Young people, especially those who are sexually active, need a variety of services, including contraception, HIV counseling and testing, testing and treatment for other sexually transmitted infections (STIs), pre- and postnatal care, gender-based violence (GBV) screening, and post-abortion care. Health facilities serving youth may offer one primary service, have separate units providing different types of services, or rely on a referral system. As a result, many young people who are at risk of pregnancy, STIs/HIV or GBV may receive only one service while related reproductive health needs are not addressed. Much the same is true for the integration of other types of programming that combines areas such as livelihoods with reproductive health care or intimate partner violence.
Research shows that integrated services for youth are feasible in diverse settings and there is a strong need for various services in a single setting. While programs are beginning to offer integrated services for youth using various approaches, more research is needed to determine cost-efficient and effective service delivery models. Below are resources that may provide guidance.
The review by Narasimhan et al. compares family planning (FP) services with integrated HIV testing services (HTS) to those without integrated HTS or with a lower level of integration on the following outcomes: uptake/counseling/offer of HTS, new cases of HIV identified, linkage to HIV care and treatment, dual method use, client satisfaction and service quality, and provider knowledge and attitudes about integrating HTS. The evidence base suggests that integration of HTS into FP services is feasible and has potential for positive joint outcomes, but the success and scale-up of this approach will depend on population needs and health system factors (2019).
The Current Status of Research on the Integration of Sexual and Reproductive Health and HIV Services
Integration of services for sexual and reproductive health (SRH) and HIV has been widely promoted globally in the belief that both clients and health providers benefit through improvements in quality, efficient use of resources, and lower costs, helping to maximize limited health resources and provide comprehensive client-centered care. This article by Warren et al. builds on the growing body of research on integrated sexual SRH and HIV services. It brings together critical reviews on issues within the wider SRH and rights agenda and synthesizes recent research on integrated services, drawing on the Integra Initiative and other major research (2017).
This interactive map from the WHO includes links to relevant WHO reports and tools to strengthen linkages between FP and HIV services. Sexual health, human rights and gender equality are central to integration efforts (2017)
Linkages between SRH and HIV policies, programs and services are key to influencing both HIV and SRH response outcomes, and are therefore understood to be an important development synergy. This guidance document published by the Southern African Development Community (SADC) outlines the minimum standards required to integrate HIV and SRH services in Southern Africa. Adolescent SRH and HIV services are a key focus (2015).
This K4H Toolkit is for policy makers, program managers, service providers, advocates, and others provides information on the rationale for integration and resources for research, policy, training, rationale, service delivery, program management, communication & advocacy, and country experiences (2019).
This report, published in 2013, documents research on comprehensive programming aimed at adolescent girls in India, particularly in terms of those that combine interventions around reproductive health and rights with programs aimed broadly at livelihoods. The report identifies particularly effective approaches and uses the experience of these programs to develop recommendations for programming and policy around adolescent girls specifically (2013).
This interactive online toolkit is intended as a resource for both strengthening existing youth programs and developing new programs for youth that incorporate reproductive and sexual health education and empowerment. The toolkit is organized into five categories: Strategic Framework, Project Development & Design, Curricula, and Lessons Learned (2013).
This set of two guidance notes, developed by DFID, set out the strategic rationale for approaching violence against women and girls (VAWG), develops a broad theory of change for integrated programming focused on economic development and VAWF, and provides practical programmatic recommendations on types of interventions that achieve these broad goals (2015).
This report summarizes tools that can assist programs to plan and implement integrated services for youth. The tools are summarized in four sections: developing youth-friendly services, training providers, supporting providers with job aids, and promoting services in the community (2007).
This document provides a strategic framework for the integration of youth reproductive health and family planning into youth development programs (2007).
This document offers a strategic proposal to guide effective coordination, collaboration, and participation among programs and services devoted to gender, sexual and reproductive health and HIV and STI prevention and treatment. Among the desired results of these synergies are expanded coverage, adaptation for greater use, greater resiliency in the population, integrated services, general well-being, and equity (2010).
This compendium discusses the linkages between RH and HIV and how to best measure these. A theory of change describing the linkages is presented, followed by detailed recommendations for measurement based on the experience of the field over the past decade (2014).