The Promise of Integration of HIV Into Primary Care: Challenges and Opportunities.

introductionRemarkable progress has been made in response to the global HIV epidemic, yet critical gaps and inequities remain, combined with challenges stemming from the current threats to global funding, complacency and competing global health priorities. These constraints threaten to unravel the hard-won gains and to stall progress towards control of the HIV epidemic. In response to this rapidly changing landscape, the integration of HIV services into primary care has emerged as a potential solution to this crisis that would bring possible efficiencies and sustainability of the response. DISCUSSION: Recognition that persons with HIV often experience a range of other health challenges over their lifetime has compelled the need for integration of non-HIV services into HIV programmes to allow for delivery of comprehensive person-centred care. However, most attention at present is centred on the integration of HIV treatment into primary care, raising concerns about whether this might risk the quality of care for persons with HIV. The limited availability of primary care services that offer comprehensive and effective continuity care in many low- and middle-income countries presents a major challenge to providing such care. Nonetheless, such integration offers a historic opportunity to enhance healthcare for all people with chronic health conditions, including for persons with HIV.

conclusionsThe integration of non-HIV services into HIV programming is recognized as necessary to meet the needs of persons with HIV, enhancing their quality of life and health outcomes. At the same time, the imperative for integration of HIV treatment into primary care programmes raises an important question. Can primary care programmes be transformed to allow for the provision of the necessary continuity care with the required supportive services that persons with HIV need? Accomplishing this goal may present a pathway to sustaining the HIV response in the current resource-constrained context while enabling the long-desired transformation of primary care services to effectively deliver on their potential for advancing the health of all people.