficiency Virus and Reproductive, Maternal and Child, and Tuberculosis Health Services Within National Health Systems

Abstract

Joint United Nations Programme on HIV/AIDS (UNAIDS) established 90–90–90 HIV treatment targets for 2020 including the following: 90 % of HIV-infected people know their HIV status, 90 % of HIV-infected people who know their status are on treatment, and 90 % of people on HIV treatment have a suppressed viral load. Integration of HIV and other programs into the national health system provides an important pathway to reach those targets. We examine the case for integrating HIV and other health services to ensure sustainability and improve health outcomes within national health systems. In this non-systematic review, we examined recent studies on integrating HIV, tuberculosis (TB), maternal-child health (MCH), and sexually transmitted infection (STI) programs. Existing evidence is limited about the effectiveness of integration of HIV and other services. Most studies found that service integration increased uptake of services, but evidence is mixed about the effect on health outcomes or quality of health services. More rigorous studies of different strategies to promote integration over a wider range of services and settings are needed. Research on how best to maximize benefits, including sustainability, of integrated services is necessary to help inform international and national policy. We recommend additional interventions to test how best to integrate HIV and MCH services, HIV and TB services, HIV testing and treatment, and STI testing and treatment.

Collaborative care for the detection and management of depression among adults receiving antiretroviral therapy in South Africa: study protocol for the CobALT randomised controlled trial

“…Current debate regarding the targets has concerned the funding required and the shape of the interventions needed to be scaled in order to meet them [ 2 ]. These include focusing on key populations such as young women [ 3 , 4 ], the introduction of universal test and treat programmes [ 5 ], and integration with related programmes including those for tuberculosis, maternal and child health, and sexually transmitted infections [ 6 ]. The intersection between HIV, non-communicable diseases (NCDs) and mental health is notably absent from this discourse, despite recent evidence demonstrating the scale and consequences of the collision of these respective epidemics.…”

Decentralising and integrating HIV services in community-based health systems: a qualitative study of perceptions at macro, meso and micro levels of the health system

“…A recent review of the literature on the evidence for integrating HIV and other health services, such as TB care, into national health systems, showed that the effect on health outcomes and quality of services was mixed. 35 As Kenya moves forward with expanding HIV testing as a priority health service there is a need to seek synergies between vertical and horizontal programmes, 36 ensuring that the integration of HIV services leads to a strengthening of community systems. 37 38 …”

‘Protecting Life in Global Health Assistance’? Towards a framework for assessing the health systems impact of the expanded Global Gag Rule

“…Referral systems and integrated services connect patients across multiple domains of the health system including HIV/AIDS, TB control, FP and MCH. This integration can be more efficient, increase service uptake, improve patient satisfaction and improve health outcomes 25–30…”