Linking sexual and reproductive health and HIV interventions: a systematic review

Abstract

BackgroundThe international community agrees that the Millennium Development Goals will not be achieved without ensuring universal access to both sexual and reproductive health (SRH) services and HIV/AIDS prevention, treatment, care and support. Recently, there has been increasing awareness and discussion of the possible benefits of linkages between SRH and HIV programmes at the policy, systems and service delivery levels. However, the evidence for the efficacy of these linkages has not been systematically assessed.MethodsWe conducted a systematic review of the evidence for interventions linking SRH and HIV. Structured methods were employed for searching, screening and data extraction. Studies from 1990 to 2007 reporting pre-post or multi-arm evaluation data from SRH-HIV linkage interventions were included. Study design rigour was scored on a nine-point scale. Unpublished programme reports were gathered as "promising practices".ResultsOf more than 50,000 citations identified, 185 studies were included in the review and 35 were analyzed. These studies had heterogeneous interventions, populations, objectives, study designs, rigour and measured outcomes. SRH-HIV linkage interventions were generally considered beneficial and feasible. The majority of studies showed improvements in all outcomes measured. While there were some mixed results, there were very few negative findings. Generally, positive effects were shown for key outcomes, including HIV incidence, sexually transmitted infection incidence, condom use, contraceptive use, uptake of HIV testing and quality of services. Promising practices (n = 23) tended to evaluate more recent and more comprehensive programmes. Factors promoting effective linkages included stakeholder involvement, capacity building, positive staff attitudes, non-stigmatizing services, and engagement of key populations.ConclusionsExisting evidence provides support for linkages, although significant gaps in the literature remain. Policy makers, programme managers and researchers should continue to advocate for, support, implement and rigorously evaluate SRH and HIV linkages at the policy, systems and service levels.

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“…Despite the recognized clinical benefits of FP/HIV integration, evidence documenting its cost-efficiency is limited [6][7][8][9]. The recent Integra Initiative, funded by the Bill & Melinda Gates Foundation, partly addressed this evidence gap but it's costing studies considered integration of HIV services into various sexual and reproductive health (SRH) services, including Family Planning [10].…”

Improving Access to HIV and Sexual Reproductive Health Services for Key Populations along Nigeria’s Transport Corridors: The STOP Project

“…Such limitations are also seen among women and men living with HIV as there is little programmatic guidance as to how best ensure access to sexual and reproductive health services [3]. As HIV/AIDS remains a major public health burden around the world, affecting over 36 million people and leading to the death of about 34 million people, there has been an increasing awareness and discussion of the benefits of linkage between Sexual Reproductive Health (SRH) and HIV programs at the policy, systems and service delivery levels [4,5]. Moreover, in 2010, HIV/AIDS was reported as having the 5 th largest associated Disability-Adjusted Life Year (DALY) measurement -a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.…”