Integrating HIV and STI Services into Primary Health Care: A Path to Sustainable Health Systems

As international donor support wanes, countries are increasingly integrating services for HIV, viral hepatitis, and sexually transmitted infections (STIs) into their primary health care (PHC) systems in an effort to strengthen sustainability and improve public health outcomes.

A new policy brief titled Integrating HIV, Viral Hepatitis and Sexually Transmitted Infections with Primary Health Care: Learning from Countries, released by the World Health Organization (WHO), offers key insights from a diverse group of low- and middle-income nations. The brief draws from case studies in Angola, Botswana, Brazil, Ethiopia, Indonesia, Kenya, Pakistan, Rwanda, Viet Nam, and Zambia—highlighting a shift towards a people-centered, holistic approach to health.

According to the brief, this transition comes at a critical time. Many countries are facing acute funding gaps as international support for disease-specific programs declines. In response, governments are being urged to assume greater ownership of HIV, hepatitis, and STI services, with a focus on embedding them within broader health systems.

The WHO brief emphasizes that integration is not a one-size-fits-all approach. Countries that succeeded in aligning their services with the WHO/UNICEF Primary Health Care Operational Framework did so by engaging with at least four or more strategic and operational levers simultaneously. These levers include governance, funding, service delivery models, workforce strengthening, community engagement, and the use of digital health technologies.

“Acting on only one or two levers is not enough,” the brief warns. “Countries that implemented comprehensive strategies across multiple domains reported the most sustainable results.”

Benefits of this integrated approach include improved access to services, more efficient service delivery, enhanced community involvement, better health outcomes, and more stable funding models.

Key recommendations from the policy brief include stronger coordination and political leadership, sustainable domestic health financing, and a focus on health system strengthening rather than disease-specific programming. Additionally, it emphasizes task-sharing within the health workforce, meaningful community engagement to build trust, combating stigma and discrimination in health settings, leveraging digital tools to enhance service delivery, and partnering with the private sector to foster innovation and expand reach.

The experience of Rwanda, among others, shows that when HIV, hepatitis, and STI services are integrated into PHC systems, they become more resilient and better able to serve communities, especially in rural and underserved areas.

As the global health landscape evolves, this push for integration represents a paradigm shift—from vertical, disease-specific responses toward more sustainable, inclusive, and health system–driven strategies.