Pilot integration of HIV and nutrition services shows great potential for health impact

Outcomes and cost-effectiveness of integrating HIV and nutrition service delivery: pilots in Malawi and Mozambique.

Bergmann JN, Legins K, Sint TT, Snidal S, Group UR, Amor YB, McCord GC. AIDS Behav. 2016 Apr 19. [Epub ahead of print]

This paper provides the first estimates of impact and cost-effectiveness for integrated HIV and nutrition service delivery in sub-Saharan Africa. HIV and undernutrition are synergistic co-epidemics impacting millions of children throughout the region. To alleviate this co-epidemic, UNICEF supported small-scale pilot programs in Malawi and Mozambique that integrated HIV and nutrition service delivery. We use trends from integration sites and comparison sites to estimate the number of lives saved, infections averted and/or undernutrition cases cured due to programmatic activities, and to estimate cost-effectiveness. Results suggest that Malawi's program had a cost-effectiveness of $11-29/DALY, while Mozambique's was $16-59/DALY. Some components were more effective than others ($1-4/DALY for Malawi's Male motivators vs. $179/DALY for Mozambique's One stop shops). These results suggest that integrating HIV and nutrition programming leads to a positive impact on health outcomes and should motivate additional work to evaluate impact and determine cost-effectiveness using an appropriate research design.

Abstract access [1]

Editor’s notes: This paper presents outcomes and cost-effectiveness of a variety of programmes intended to facilitate integration of HIV treatment and care services with community management of acute malnutrition (CMAM) services in Malawi and Mozambique. In Malawi, programmes included SMS reminders to encourage attendance and adherence, “male motivators” who encouraged men to be involved in children’s health, and child health passports. In Mozambique, programmes included one-stop shops where children could access HIV-associated and vaccination services. Flowcharts to facilitate referral between HIV and nutrition services were also tried. Difference in difference estimates indicate substantial improvements in child health outcomes, and cost-effectiveness estimates are in line with other services. The programmes were funded by UNICEF, and not designed for research purposes. The authors therefore acknowledge some limitations in the external validity of their findings.  This paper should be taken as proof of concept rather than a final word on the effectiveness or cost-effectiveness of these activities. However, these preliminary estimates illustrate that there is great potential in facilitating integration of these two services.  Further research into integration of nutritional support services with HIV services is necessary.

Africa [5]
Malawi [6], Mozambique [7]
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