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Integrating HIV services and other health services: A systematic review and meta-analysis

Author

Listed:
  • Caroline A Bulstra
  • Jan A C Hontelez
  • Moritz Otto
  • Anna Stepanova
  • Erik Lamontagne
  • Anna Yakusik
  • Wafaa M El-Sadr
  • Tsitsi Apollo
  • Miriam Rabkin
  • UNAIDS Expert Group on Integration
  • Rifat Atun
  • Till Bärnighausen

Abstract

Background: Integration of HIV services with other health services has been proposed as an important strategy to boost the sustainability of the global HIV response. We conducted a systematic and comprehensive synthesis of the existing scientific evidence on the impact of service integration on the HIV care cascade, health outcomes, and cost-effectiveness. Methods and findings: We reviewed the global quantitative empirical evidence on integration published between 1 January 2010 and 10 September 2021. We included experimental and observational studies that featured both an integration intervention and a comparator in our review. Of the 7,118 unique peer-reviewed English-language studies that our search algorithm identified, 114 met all of our selection criteria for data extraction. Most of the studies (90) were conducted in sub-Saharan Africa, primarily in East Africa (55) and Southern Africa (24). The most common forms of integration were (i) HIV testing and counselling added to non-HIV services and (ii) non-HIV services added to antiretroviral therapy (ART). The most commonly integrated non-HIV services were maternal and child healthcare, tuberculosis testing and treatment, primary healthcare, family planning, and sexual and reproductive health services. Values for HIV care cascade outcomes tended to be better in integrated services: uptake of HIV testing and counselling (pooled risk ratio [RR] across 37 studies: 1.67 [95% CI 1.41–1.99], p

Suggested Citation

  • Caroline A Bulstra & Jan A C Hontelez & Moritz Otto & Anna Stepanova & Erik Lamontagne & Anna Yakusik & Wafaa M El-Sadr & Tsitsi Apollo & Miriam Rabkin & UNAIDS Expert Group on Integration & Rifat Atu, 2021. "Integrating HIV services and other health services: A systematic review and meta-analysis," PLOS Medicine, Public Library of Science, vol. 18(11), pages 1-31, November.
    • Handle: RePEc:plo:pmed00:1003836
    DOI: 10.1371/journal.pmed.1003836
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    References listed on IDEAS

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    1. Glasgow, R.E. & Vogt, T.M. & Boles, S.M., 1999. "Evaluating the public health impact of health promotion interventions: The RE-AIM framework," American Journal of Public Health, American Public Health Association, vol. 89(9), pages 1322-1327.
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    3. Jacob Bor & Anna Gage & Dorina Onoya & Mhairi Maskew & Yorghos Tripodis & Matthew P Fox & Adrian Puren & Sergio Carmona & Koleka Mlisana & William MacLeod, 2021. "Variation in HIV care and treatment outcomes by facility in South Africa, 2011–2015: A cohort study," PLOS Medicine, Public Library of Science, vol. 18(3), pages 1-18, March.
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    1. Simamkele Bokolo & Suzanne Mabaso & Wentzel Kruger & Preethi Mistri & Laura Schmucker & Candice Chetty-Makkan & Sophie J S Pascoe & Alison Buttenheim & Harsha Thirumurthy & Lawrence Long, 2024. "Applying behavioural economics principles to increase demand for free HIV testing services at private doctor-led clinics in Johannesburg, South Africa: A randomised controlled trial," PLOS Global Public Health, Public Library of Science, vol. 4(8), pages 1-13, August.

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