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Improving antiretroviral therapy scale-up and effectiveness through service integration and decentralization.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Suthar, Amitabh B. Rutherford, George W. Horvath, Tara Doherty, Meg C. Negussie, Eyerusalem K.
Description	Country affiliation: United States Author Affiliation: Suthar AB ( aHIV Department, World Health Organization, Geneva, Switzerland bGlobal Health Sciences, University of California at San Francisco, San Francisco, California, USA.)
Abstract	BACKGROUND: Current service delivery systems do not reach all people in need of antiretroviral therapy (ART). In order to inform the operational and service delivery section of the WHO 2013 consolidated antiretroviral guidelines, our objective was to summarize systematic reviews on integrating ART delivery into maternal, newborn, and child health (MNCH) care settings in countries with generalized epidemics, tuberculosis (TB) treatment settings in which the burden of HIV and TB is high, and settings providing opiate substitution therapy (OST); and decentralizing ART into primary health facilities and communities. DESIGN: A summary of systematic reviews. METHODS: The reviewers searched PubMed, Embase, PsycINFO, Web of Science, CENTRAL, and the WHO Index Medicus databases. Randomized controlled trials and observational cohort studies were included if they compared ART coverage, retention in HIV care, and/or mortality in MNCH, TB, or OST facilities providing ART with MNCH, TB, or OST facilities providing ART services separately; or primary health facilities or communities providing ART with hospitals providing ART. RESULTS: The reviewers identified 28 studies on integration and decentralization. Antiretroviral therapy integration into MNCH facilities improved ART coverage (relative risk [RR] 1.37, 95% confidence interval [CI] 1.05-1.79) and led to comparable retention in care. ART integration into TB treatment settings improved ART coverage (RR 1.83, 95% CI 1.48-2.23) and led to a nonsignificant reduction in mortality (RR 0.55, 95% CI 0.29-1.05). The limited data on ART integration into OST services indicated comparable rates of ART coverage, retention, and mortality. Partial decentralization into primary health facilities improved retention (RR 1.05, 95% CI 1.01-1.09) and reduced mortality (RR 0.34, 95% CI 0.13-0.87). Full decentralization improved retention (RR 1.12, 95% CI 1.08-1.17) and led to comparable mortality. Community-based ART led to comparable rates of retention and mortality. CONCLUSION: Integrating ART into MNCH, TB, and OST services was often associated with improvements in ART coverage, and decentralization of ART into primary health facilities and communities was often associated with improved retention. Neither integration nor decentralization was associated with adverse outcomes. These data contributed to recommendations in the WHO 2013 consolidated antiretroviral guidelines to integrate ART delivery into MNCH, TB, and OST services and to decentralize ART.
File Format	HTM / HTML
ISSN	02699370
Issue Number	Suppl 2
Volume Number	28
e-ISSN	14735571
Journal	AIDS
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2014-03-01
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Immunology Anti-retroviral Agents Therapeutic Use Hiv Infections Drug Therapy Review Literature As Topic Child Child Health Services Organization & Administration Female Humans Infant, Newborn Maternal Health Services Pregnancy Substance Abuse Treatment Centers Tuberculosis Therapy Journal Article
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Immunology and Allergy Immunology

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