Systematic review of integration of neonatal and child health interventions with pediatric HIV interventions

Abstract

Background/Objectives:In the last decade, many strategies have called for integration of HIV and child survival platforms to reduce missed opportunities and improve child health outcomes. Countries with generalized HIV epidemics have been encouraged to optimize each clinical encounter to bend the HIV epidemic curve. This systematic review looks at integrated child health services and summarizes evidence on their health outcomes, service uptake, acceptability, and identified enablers and barriers.Methods:Databases were systematically searched for peer-reviewed studies. Interventions of interest were HIV services integrated with: neonatal/child services for children <5 years, hospital care of children <5 years, immunizations, and nutrition services. Outcomes of interest were: health outcomes of children <5 years, integrated services uptake, acceptability, and enablers and barriers. PROSPERO ID: CRD42017082444.Results:Twenty-eight articles were reviewed: 25 (89%) evaluated the integration of HIV services into child health platforms, while three articles (11%) investigated the integration of child health services into HIV platforms. Studies measured health outcomes of children (n=9); service uptake (n=18); acceptability of integrated services (n=8), and enablers and barriers to service integration (n=14). Service integration had positive effects on child health outcomes, HIV testing, and postnatal service uptake. Integrated services were generally acceptable, although confidentiality and stigma were concerns.Conclusion and Global Health Implications:Each clinical “touch point” with infants and children is an opportunity to provide comprehensive health services. In the current era of flat funding levels, integration of HIV and child health services is an effective, acceptable way to achieve positive child health outcomes.

Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low- and middle-income countries (LMICs): An umbrella review

“…The vast majority of included reviews covered interventions aiming at preventing infectious diseases in children [ 49 , 50 , 54 – 59 , 62 , 64 , 65 , 68 , 69 , 71 – 82 , 84 – 99 , 101 , 102 , 104 , 106 , 108 – 110 ]. Over a quarter included health promoting interventions [ 48 , 49 , 60 – 64 , 66 , 67 , 70 , 72 , 78 , 83 , 92 , 103 , 107 ] and only two covered health protection interventions [ 100 , 105 ].…”

“…Looking at the number of included reviews per intervention level, two reviews included interventions at the structural level [ 49 , 85 ], twenty-five covered interventions at the public policy level [ 49 , 55 , 58 , 62 , 64 , 68 , 69 , 72 , 78 , 81 , 83 , 85 – 88 , 90 , 91 , 93 , 97 , 98 , 101 , 102 , 104 , 108 , 110 ], twenty-four at the community level [ 50 , 59 , 62 , 64 , 65 , 69 , 72 – 74 , 76 , 78 , 80 , 82 , 84 , 85 , 89 , 92 , 95 – 97 , 99 , 100 , 106 , 109 ] and twenty-five at the individual level [ 48 , 55 – 57 , 60 , 61 , 63 …”

“…Regarding approaches to health inequalities adopted by the interventions covered, the vast majority of reviews (forty-five in total) included interventions with a universal approach [ 48 , 50 , 55 , 58 – 63 , 66 – 68 , 71 – 74 , 77 – 81 , 85 – 88 , 90 – 102 , 104 – 108 , 110 ]. Twenty-six reviews included interventions adopting a targeted approach [ 48 , 49 , 54 , 56 , 57 , 62 – 65 , 67 , 68 , 70 , 72 , 75 , 76 , 78 , 82 – 85 , 89 , 92 , 97 , 99 , 103 , 109 ], and ten included a mix of both approaches [ 48 , 62 , 63 , 68 , 72 , 78 , 85 , 92 , 97 , 99 ]. None of the included reviews described interventions adopting a proportionate universalism approach.…”

“…Only twenty reviews reported intervention effects across different groups [ 48 , 50 , 58 , 63 , 68 , 69 , 72 , 77 , 80 , 81 , 83 , 88 , 93 , 94 , 97 , 99 , 102 , 104 , 109 , 110 ]. Another twenty one reviews reported the interventions’ effect on targeted disadvantaged groups as one population [ 49 , 54 , 56 , 57 , 61 – 64 , 67 , 75 , 76 , 82 – 85 , 88 , 89 , 92 , 97 , 99 , 103 ]. In terms of factors of disadvantages or variations in health covered by these studies, the most common ones found in the reviews are health-related vulnerabilities or higher needs (e.g.…”

Beyond the facility: An evaluation of seven community-based pediatric HIV testing strategies and linkage to care outcomes in a high prevalence, resource-limited setting

“…This suggests the widespread success observed in expanding facility-based HTS among young children through offering multiple services at the same delivery point (e.g. immunization) can and should be transferred to a community setting [37]. The majority of children tested at MOCs were under 5 years, which is unsurprising given the package of services (ANC and immunization) that was designed to attract this age group.…”