Understanding pathways to HIV integration and the impact on costs and resource requirements

Global evidence suggests that integrating HIV services is essential for sustaining the HIV response, ending AIDS by 2030, and advancing universal health coverage. Traditionally, HIV programs have operated in silos, raising concerns about access, coordination, and long-term sustainability amid donor transitions. Many countries are working to integrate HIV with other health services, including primary health care (PHC), but evidence on how this process unfolds, particularly at the above-facility level, remains limited, as do insights into cost implications and resource requirements to integrate HIV services into government systems.

You can read our report on practical considerations for integrating HIV programmes into primary health care systems here.

As part of a broader initiative to understand the cost and sustainability of HIV responses, Genesis Analytics, in collaboration with the Gates Foundation, conducted research to address some of these evidence gaps. The project aimed to: 

• Examine how the cost structure of integrated services differs depending on what, when, for whom, and how services are integrated.
• Explore the likely impact of integration on unit and total costs of HIV services.
• Describe pathways to integration and develop guidance that can inform planning for future integration efforts.

We reviewed 170 studies to examine pathways to integration, key characteristics of existing HIV integration efforts and related cost and cost-effectiveness. These studies have been compiled into a user-friendly dashboard that allows users to easily access insights from these studies.

Drawing from the detailed literature review and five country case studies on HIV integration with sexual and reproductive health (SRH) services, non-communicable diseases (NCDs), and broader PHC services, we developed a generic pathway to integration organized around eight essential steps. For each step in the process we listed and described key considerations for integrating HIV programs into primary health care systems. Addressing the considerations in each step will enhance planning and contribute to successful large-scale implementation.

“Integrating HIV programs into primary health care systems: Practical considerations for country decision-makers” can be viewed and downloaded here.