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Abstract
BackgroundDespite significant interest in integrating sexual and reproductive health (SRH) services into HIV services, less attention has been paid to linkages in the other direction. Where women and girls are at risk of HIV, offering HIV testing services (HTS) during their visits to family planning (FP) services offers important opportunities to address both HIV and unwanted pregnancy needs simultaneously.MethodsWe conducted a systematic review of studies comparing FP services with integrated HTS to those without integrated HTS or with a lower level of integration (e.g., referral versus on-site services), on the following outcomes: uptake/counseling/offer of HTS, new cases of HIV identified, linkage to HIV care and treatment, dual method use, client satisfaction and service quality, and provider knowledge and attitudes about integrating HTS. We searched three online databases and included studies published in a peer-reviewed journal prior to the search date of June 20, 2017.ResultsOf 530 citations identified, six studies ultimately met the inclusion criteria. Three studies were conducted in Kenya, and one each in Uganda, Swaziland, and the USA. Most were in FP clinics. Three were from the Integra Initiative. Overall rigor was moderate, with one cluster-randomized trial. HTS uptake was generally higher with integrated sites versus comparison or pre-integration sites, including in adjusted analyses, though outcomes varied slightly across studies. One study found that women at integrated sites were more likely to have high satisfaction with services, but experienced longer waiting times. One study found a small increase in HIV seropositivity among female patients testing after full integration, compared to a dedicated HIV tester. No studies comparatively measured linkage to HIV care and treatment, dual method use, or provider knowledge/attitudes.ConclusionsGlobal progress and success for reaching SRH and HIV targets depends on progress in sub-Saharan Africa, where women bear a high burden of both unintended pregnancy and sexually transmitted infections, including HIV. While the evidence base is limited, it suggests that integration of HTS into FP services is feasible and has potential for positive joint outcomes. The success and scale-up of this approach will depend on population needs and health system factors.
Highlights
Despite significant interest in integrating sexual and reproductive health (SRH) services into HIV services, less attention has been paid to linkages in the other direction
The World Health Organization (WHO) global reproductive health strategy outlines a comprehensive approach to sexual and reproductive health (SRH) that includes HIV, [2] and integrating HIV testing services into family planning (FP) services can contribute to achieving joint health and human rights outcomes and accelerate progress towards comprehensive SRH and rights [3, 4]
Attention has been given to integrating FP services into HIV testing, care, and treatment services [5,6,7] and provision of FP counseling for women living with HIV, [8,9,10] but there has been comparatively less attention to integrating HIV testing services (HTS) into FP sites, even though there is evidence that routine, opt-out HIV testing integrated into FP clinics can potentially increase rates of testing acceptance, receipt of test results, and HIV-positive diagnoses among adolescents and young adults [11]
Summary
Despite significant interest in integrating sexual and reproductive health (SRH) services into HIV services, less attention has been paid to linkages in the other direction. Where women and girls are at risk of HIV, offering HIV testing services (HTS) during their visits to family planning (FP) services offers important opportunities to address both HIV and unwanted pregnancy needs simultaneously. Where women and girls are at risk of HIV, offering HIV testing during their visits to family planning (FP) services offers important opportunities to address HIV and unwanted pregnancy simultaneously. A 2009 systematic review of multi-directional linkages between family planning and HIV services identified two studies that provided HTS to clients of family planning clinics [12]. Apart from a Cochrane review in 2012 that looked at bidirectional integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and FP services, [17] there have not been any more recent systematic reviews specific to integrating HTS into FP services, which remains an important programmatic gap in providing these services
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