Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services Público
Lindegren, Mary Louise (2012)
Abstract
Background: The integration of HIV and maternal, neonatal, child health and nutrition services (MNCHN), including family planning (FP) is recognized as a key strategy to reduce maternal and child mortality and control the HIV epidemic. However, limited evidence exists on the effectiveness of service integration.
Objective: To evaluate the impact of integrating MNCHN-FP and HIV services on health, behavioral, and economic outcomes and to identify research gaps.
Methods: Using the Cochrane Collaboration's validated search strategies for identifying reports of HIV interventions, along with appropriate keywords and MeSH terms, a range of electronic databases were searched, including CENTRAL, CINAHL, EMBASE, MEDLINE, and Web of Science, from January 1990 to October 2010. Included studies were published in peer-reviewed journals, and provided intervention evaluation data (pre-post or multi-arm study design). Interventions were organizational strategies or change, process modifications or introductions of technologies aimed at integrating MNCHN-FP and HIV service delivery.
Analysis: A total of 10,619 citations were identified from electronic databases and 101 citations from hand searching, cross-references and interpersonal communication. After screening for relevance, 121 full-text articles were reviewed.
Results: Twenty peer-reviewed articles representing 19 interventions met inclusion criteria. There were no randomized controlled trials. One study utilized a stepped wedge design, while the rest were non-randomized trials, cohort studies, time series, cross-sectional, serial crosssectional and before-after studies. It was not possible to perform meta-analysis. Risk of bias was generally high. There was high between-study heterogeneity in intervention types, study objectives, settings and designs, and reported outcomes. Most studies integrated FP with HIV testing or HIV treatment. Overall, HIV and MNCHN-FP service integration was feasible across a variety of integration models, settings and target populations. Nearly all studies reported positive post-integration effects on key outcomes including contraceptive use, HIV treatment initiation, HIV testing, and quality of services.
Conclusion: This systematic review found that integrated HIV and MNCHN-FP services were feasible to implement and can improve a variety of health and behavioral outcomes. However, significant evidence gaps remain. Rigorous research comparing outcomes of integrated with non-integrated services, including cost-effectiveness, HIV and STI incidence, morbidity and mortality are needed to inform programs and policy.
Table of Contents
Table of contents
Background...3
Description of the Intervention...5
How the intervention might work...5
Why it is important to do this review...6
Objectives...6
Methods...6
Criteria for including studies for this review...6
Types of studies...6
Types of participants...8
Types of interventions...8
Types of outcome measures...10
Search methods for identification of studies...10
Electronic searches...10
Searching other resources...11
Data collection and analysis...12
Data extraction and management...12
Assessment of risk of bias in included studies...13
Results...14
Description of studies...14
Results of the search...14
Included studies...15
Excluded studies...20
Risk of bias in included studies...20
Effects of interventions...21
Discussion...23
Summary of main results...23
Overall completeness and applicability of evidence...25
Quality of evidence...25
Potential biases in the review process...25
Agreements and disagreement with other studies or reviews...25
Conclusions...26
Implications for practice...26
Implications for research...26
Acknowledgements...26
Tables...27
Characteristics of studies and risk of
bias...27
Characteristics of excluded studies...48
References...49
Figures...56
Figure 1. Study Flow Diagram...57
Figure 2. Risk of bias summary...58
Appendices...59
Appendix 1. MNCHN-FP and HIV integration
matrix...59
Appendix 2. Example of PubMed search strategy...60
Appendix 3. Study Rigor...61
Appendix 4. Integration implementation...64
Appendix 5. ANC services adding ART for eligible pregnant
women...83
Appendix 6. Effect of PMTCT integration on ANC services...85
Appendix 7. Child malnutrition services adding HIV
testing...86
Appendix 8. Post-abortion care adding HIV testing...86
Appendix 9. HIV treatment/secondary prevention adding FP
services...87
Appendix 10. HIV counseling and testing adding FP
services...88
Appendix 11. Table of Study Descriptions and Table of
Outcomes...89
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