title: Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services.
abstract: BACKGROUND
  The integration of HIV/AIDS and maternal, neonatal, child health and nutrition services (MNCHN), including family planning (FP) is recognized as a key strategy to reduce maternal and child mortality and control the HIV/AIDS epidemic. However, limited evidence exists on the effectiveness of service integration.
  
  
  OBJECTIVE
  To evaluate the impact of integrating MNCHN-FP and HIV/AIDS services on health, behavioral, and economic outcomes and to identify research gaps.
  
  
  METHODS
  Using the Cochrane Collaboration's validated search strategies for identifying reports of HIV interventions, along with appropriate keywords and MeSH terms, we searched a range of electronic databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE (via PubMed), and Web of Science / Web of Social Science. The date range was from 01 January 1990 to 15 October 2010. There were no limits to language.
  
  
  METHODS
  Included studies were published in peer-reviewed journals, and provided intervention evaluation data (pre-post or multi-arm study design).The interventions described were organizational strategies or change, process modifications or introductions of technologies aimed at integrating MNCHN-FP and HIV/AIDS service delivery.
  
  
  METHODS
  We identified 10,619 citations from the electronic database searches and 101 citations from hand searching, cross-reference searching and interpersonal communication. After initial screenings for relevance by pairs of authors working independently, a total of 121 full-text articles were obtained for closer examination.
  
  
  RESULTS
  Twenty peer-reviewed articles representing 19 interventions met inclusion criteria. There were no randomized controlled trials. One study utilized a stepped wedge design, while the rest were non-randomized trials, cohort studies, time series studies, cross-sectional studies, serial cross-sectional studies, and before-after studies. It was not possible to perform meta-analysis. Risk of bias was generally high. We found high between-study heterogeneity in terms of intervention types, study objectives, settings and designs, and reported outcomes. Most studies integrated FP with HIV testing (n=7) or HIV care and treatment (n=4). Overall, HIV and MNCHN-FP service integration was found to be feasible across a variety of integration models, settings and target populations. Nearly all studies reported positive post-integration effects on key outcomes including contraceptive use, antiretroviral therapy initiation in pregnancy, HIV testing, and quality of services.
  
  
  CONCLUSIONS
  This systematic review's findings show that integrated HIV/AIDS and MNCHN-FP services are feasible to implement and show promise towards improving a variety of health and behavioral outcomes. However, significant evidence gaps remain. Rigorous research comparing outcomes of integrated with non-integrated services, including cost, cost-effectiveness, and health outcomes such as HIV and STI incidence, morbidity and mortality are greatly needed to inform programs and policy.
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA. mllindegren@gmail.com.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Lindegren
authors.forename: Caitlin E
authors.initials: CE
authors.lastname: Kennedy
authors.forename: Deborah
authors.initials: D
authors.lastname: Bain-Brickley
authors.forename: Hana
authors.initials: H
authors.lastname: Azman
authors.forename: Andreea A
authors.initials: AA
authors.lastname: Creanga
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Butler
authors.forename: Alicen B
authors.initials: AB
authors.lastname: Spaulding
authors.forename: Tara
authors.initials: T
authors.lastname: Horvath
authors.forename: Gail E
authors.initials: GE
authors.lastname: Kennedy
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005193:Family Planning Services / Q000458:organization & administration*; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration*; D009359:Neonatology / Q000458:organization & administration*; D052756:Nutritional Sciences