title: Health systems integration of sexual and reproductive health and HIV services in sub-Saharan Africa: a scoping study.
abstract: OBJECTIVE
  Both sexual and reproductive health (SRH) services and HIV programs in sub-Saharan Africa are typically delivered vertically, operating parallel to national health systems. The objective of this study was to map the evidence on national and international strategies for integration of SRH and HIV services in sub-Saharan Africa and to develop a research agenda for future health systems integration.
  
  
  METHODS
  We examined the literature on national and international strategies to integrate SRH and HIV services using a scoping study methodology. Current policy frameworks, national HIV strategies and research, and gray literature on integration were mapped. Five countries in sub-Saharan Africa with experience of integrating SRH and HIV services were purposively sampled for detailed thematic analysis, according to the health systems functions of governance, policy and planning, financing, health workforce organization, service organization, and monitoring and evaluation.
  
  
  RESULTS
  The major international health policies and donor guidance now support integration. Most integration research has focused on linkages of SRH and HIV front-line services. Yet, the common problems with implementation are related to delayed or incomplete integration of higher level health systems functions: lack of coordinated leadership and unified national integration policies; separate financing streams for SRH and HIV services and inadequate health worker training, supervision and retention.
  
  
  CONCLUSIONS
  Rigorous health systems research on the integration of SRH and HIV services is urgently needed. Priority research areas include integration impact, performance, and economic evaluation to inform the planning, financing, and coordination of integrated service delivery.
authors.affiliation: *Women and Health Initiative, Department of Global Health and Population, Harvard School of Public Health, Harvard University, Boston, MA; †Department of Global Health and Population, Harvard School of Public Health, Harvard University, Boston, MA; and ‡Programme on Health Systems and Impact Evaluation, Wellcome Trust Africa Centre for Health and Population Studies, Mtubatuba, South Africa.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hope
authors.forename: Tamil
authors.initials: T
authors.lastname: Kendall
authors.forename: Ana
authors.initials: A
authors.lastname: Langer
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
mesh_terms: D017954:Africa South of the Sahara; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006291:Health Policy; D006801:Humans; D008297:Male; D034121:Reproductive Health Services / Q000458:organization & administration*