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

<h4>Background</h4>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...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/5aa6a18cba7c42d2b50c57eea41c8a1b
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:5aa6a18cba7c42d2b50c57eea41c8a1b
record_format	dspace
spelling	oai:doaj.org-article:5aa6a18cba7c42d2b50c57eea41c8a1b2021-12-02T19:55:43ZIntegrating HIV services and other health services: A systematic review and meta-analysis.1549-12771549-167610.1371/journal.pmed.1003836https://doaj.org/article/5aa6a18cba7c42d2b50c57eea41c8a1b2021-11-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003836https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>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.<h4>Methods and findings</h4>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 < 0.001), ART initiation coverage (pooled RR across 19 studies: 1.42 [95% CI 1.16-1.75], p = 0.002), time until ART initiation (pooled RR across 5 studies: 0.45 [95% CI 0.20-1.00], p = 0.050), retention in HIV care (pooled RR across 19 studies: 1.68 [95% CI 1.05-2.69], p = 0.031), and viral suppression (pooled RR across 9 studies: 1.19 [95% CI 1.03-1.37], p = 0.025). Also, treatment success for non-HIV-related diseases and conditions and the uptake of non-HIV services were commonly higher in integrated services. We did not find any significant differences for the following outcomes in our meta-analyses: HIV testing yield, ART adherence, HIV-free survival among infants, and HIV and non-HIV mortality. We could not conduct meta-analyses for several outcomes (HIV infections averted, costs, and cost-effectiveness), because our systematic review did not identify sufficient poolable studies. Study limitations included possible publication bias of studies with significant or favourable findings and comparatively weak evidence from some world regions and on integration of services for key populations in the HIV response.<h4>Conclusions</h4>Integration of HIV services and other health services tends to improve health and health systems outcomes. Despite some scientific limitations, the global evidence shows that service integration can be a valuable strategy to boost the sustainability of the HIV response and contribute to the goal of 'ending AIDS by 2030', while simultaneously supporting progress towards universal health coverage.Caroline A BulstraJan A C HontelezMoritz OttoAnna StepanovaErik LamontagneAnna YakusikWafaa M El-SadrTsitsi ApolloMiriam RabkinUNAIDS Expert Group on IntegrationRifat AtunTill BärnighausenPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 11, p e1003836 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R 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 Integrating HIV services and other health services: A systematic review and meta-analysis.
description	<h4>Background</h4>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.<h4>Methods and findings</h4>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 < 0.001), ART initiation coverage (pooled RR across 19 studies: 1.42 [95% CI 1.16-1.75], p = 0.002), time until ART initiation (pooled RR across 5 studies: 0.45 [95% CI 0.20-1.00], p = 0.050), retention in HIV care (pooled RR across 19 studies: 1.68 [95% CI 1.05-2.69], p = 0.031), and viral suppression (pooled RR across 9 studies: 1.19 [95% CI 1.03-1.37], p = 0.025). Also, treatment success for non-HIV-related diseases and conditions and the uptake of non-HIV services were commonly higher in integrated services. We did not find any significant differences for the following outcomes in our meta-analyses: HIV testing yield, ART adherence, HIV-free survival among infants, and HIV and non-HIV mortality. We could not conduct meta-analyses for several outcomes (HIV infections averted, costs, and cost-effectiveness), because our systematic review did not identify sufficient poolable studies. Study limitations included possible publication bias of studies with significant or favourable findings and comparatively weak evidence from some world regions and on integration of services for key populations in the HIV response.<h4>Conclusions</h4>Integration of HIV services and other health services tends to improve health and health systems outcomes. Despite some scientific limitations, the global evidence shows that service integration can be a valuable strategy to boost the sustainability of the HIV response and contribute to the goal of 'ending AIDS by 2030', while simultaneously supporting progress towards universal health coverage.
format	article
author	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
author_facet	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
author_sort	Caroline A Bulstra
title	Integrating HIV services and other health services: A systematic review and meta-analysis.
title_short	Integrating HIV services and other health services: A systematic review and meta-analysis.
title_full	Integrating HIV services and other health services: A systematic review and meta-analysis.
title_fullStr	Integrating HIV services and other health services: A systematic review and meta-analysis.
title_full_unstemmed	Integrating HIV services and other health services: A systematic review and meta-analysis.
title_sort	integrating hiv services and other health services: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/5aa6a18cba7c42d2b50c57eea41c8a1b
work_keys_str_mv	AT carolineabulstra integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT janachontelez integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT moritzotto integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT annastepanova integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT eriklamontagne integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT annayakusik integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT wafaamelsadr integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT tsitsiapollo integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT miriamrabkin integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT unaidsexpertgrouponintegration integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT rifatatun integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis AT tillbarnighausen integratinghivservicesandotherhealthservicesasystematicreviewandmetaanalysis
_version_	1718375840521125888

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

Ejemplares similares