Tuesday, June 1, 2010

Two Queue or Not Two Queue: When and How to Integrate HIV Care and Treatment into Outpatient Services in Resource-Limited Settings

Sub-Saharan Africa bears a disproportionate burden of the current global HIV/AIDS epidemic. In 2008, the region accounted for 67% of HIV infections and 72% of the AIDS-related deaths worldwide. Rapid growth in international donor funding to combat the HIV epidemic has placed an enormous additional strain on already weak public health systems and fueled the debate over vertical versus integrated (or horizontal) health systems and their pros and cons.

International donors and their implementing partners have typically favored vertical systems as they enable rapid scale-up of higher quality and more reliable delivery of care in the short term, bypassing potential bottlenecks in public health systems. In the longer term, however, vertical systems can lead to the diversion of human and material resources towards individual diseases, potentially harming overall primary health outcomes for the future. Moreover, disease-specific international funding may not be sustained at its current levels.

As a result, there has been a growing need for evidence of feasible integration strategies for HIV services in resource-limited settings. Very little work has been done to evaluate the impact of integration on service delivery systems themselves, specifically focusing on integration of HIV and outpatient care.

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