There is some evidence that 'adding on' services (or linkages) may improve the utilisation and outputs of healthcare delivery. However, there is no evidence to date that a fuller form of integration improves healthcare delivery or health status. Available evidence suggests that full integration probably decreases the knowledge and utilisation of specific services and may not result in any improvements in health status. More rigorous studies of different strategies to promote integration over a wider range of services and settings are needed. These studies should include economic evaluation and the views of clients as clients' views will influence the uptake of integration strategies at the point of delivery and the effectiveness on community health of these strategies.
Contraception among HIV concordant and discordant couples in Zambia: a randomized controlled trial.
This study examines the impact of an intervention to promote dual-method contraceptive use among HIV concordant and discordant couples already using condoms for HIV prevention.
                A three-armed randomized, controlled trial was conducted at a voluntary HIV testing and counseling clinic in Lusaka, Zambia; 251 couples were randomized. Control couples received family planning education and referral to an outside clinic for nonbarrier contraceptives, intervention 1 couples received education and offer of contraceptives at the research clinic, and intervention 2 couples received intervention 1 plus a presentation designed to reduce outside pressures to conceive.
                There was a 3-fold higher contraceptive initiation rate in both intervention arms compared with the control arm. The interventions had no impact on incident pregnancy, largely due to high levels of contraceptive discontinuation and user failure. HIV-positive women who initially selected injectable contraception were less likely to abandon the method and significantly less likely to conceive than other study participants.
                Improving access to nonbarrier contraceptives among couples already using condoms for HIV prevention increased dual-method use. Selection of longer-acting injectable contraception was associated with lower pregnancy rates among HIV-positive women. Further research is needed to identify ways to help couples in this population continue to correctly use nonbarrier contraceptives.