Integration of Neonatal and Child Health Interventions with Pediatric HIV Interventions in Global Health.

Brianna L Smith,Anouk Amzel,Alexandra C Vrazo,Sarah Konopka,Sarah Wiant,Molly C Pezzulo,Rachel Golin,Sara Sara Zizzo

doi:10.21106/ijma.268

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.

Highlights

Sub-Saharan Africa remains the region with the highest under-five mortality rate in the world
Identifying the HIV status of children and linking them to care and treatment is crucial for child survival,especially among HIV-exposed infants (HEI) where peak mortality from HIV infection occurs between six weeks to four months of age.[6,7,8]
Results from this review show that integration of HIV testing services into child health platforms increases the number of infants and children living with HIV identified, the first step to getting them access to antiretroviral therapy (ART) and preventing under five mortality

Summary

Introduction

Sub-Saharan Africa remains the region with the highest under-five mortality rate in the world. Despite an estimated 210,000 HIV infections averted in 2017 due to successful PMTCT programs, there were still approximately 180,000 infants who were vertically infected with the virus in the same year.[5] Finding children living with HIV (CLHIV) remains challenging, and children are less likely to receive ART than adults (52% vs 59%).[5] Rapidly identifying the HIV status of children and linking them to care and treatment is crucial for child survival,especially among HIV-exposed infants (HEI) where peak mortality from HIV infection occurs between six weeks to four months of age.[6,7,8] Despite the potential for case finding during provision of services at child survival entry points, vertical programming has historically missed these opportunities, resulting in poor survival outcomes for children with comorbidities.[3]

Methods

Results

Discussion

Conclusion