FHI 360, Research Triangle Park, North Carolina, USA.
AIDS. 2013 Oct;27 Suppl 1:S65-75. doi: 10.1097/QAD.0000000000000051.
Increasing access to contraception among women who enter the health system for HIV care is crucial to help them achieve their fertility intentions and reduce vertical transmission of HIV. Identifying intervention strategies that contribute to effective family planning/HIV service integration and synthesizing lessons for future integration programming and research is important to move the field forward.
Using a standard review methodology, we searched for articles in the peer-reviewed literature published between January 2008 and August 2013 that addressed the integration of family planning interventions into HIV service settings. Eligible studies were assessed in terms of methodological rigor; documented outcomes; and reported process and cost data.
Twelve studies met our inclusion criteria. Eight studies documented significant increases in contraceptive use by HIV service clients, and three reported significant increases in completed referrals from HIV services to family planning clinics. The outcomes of the seven studies implemented in public sector facilities were more modest than the five studies embedded in clinical trials. Process evaluation measures for some of the studies indicated weak implementation of the intervention as intended. The average rigor score was low, 3.4 out of 9.
Our review reveals an expanding evidence base for integrated family planning/HIV service delivery innovations. However, the modest observed effect under typical settings and the evidence of weak intervention implementation emphasize the need for stronger programmatic efforts and implementation research to address the health system obstacles to integrating these two essential services.
增加进入艾滋病毒护理健康系统的妇女获取避孕措施的机会，对于帮助她们实现生育意愿和减少艾滋病毒垂直传播至关重要。确定有助于有效计划生育/艾滋病毒服务整合的干预策略，并总结未来整合规划和研究的经验教训，对于推动该领域的发展非常重要。
我们使用标准的审查方法，在 2008 年 1 月至 2013 年 8 月期间，在同行评议文献中搜索了有关将计划生育干预措施纳入艾滋病毒服务环境的文章。根据方法严谨性、记录的结果、报告的过程和成本数据，对合格的研究进行评估。
符合纳入标准的研究有 12 项。8 项研究记录了艾滋病毒服务客户的避孕措施使用率显著增加，3 项研究报告了艾滋病毒服务向计划生育诊所的转介完成率显著增加。在公立部门设施中实施的七项研究的结果不如五项临床试验中嵌入的研究结果显著。一些研究的过程评估措施表明，干预措施的实施与预期意图不符。平均严谨评分较低，为 9 分中的 3.4 分。
我们的审查揭示了计划生育/艾滋病毒服务综合提供创新的证据基础不断扩大。然而，在典型环境下观察到的适度效果以及干预措施实施不力的证据强调，需要更有力的方案努力和实施研究来解决整合这两项基本服务的卫生系统障碍。
