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: 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.

A framework for priority linkages

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

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

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 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) Citations included in review (n=225) Citations identified through search strategy (n=50,797) Results

SRH-HIV Linkages Matrix Element 3 of PMTCT HIV prevention, education & condoms HIV counselling & testing Maternal & child health care STI prevention & management Other SRH services GBV prevention & management Family planning Clinical care for PLHIV Psychosocial & other services for PLHIV Peer-Reviewed Studies Promising Practices

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

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

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

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