Costs and efficiency of integrating HIV/AIDS services with other health services: a systematic review of evidence and experience
Costs and efficiency of integrating HIV/AIDS services with other health services: a systematic review of evidence and experience
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DOI：
10.1136/sextrans-2011-050199
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发表时间：
2012-03-01
影响因子：
3.6
通讯作者：
Vassall, Anna
中科院分区：
文献类型：
--
作者：
Sweeney, Sedona;Obure, Carol Dayo;Vassall, Anna
目的回顾艾滋病服务与其他卫生服务整合的潜在效率增益的文献。电子数据库搜索、手动搜索和滚雪球抽样。其中包括介绍艾滋病毒综合服务的成本、效率或成本效益结果的研究，重点是低收入和中等收入国家。证据进行了分析和合成，通过叙述性的方法和研究的质量assessed.Results检索到的666引文，46（35同行评议和灰色文献11）。与“无所作为”的替代办法相比，一系列艾滋病毒综合服务具有成本效益，包括将艾滋病毒服务纳入性健康和生殖健康服务、结核病/艾滋病毒综合服务以及将艾滋病毒服务纳入初级保健。艾滋病毒综合咨询和检测的费用可能低于单独提供咨询和检测的费用;但是，其他服务，特别是艾滋病毒护理和治疗的比较费用方面的证据有限。也有鲜为人知的最有效的整合模式，从整合超出服务水平和任何经济效益的HIV服务users.Conclusions的政治承诺和以前的审查表明一个强有力的公共卫生论据整合艾滋病毒服务的背景下，效率的证据广泛支持进一步的努力，整合艾滋病毒服务。然而，关键的证据差距仍然存在，迫切需要在这一领域开展进一步的研究。
Objectives To review the literature on the potential efficiency gains of integrating HIV services with other health services.Design Systematic literature review. Search of electronic databases, manual searching and snowball sampling. Studies that presented results on cost, efficiency or cost-effectiveness of integrated HIV services were included, focusing on low- and middle-income countries. Evidence was analysed and synthesised through a narrative approach and the quality of studies assessed.Results Of 666 citations retrieved, 46 were included (35 peer reviewed and 11 from grey literature). A range of integrated HIV services were found to be cost-effective compared with 'do-nothing' alternatives, including HIV services integrated into sexual and reproductive health services, integrated tuberculosis/HIV services and HIV services integrated into primary healthcare. The cost of integrated HIV counselling and testing is likely to be lower than that of stand-alone counselling and testing provision; however, evidence is limited on the comparative costs of other services, particularly HIV care and treatment. There is also little known about the most efficient model of integration, the efficiency gain from integration beyond the service level and any economic benefit to HIV service users.Conclusions In the context of increasing political commitment and previous reviews suggesting a strong public health argument for the integration of HIV services, the authors found the evidence on efficiency broadly supports further efforts to integrate HIV services. However, key evidence gaps remain, and there is an urgent need for further research in this area.