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More than just reinventing the wheel … Evidence review: Linking SRH and HIV

More than just reinventing the wheel … Evidence review: Linking SRH and HIV. Alejandra Trossero Senior HIV Officer: Linking SRH and HIV. Background. Two policy statements call upon both the SRH and HIV/AIDS communities to strengthen programmatic linkages between SRH and HIV/AIDS:

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More than just reinventing the wheel … Evidence review: Linking SRH and HIV

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  1. More than just reinventing the wheel …Evidence review: Linking SRH and HIV Alejandra Trossero Senior HIV Officer: Linking SRH and HIV

  2. Background • Two policy statements call upon both the SRH and HIV/AIDS communities to strengthen programmatic linkages between SRH and HIV/AIDS: • The New York Call to Commitment: Linking HIV/AIDS and Sexual and Reproductive Health (2004) • The Glion Call to Action on Family Planning and HIV/AIDS in Women and Children (2004) • The international community agrees that the Millennium Development Goals will not be achieved without ensuring universal access to sexual & reproductive health (SRH) and HIV prevention, treatment, care and support.

  3. A framework for priority linkages

  4. A systematic review of evidence • A systematic review of the literature was conducted to gain a clearer understanding of the effectiveness, optimal circumstances, and best practices for strengthening SRH and HIV linkages. • Linkages: Policy, programmatic, services and advocacy bi-directional synergies between SRH and HIV services • Integration: Different kinds of SRH and HIV services or operational programmes joined together to ensure and perhaps maximize collective outcomes 

  5. Methods • Systematic literature review • Systematic methods for searching, screening, and data extraction • Inclusion criteria: Peer-reviewed studies • Published in peer-reviewed journal (1990-2007) • Rigorous evaluation study (pre-post or control group) • Conducted in any setting Promising practices • ‘Grey’ (non-peer-reviewed) literature (1990-2007) • Some evaluation results reported • Conducted in resource-limited settings only

  6. Results Citations excluded from review (n=50,570) • Did not meet inclusion criteria • Interventions with element 3 of PMTCT not linked to other areas of SRH (matrix column 3, row 2) were reviewed elsewhere (see full report) Citations included in review(n=225) Citations identified through search strategy (n=50,797) Citations not retained for analysis (n=167) • Interventions linking HIV prevention, education and condoms with SRH services (matrix column 1) were reviewed elsewhere (see full report) Citations included in analysis(n=58)

  7. SRH-HIV Linkages Matrix Element 3 of PMTCT HIV prevention, education & condoms HIV counselling & testing Clinical care for PLHIV Peer-Reviewed Studies Promising Practices Psychosocial & other services for PLHIV 1 4 6 16 2 5 Family planning 6 5 54 24 15 10 7 10 Maternal & child health care 2 3 1 4 1 2 1 2 4 8 GBV prevention & management 1 1 0 1 9 10 4 2 129 23 1 2 STI prevention & management 5 2 0 5 0 1 2 0 1 0 Other SRH services 1 2

  8. Overall Findings • Despite diverse settings and clients, the majority of studies showed improvements in all outcomes measured • A few mixed results • Few negative findings • Linking SRH and HIV services was considered beneficial and feasible, especially in: • Family planning clinics • HIV counselling and testing centres • HIV clinics

  9. 3 Key Recommendations • Policy makers: Develop, adopt, modify and strengthen relevant policies, HIV and SRH strategic plans and coordination mechanisms to foster effective linkages • Programme managers: Strengthen linked SRH and HIV responses in both directions and rigorously monitor and evaluate integrated programmes during all phases of implementation • Researchers: Direct rigorous research towards areas of integration that are currently understudied, evaluate key outcomes, and disseminate findings

  10. Communication strategy • An 8-page summary was presented at: • Mexico IAC – August 2008 • USAID working group – October 2008 • Training workshops on Rapid Assessment tool in 5 regions – Oct/Nov 2008

  11. More than just reinventing the wheel • We need models that bring together a wide range of partners, including HIV and SRH organizations, network of people living with HIV, research institutions, UN agencies, key women’s groups. • A cohesive strategy to maintain “momentum” on the importance of linking HIV and SRH programmes and policies • Continue advocating for: • Harmonization of funding streams for HIV and SRH programmes • Ensuring a unified supply of commodities for HIV and SRH services

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