Sexual and reproductive health services for people living with HIV: a systematic review

Abstract

People living with HIV often have unmet needs for sexual and reproductive health (SRH) services. We present results of a systematic review of studies offering SRH services targeted to people living with HIV. Studies were selected from a broader SRH and HIV linkages review. Inclusion criteria included: (1) peer-reviewed journal articles with a pre-post or multiple-arm study design; (2) reported post-intervention evaluation data; and (3) published 1 January 1990 through 31 December 2007. Nine studies were identified with an average rigour score of 5.1 out of 9. Services included family planning (one study), sexually transmitted infection (STI) services (two studies), combined family planning and STI services (three studies) and multiple services (three studies). The review identified mostly positive effects on the outcomes measured, including condom and contraceptive use and quality of services. Yet gaps remain in the research to establish the best approaches for addressing needs and choices of people living with HIV. There is a need for high-quality intervention studies to determine the most successful and cost-effective strategies for providing SRH services to people living with HIV.

The Study of HIV and Antenatal Care Integration in Pregnancy in Kenya: Design, Methods, and Baseline Results of a Cluster-Randomized Controlled Trial

“…Although recent systematic reviews of sexual and reproductive health and HIV integration intervention studies have found that integration is feasible and that the majority of studies report positive effects on outcomes [28], [29]; they also point out the dearth of rigorous study designs examining this issue [28], [46]. The SHAIP Trial is the first cluster-randomized trial of ANC and HIV care service integration in sub-Saharan Africa.…”

“…While experience and related studies have indicated that integration of services may improve uptake and utilization of HIV care and treatment by pregnant women, full integration needs rigorous evaluation before adoption on a wider scale [12], [20], [26]–[29]. Thus, in order to ensure provision of the highest quality ANC, PMTCT, and comprehensive HIV care and treatment to pregnant women, a new service model should have strong evidence supporting its effectiveness.…”

Does integrating family planning into HIV care and treatment impact intention to use contraception? Patient perspectives from HIV‐infected individuals in Nyanza Province, Kenya

“…Despite high unmet need for contraception among HIV-infected individuals, family planning and HIV treatment services remain largely separate, leaving many HIV-infected women without easy access to contraception. Globally, interest in integrating family-planning services into HIV care has grown [4–12], yet few studies have rigorously evaluated the impact of service integration [13–15]. …”

The role of family planning in elimination of new pediatric HIV infection

“…The bulk of studies evaluating interventions to deliver sexual and reproductive health services to women living with HIV have reported positive effects on health outcomes, including contraceptive use [45–47]. More recent studies have broadened the evidence base in this area.…”