Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services
Editorial Group: Cochrane HIV/AIDS Group
Published Online: 12 SEP 2012
Assessed as up-to-date: 21 JUN 2012
Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Lindegren ML, Kennedy CE, Bain-Brickley D, Azman H, Creanga AA, Butler LM, Spaulding AB, Horvath T, Kennedy GE. Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD010119. DOI: 10.1002/14651858.CD010119.
- Publication Status: Edited (no change to conclusions)
- Published Online: 12 SEP 2012
The integration of HIV/AIDS 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/AIDS epidemic. However, limited evidence exists on the effectiveness of service integration.
To evaluate the impact of integrating MNCHN-FP and HIV/AIDS services on health, behavioral, and economic outcomes and to identify research gaps.
Using the Cochrane Collaboration's validated search strategies for identifying reports of HIV interventions, along with appropriate keywords and MeSH terms, we searched a range of electronic databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE (via PubMed), and Web of Science / Web of Social Science. The date range was from 01 January 1990 to 15 October 2010. There were no limits to language.
Included studies were published in peer-reviewed journals, and provided intervention evaluation data (pre-post or multi-arm study design).The interventions described were organizational strategies or change, process modifications or introductions of technologies aimed at integrating MNCHN-FP and HIV/AIDS service delivery.
Data collection and analysis
We identified 10,619 citations from the electronic database searches and 101 citations from hand searching, cross-reference searching and interpersonal communication. After initial screenings for relevance by pairs of authors working independently, a total of 121 full-text articles were obtained for closer examination.
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 studies, cross-sectional studies, serial cross-sectional studies, and before-after studies. It was not possible to perform meta-analysis. Risk of bias was generally high. We found high between-study heterogeneity in terms of intervention types, study objectives, settings and designs, and reported outcomes. Most studies integrated FP with HIV testing (n=7) or HIV care and treatment (n=4). Overall, HIV and MNCHN-FP service integration was found to be 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, antiretroviral therapy initiation in pregnancy, HIV testing, and quality of services.
This systematic review's findings show that integrated HIV/AIDS and MNCHN-FP services are feasible to implement and show promise towards improving a variety of health and behavioral outcomes. However, significant evidence gaps remain. Rigorous research comparing outcomes of integrated with non-integrated services, including cost, cost-effectiveness, and health outcomes such as HIV and STI incidence, morbidity and mortality are greatly needed to inform programs and policy.
Plain language summary
Integrating HIV/AIDS services with services focused on the health of mothers, infants and children, as well as on nutrition and family planning
Integrating HIV/AIDS prevention and treatment services with services focused on the health of mothers, infants and children, as well as on nutrition and family planning (MNCHN-FP) may improve the health of mothers and children affected by HIV/AIDS or a risk of HIV infection. We identified 20 articles representing 19 strategies for integrating these kinds of services. Overall, we found that integrating HIV/AIDS and MNCHN-FP services was was feasible across a variety of integration models, locations, and populations. Most studies reported that integration had a positive impact on health outcomes. Many studies, however, also reported that some outcomes had improved, while others had not improved; or that there was no effect at all.
There are still significant gaps in the evidence. There is a need for rigorous research comparing the outcomes of integrated services with those of non-integrated services. Such studies should look at the impact of integrated programs on cost, cost-effectiveness, the rate at which new HIV and other sexually transmitted infections occur in the population, and the impact on the rate of serious illness and death in women and children. These rigorous studies will help researchers and doctors to develop effective integrated programs, and will help policy-makers to develop evidence-based health policy.