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Can we get the benefits of integrated services? An evaluation of the delivery of integrated prenatal HIV, syphilis and hepatitis B testing services in China


Integration of services for prevention of mother-to-child transmission (PMTCT) of HIV into routine maternal and child health care has been promoted as a priority strategy by WHO to help optimize health outcomes for mother and children [1]. However, integrated services require a shift in the management model from providing stand-alone services to integrating services, which requires more complex management [2]. China initiated the process of integrating prenatal HIV, syphilis and hepatitis B testing services in 2009, and many health agencies need to work together [3]. So this study is to evaluate the effectiveness of the current integrated services and examine barriers to coordination in this complicated service system in China.

Materials and methods

The research was conducted in Guangdong province, used mixed quantitative and qualitative methods. We drew quantitative data from routine monitoring system for PMTCT and a quantitative survey; and collected interviews for qualitative data to assess and examine barriers.


The testing rates of prenatal HIV, syphilis and hepatitis testing were 95%, 47% and 47% respectively, which were inconsistent, although the three testing services have been integrated. For the prenatal HIV testing service, it took an average of one month to get results because of multi-agency referrals. In addition, almost 80% of the positive mothers were not referred to the hospitals for continuous monitoring and treatment services. The reasons behind these statistics are that the responsibilities assigned to the different health agencies were not clear, and outcome evaluation was not consistent among different health agencies. There was a lack of concrete coordination and referral scheme which must be built on the basis of effective collaboration and communication between different health agencies.


The results indicate that the benefits of integrated services have not been completely achieved in China. The many barriers to coordination in a complex health service system form a great challenge to effective delivery of integrated services. A concrete operational strategy is needed to fill the gap in order to achieve the desirable outcomes from integrated services.


  1. WHO: Global health sector strategy on HIV/AIDS 2011-2015 2011: a new health sector agenda for HIV/AIDS. 2011, Geneva, Switzerland: World Health Organization, []

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  2. Dichinson C, Attawell K, Druce N: Progress on scaling up integrated services for sexual and reproductive health and HIV. Bull World Health Organ. 2009, 87: 846-851. 10.2471/BLT.08.059279.

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  3. MOH: Report on Women and Children’s Health Development in China 2011. 2011, Beijing, China: Ministry Of Health, []

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Xia, J., Ma, Y., Gao, S. et al. Can we get the benefits of integrated services? An evaluation of the delivery of integrated prenatal HIV, syphilis and hepatitis B testing services in China. BMC Health Serv Res 14 (Suppl 2), P140 (2014).

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