The International AIDS Conference in Washington, DC, this week is attracting major media attention daily. The implications of the presentations go beyond one disease and address important health systems issues. Those presentations that address both HIV/AIDS and other infectious diseases like malaria are of particular interest when considering integration as part of health systems strengthening.
Integration in Service Delivery
Gebru and colleagues share experiences from Ethiopia. Community health extension workers integrated services at the household and showed that, â€œIntegrating malaria program with HIV/AIDS at community level has brought health benefits among PLHIV. We have learned this project it is cost effective and advances efficient use of human and material resources. We also learnt that insuring active participation and involvement of HIV infected people is very instrumental for successful integration of Malaria activities with HIV care and support program.â€
Efforts to re-energize integrated clinical care in Zambia were presented by Mugala et al. With PEPFAR support they expanded enrollment, conducted mobile outreach and ensured that HIV, malaria and other maternal health services were integrated throughout the district.
Researchers in Kenya reported on provision of integrated preventive services to people living with HIV/AIDS and noted that, â€œThe provision of LLIN and a water filter in the context of routine HIV care is associated with a significant delay in C D4 decline and represents a simple, practical and cost-effective method to delay HIV-1 progression in many settings.â€
Integration in Diagnostics
A Ugandan experience with integrated community HIV testing campaigns was shared by Chamie et al. A 5-day campaign provided point of care screening for HIV, malaria, TB, hypertension and diabetes. They were able to reach 74% of the adult population, found undiagnosed conditions and proved the feasibility of integrated testing.
Echete and co-workers shared experiences in strengthening rural health center laboratories in Ethiopia. Lab staff were trained on HIV, TB, and malaria diagnosis and received follow up supervision and performance checks. While they found integrated laboratory services could be brought to remote areas, they also cautioned on the need to guarantee sustainability.
From these few examples, we can see that integration helps improve quality of care, ability to reach out to communities and even improves quality of life for community members.Â More operational research is needed to identify additional synergies that arise from integrating and malaria services.