Integrating care for hypertension, diabetes and HIV in Africa: toolkit development and content

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

2D.6

Presenter:

Geoff McCombe

Twitter:

@geoffmccombe

Co-authors:

Jayleigh Lim1, Sara Murtagh1, Jeffrey V. Lazarus2,3, Marie Claire Van Hout4, Max Bachmann5, Shabbar Jaffar6, Anupam Garrib6, Kaushik Ramaiya7, Nelson K. Sewankambo8, Sayoki Mfinanga9, Walter Cullen1

Author institutions:

1,University College Dublin, 2Barcelona Institute for Global Health (ISGlobal),3Hospital Clínic, University of Barcelona, 4Liverpool John Moores University, 5University of East Anglia, 6Liverpool School of Tropical Medicine, 7Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania, 8Makerere University, Uganda, 9National Institute for Medical Research, Tanzania

Problem

Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. The INTE-AFRICA consortium comprises a group of researchers and policymakers from Tanzania, Uganda, and Europe who aim to scale up provision for diabetes and hypertension in SSA by testing the efficacy of integrating diabetes and hypertension services alone, or in combination with HIV-infection services. This paper describes the development and content of a toolkit to identify best practices and produce evidence to inform researchers, and public and private policy makers on best practice to integrate diabetes, hypertension and HIV care in SSA.

Approach

A scoping review was conducted to map existing policy and evidence based literature on the feasibility of integrating NCD care with HIV in SSA. This was followed by carrying out an international, multi stakeholder e-Delphi consensus study to identify key components, outcomes, and best practice in integrated service provision for the prevention, identification and treatment of HIV, hypertension and diabetes. The findings of these two studies complemented by a search of key online resources informed the development and content of the toolkit which was part of Work Package 3 of the INTE-AFRICA project.

Findings

Integrated HIV/NCD care in the SSA region is challenging but potentially feasible. However, there remain various country specific, contextual, human resource, logistical and infrastructural barriers that need to be considered in order to best achieve efficient and effective integrated care delivery. The toolkit highlights that there is no single approach likely to work in all settings, and hence countries should devise an integrated model of care that is contextually appropriate, so as to maximize existing resources and leverage upon the strengths of the local health system while preventing prevailing cracks from impacting on hard-earned HIV gains and quality of clinical care.

Consequences

Further research is required to generate more robust evidence on the benefits, challenges, and cost-effectiveness of integration of HIV and NCD services in SSA, particularly in those countries where NCD services are still developing. Conducting high quality trials and implementing their findings will enable the optimization of existing resources and enhance the outcomes of NCD detection, treatment and care for all patients in a manner that is both cost-effective, and which does not weaken the well-functioning HIV efforts in the SSA region.

Submitted by:

Geoff McCombe

Funding acknowledgement:

The INTE-AFRICA project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 825698