A systematic review on health systems integrated approach towards elimination of HIV, syphilis and viral hepatitis as public health threats in sub-Saharan Africa

Abstract

Health systems (HSs) in sub-Saharan Africa (SSA) face significant challenges. Integrated HSs approach has been considered a feasible option for eliminating HIV, syphilis and hepatitis B (triple elimination). We performed a systematic review to determine the extent of utilisation of the integrated HSs approach towards triple elimination in SSA countries. We registered the systematic review protocol on PROSPERO (ID: CRD420251011221). We adopted Arksey and O'Malley's review methodology framework for article searching on databases: Medline (using PubMed interface), EMBASE and EBSCOHOST. Studies published from March 2015 to March 2025 were assessed by two reviewers independently. Joanna Briggs' checklist was used to assess the quality of included studies. Thematic analysis was performed, and results were reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. A total of 533 studies were identified from databases. Eighteen studies were fully reviewed. Five themes were developed: Effectiveness of HSs integration, Barriers to HSs integration, Facilitators for HSs integrated approach on triple elimination, Improved case detection, and Recommendations to HSs integration. All themes but one were developed from sub-themes that were built around six blocks of the health systems, according to the World Health Organization. Progress in the integrated approach exists. A fully integrated HSs approach for triple elimination remains unmet in SSA. Facilitators and barriers within the WHO's HSs building blocks can work for or against an integrated approach towards triple elimination, offering a roadmap for future efforts to strengthen HSs. Further enquiry into HSs integrated approach needs to be considered towards triple elimination.