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

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.

Keywords: Africa; Child health services; HIV; Immunization program; Literature review; PITC; PMTCT; neonatal health.

Figure 1

Timeline of Service Provision for Maternal, Newborn, Child Survival and HIV Programs. Notes: In sub-Saharan Africa, progress on reducing preventable child deaths and increasing antiretroviral therapy (ART) coverage in children living with HIV (CLHIV), while gaining ground, has been slower than desired. Too often, the delivery of health programs for children are “siloed” in specific intervention areas focused on HIV, TB, Nutrition, or Immunizations. This is often a product of how Ministries of Health or clinics are organized, or how international donor funding streams are allocated and regulated. “Siloed” or non-integrated programs can lead to mother-child dyad being reached with one type of intervention, while being missed for another. Programmers and implementers could better optimize each clinical “touch-point” with a mother-child dyad to provide more integrated and comprehensive services. Abbreviations and acronyms: ART-Antiretroviral Therapy, DBS-Dried Blood Spot, EPI-Expanded Program on Immunization, HIV- Human Immunodeficiency Virus, PMTCT-Prevention of Mother to Child Transmission, TB-Tuberculosis.

Figure 2

Study Flowchart

Figure 3

Number of Articles and Age of Child Receiving Study Interventions