Intervention Review

Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services

  1. Mary Lou Lindegren1,*,
  2. Caitlin E Kennedy2,
  3. Deborah Bain-Brickley3,
  4. Hana Azman3,
  5. Andreea A Creanga4,
  6. Lisa M Butler3,
  7. Alicen B Spaulding5,
  8. Tara Horvath3,
  9. Gail E Kennedy3

Editorial Group: Cochrane HIV/AIDS Group

Published Online: 12 SEP 2012

Assessed as up-to-date: 21 JUN 2012

DOI: 10.1002/14651858.CD010119

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.

Author Information

  1. 1

    Vanderbilt University, Vanderbilt Institute for Global Health, Nashville, Tennessee, USA

  2. 2

    Johns Hopkins Bloomberg School of Public Health, Department of International Health, Social and Behavioral Interventions Program, Baltimore, Maryland, USA

  3. 3

    University of California, San Francisco, Global Health Sciences, San Francisco, California, USA

  4. 4

    Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, USA

  5. 5

    University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota, USA

*Mary Lou Lindegren, Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA. marylou.lindegren@vanderbilt.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 12 SEP 2012

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

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.

Objectives

To evaluate the impact of integrating MNCHN-FP and HIV/AIDS services on health, behavioral, and economic outcomes and to identify research gaps.

Search methods

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.

Selection criteria

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.

Main 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 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.

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. 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.