The role of integration in achieving an AIDS-free generation: Best practices from a comprehensive review of the peer-reviewed and gray literature

: 2.009_TEC The role of integration in achieving an AIDS-free generation: Best practices from a comprehensive review of the peerreviewed and gray literature R.J. Limaye, R.M. Salem, A.E. Ballard, S. Jaffer; Johns Hopkins Center for Communication Programs, Baltimore, MD, USA, United States Agency for International Development, Maputo, Mozambique Background: The global health community has recently turned its attention toward integration of health programs as an innovation to optimize resources and achieve greater impact. However, knowledge of the impact of and best practices for such integrated programming is limited. To fill these gaps, we conducted a scan of the peerreviewed and gray literature of programs integrating HIV services with family planning (FP), maternal and child health (MCH), malaria, nutrition, tuberculosis (TB), and/or water, sanitation, and hygiene services. Methods: We searched three databases for evaluations of HIVintegrated programs in lowerand middle-income countries published since 2010: (1) PubMed for systematic reviews and meta-analyses, (2) USAID Development Experience Clearinghouse for project evaluations, and (3) Google Scholar for highly cited articles. Findings: We reviewed 291 peer-reviewed articles and 68 program evaluations. From the peer-reviewed literature, we identified several approaches with demonstrated impact on HIV and other health outcomes, including: opt-out, provider-initiated testing and counseling (PITC) for HIV within FP and MCH services; administration of malaria prophylactic treatment in co-endemic areas and prioritization of pregnant women; integration of ART directly into antenatal clinics; vitamin A or beta-carotene supplementation for pregnant women and children with HIV; PITC, care, and preventive therapy for TB within HIV settings as well as PITC of HIV at TB clinics; and supporting exclusive breastfeeding. The program evaluations, while lacking implementation details, revealed several lessons and recurring themes including: the need for longterm funding cycles and a focus on health systems strengthening to guarantee successful integration results; the importance of investing in robust study designs and M&E systems to attribute effects; and the use of wrap-around services to enhance retention in care. Commonly used integrated approaches included services coordination at the facility level, community mobilization, behavior change communication, social marketing, public-private partnerships, and male involvement. Interpretation: It is time to integrate services intelligently by taking evidence-based interventions with demonstrated impact on HIV and other health services to scale; failure to do so denies the synergies of integrated programming. Donors and programs should invest in impact evaluations and documentation of implementation details to facilitate replication and adaptation of innovative integrated approaches. Funding: This work was supported by the Knowledge for Health Project, funded by the Office of Population and Reproductive Health, Bureau for Global Health, U.S. Agency for International Development, Cooperative Agreement No. AID-OAA-A-1300068. Abstract #: 2.010_TEC: 2.010_TEC Innovating health systems monitoring and evaluation in lowand middle-income countries: Lessons for knowledge translation E. Macaraya, M. Western, M. Curley, C. Gilks; University of Queensland, Brisbane, Australia Background: To achieve sustainable and resilient health systems, examining existing health systems performance built upon the best available evidence and a strong information system is vital. However, many lowand middle-income countries still lack the needed capacity to develop a responsive and robust monitoring and evaluation mechanism. To address this, this study investigates on available assessment technologies and innovations, data visualization tools, and other monitoring and evaluation mechanisms that countries can use despite limited resources. This study provides baseline information on these assessment and visualization technologies and innovations that are targeted for LMICs. Methods: Online databases from 2000 to present were searched systematically for innovative monitoring and evaluation mechanisms. Published studies, reports, including grey literature relevant on the topic were identified through a systematic search using the following strategies: first, to identify peer-reviewed publications, online databases such as PubMed, EMBASE, PsycInfo and the WHO GIFT and IRIS tools were searched, including their reference lists using designated MeSH terms. Second, select government and non-government organizations and research institutions were contacted to collect further information. For each technology and innovation applied for monitoring and evaluation and knowledge translation, we parsed the assessment and visualization tools to identify similarities between them, which we catalogued into a framework comprising the assessment domains and visualization requirements.


Background:
The global health community has recently turned its attention toward integration of health programs as an innovation to optimize resources and achieve greater impact. However, knowledge of the impact of and best practices for such integrated programming is limited. To fill these gaps, we conducted a scan of the peerreviewed and gray literature of programs integrating HIV services with family planning (FP), maternal and child health (MCH), malaria, nutrition, tuberculosis (TB), and/or water, sanitation, and hygiene services.

Methods:
We searched three databases for evaluations of HIVintegrated programs in lower-and middle-income countries published since 2010: (1) PubMed for systematic reviews and meta-analyses, (2) USAID Development Experience Clearinghouse for project evaluations, and (3) Google Scholar for highly cited articles.

Findings:
We reviewed 291 peer-reviewed articles and 68 program evaluations. From the peer-reviewed literature, we identified several approaches with demonstrated impact on HIV and other health outcomes, including: opt-out, provider-initiated testing and counseling (PITC) for HIV within FP and MCH services; administration of malaria prophylactic treatment in co-endemic areas and prioritization of pregnant women; integration of ART directly into antenatal clinics; vitamin A or beta-carotene supplementation for pregnant women and children with HIV; PITC, care, and preventive therapy for TB within HIV settings as well as PITC of HIV at TB clinics; and supporting exclusive breastfeeding. The program evaluations, while lacking implementation details, revealed several lessons and recurring themes including: the need for longterm funding cycles and a focus on health systems strengthening to guarantee successful integration results; the importance of investing in robust study designs and M&E systems to attribute effects; and the use of wrap-around services to enhance retention in care. Commonly used integrated approaches included services coordination at the facility level, community mobilization, behavior change communication, social marketing, public-private partnerships, and male involvement.
Interpretation: It is time to integrate services intelligently by taking evidence-based interventions with demonstrated impact on HIV and other health services to scale; failure to do so denies the synergies of integrated programming. Donors and programs should invest in impact evaluations and documentation of implementation details to facilitate replication and adaptation of innovative integrated approaches. Background: To achieve sustainable and resilient health systems, examining existing health systems performance built upon the best available evidence and a strong information system is vital. However, many low-and middle-income countries still lack the needed capacity to develop a responsive and robust monitoring and evaluation mechanism. To address this, this study investigates on available assessment technologies and innovations, data visualization tools, and other monitoring and evaluation mechanisms that countries can use despite limited resources. This study provides baseline information on these assessment and visualization technologies and innovations that are targeted for LMICs.
Methods: Online databases from 2000 to present were searched systematically for innovative monitoring and evaluation mechanisms. Published studies, reports, including grey literature relevant on the topic were identified through a systematic search using the following strategies: first, to identify peer-reviewed publications, online databases such as PubMed, EMBASE, PsycInfo and the WHO GIFT and IRIS tools were searched, including their reference lists using designated MeSH terms. Second, select government and non-government organizations and research institutions were contacted to collect further information. For each technology and innovation applied for monitoring and evaluation and knowledge translation, we parsed the assessment and visualization tools to identify similarities between them, which we catalogued into a framework comprising the assessment domains and visualization requirements. Technology and Innovation M a y eJ u n e 2 0 1 6 : 5 8 5 -6 0 3