The World Health Organization (WHO) is actively promoting the integration of HIV services as a key strategy to maintain a sustainable response in an era of reduced funding and systemic disruptions. A recent WHO pulse survey of over 80 countries revealed that HIV services, including prevention of mother-to-child transmission (PMTCT), experienced severe or moderate disruptions in 48% of surveyed nations from January to April. This situation has underscored the urgent need for a new strategy built on simplification and integration to ensure that essential services for the most vulnerable are maintained.
WHO’s Redefinition of Integration
Integration has received some negative feedback, which WHO addresses by clarifying its nuanced definition. Integration is not always about a full convergence of services. Instead, WHO emphasizes systems integration, which includes leveraging and streamlining aspects like data systems, supply chains, and other backend processes. The objective is to maximize system efficiencies through “convergence” and “layering” of services while ensuring the specificity of care and effective outcomes for people living with HIV are maintained.
Implementation Challenges and Progress
Despite WHO issuing guidelines on integration since 2013, their full implementation remains a significant challenge. WHO data highlights a gap between policy and practice:
HIV and MCH Integration: While many countries have policies for integrating HIV into maternal and child health (MCH) services, their implementation is not universal.
HIV and Primary Health Care (PHC): A low percentage of countries have policies allowing primary healthcare providers to deliver antiretroviral therapy (ART) for adults (17% to 60%) and children (8% to 65%).
Community-Based ART: The delivery of ART in community settings also remains low.
WHO notes that the African region is “showing the most innovation in this space,” indicating that despite challenges, progress is being made in certain areas.
Leveraging Science for Integrated Care
Recent scientific findings support the rationale for integration. Trials conducted by researcher Ellen Gang have shown that viral load suppression rates are not negatively affected by an integrated care model. This indicates that an integrated system can effectively control HIV while simultaneously addressing other chronic diseases. The example of integrating HIV care with hypertension and diabetes management demonstrates this point, with the crucial caveat that maintaining a focus on viral suppression is essential for the successful management of co-morbidities.
WHO’s Future Guidance and Focus
To assist countries in managing these challenges, WHO is developing new operational guidance and documentation aligned with global initiatives like the Global Fund’s sustainability roadmaps. This guidance offers a structured approach to prioritizing services, assessing risks, and ensuring the most impactful interventions are sustained. Key examples include:
New operational guidance for sustaining essential services.
Documentation on integrating HIV into primary healthcare, with examples from countries demonstrating effective learning.
Highlighting country-led examples of successful integration and elimination efforts.
WHO also commits to advancing the “science of integration,” promoting research that will improve how services and systems can be delivered efficiently without compromising the quality of care. This underscores WHO’s view of integration as a critical, complex, and evolving area of public health strategy.