Abstract
BackgroundCountry level policies and practices of testing and care for HIV, viral hepatitis and sexually transmitted infections are lagging behind European recommendations on integration across diseases. Building on previous experiences and evidence, the INTEGRATE Joint Action arranged four national stakeholder meetings. The aim was to foster cross-disciplinary and cross-disease collaborations at national level as a vehicle for strengthened integration of testing and care services. This article presents the methodology and discusses main outcomes and recommendations of these meetings.MethodsLocal partners in Croatia, Italy, Lithuania and Poland oversaw the planning, agenda development and identification of key persons to invite to ensure that meetings addressed main challenges and issues of the respective countries. Invited national stakeholders represented policy and public health institutions, clinical settings, testing sites and community organisations. National experts and experts from other European countries were invited as speakers and facilitators. Main topic discussed was how to increase integration across HIV, viral hepatitis and sexually transmitted infections in testing and care policies and practice; tuberculosis was also addressed in Lithuania and Italy.ResultsThe agendas reflected national contexts and the meetings provided a forum to engage stakeholders knowledgeable of the national prevention, testing and care systems in interaction with international experts who shared experiences of the steps needed to achieve integration in policies and practice. The evaluations showed that participants found meetings relevant, important and beneficial for furthering integration. Of the respondents 78% agreed or strongly agreed that there was a good representation of relevant national stakeholders, and 78% that decision/action points were made on how to move the agenda forward. The importance of securing participation from high level national policy makers was highlighted. Outcomes were nationally tailored recommendations on integrated policies and strategies, diversification of testing strategies, stigma and discrimination, key populations, cost effectiveness, surveillance and funding.ConclusionsShifting from single to multi-disease approaches require collaboration among a broad range of actors and national multi-stakeholder meetings have proven excellent to kick-start this. Face-to-face meetings of key stakeholders represent a unique opportunity to share cross-sectoral perspectives and experiences, identify gaps in national policies and practices and agree on required next steps.
Highlights
Country level policies and practices of testing and care for HIV, viral hepatitis and sexually transmitted infections are lagging behind European recommendations on integration across diseases
Existing structures attended by key populations, especially in urban environments, are evident places to offer testing for multiple infections, and increased investments in targeted interventions and strong focus on facilitating linkage to care and treatment for HIV, viral hepatitis and sexually transmitted infections (STIs), may rapidly lead to significant improvements in the continuum of care for all the infections
Integration is here defined as multi-disease funding schemes, service delivery and informational systems for HIV, viral hepatitis, TB and STI [4]. ’The authors selected multi-stakeholder meetings as an appropriate method to initiate collaboration because a broad array of national key stakeholders is brought together and provided a forum for discussion and reaching a common understanding of the required actions and steps
Summary
Country level policies and practices of testing and care for HIV, viral hepatitis and sexually transmitted infections are lagging behind European recommendations on integration across diseases. While inventories exist of success models and best-practices, which can be replicated and adapted to local contexts [1, 2], not all European countries have implemented European and international guidance and some health services continue to operate with diseasespecific specialties, mandates, budgets and information systems This results in siloed working and limited collaboration, which in turn means that opportunities to identify common goals, maximise service efficiency and accessibility, and share resources and rewards (i.e. the benefits of integration) are missed [3]. This article presents the results of four such meetings held in 2019 in the capitals of Croatia, Italy, Lithuania and Poland arranged by the INTEGRATE Joint Action [5] The aim of these meetings was to foster cross-disciplinary and cross-disease collaborations at national level as a vehicle for strengthened integration of testing and care services. The article focuses on the meetings as a method, and the participant evaluations and the main outcomes and recommendations identified for each country as the results
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