BackgroundLow-income and middle-income countries are struggling to manage growing numbers of patients with chronic non-communicable diseases (NCDs), while services for patients with HIV infection are well established. There have been calls for integration of HIV and NCD services to increase efficiency and improve coverage of NCD care, although evidence of effectiveness remains unclear. In this review, we assess the extent to which National HIV and NCD policies in East Africa reflect the calls for HIV-NCD service integration.MethodsBetween April 2018 and December 2020, we searched for policies, strategies and guidelines associated with HIV and NCDs programmes in Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. Documents were searched manually for plans for integration of HIV and NCD services. Data were analysed qualitatively using document analysis.ResultsThirty-one documents were screened, and 13 contained action plans for HIV and NCDs service integration. Integrated delivery of HIV and NCD care is recommended in high level health policies and treatment guidelines in four countries in the East African region; Kenya, Rwanda, Tanzania and Uganda, mostly relating to integrating NCD care into HIV programmes. The increasing burden of NCDs, as well as a move towards person-centred differentiated delivery of services for people living with HIV, is a factor in the recent adoption of integrated HIV and NCD service delivery plans. Both South Sudan and Burundi report a focus on building their healthcare infrastructure and improving coverage and quality of healthcare provision, with no reported plans for HIV and NCD care integration.ConclusionDespite the limited evidence of effectiveness, some East African countries have already taken steps towards HIV and NCD service integration. Close monitoring and evaluation of the integrated HIV and NCD programmes is necessary to provide insight into the associated benefits and risks, and to inform future service developments.

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ObjectiveTo estimate injury mortality rates in a rural population in KwaZulu-Natal, South Africa and to identify socio-demographic risk factors associated with adult injury-related deaths.MethodsThe study used population-based mortality data collected by a demographic surveillance system on all resident and non-resident members of 11 000 households. Deaths and person-years of observation (pyo) were aggregated for individuals between 01 January 2000 and 31 December 2007. Cause of death was determined by verbal autopsy, coded using ICD-10 and further categorised using global burden of disease categories. Socio-demographic risk factors associated with injuries were examined using regression analyses.ResultsWe analysed data on 133 483 individuals with 717 584.6 person-years of observation (pyo) and 11 467 deaths. Of deaths, 8.9% were because of injury-related causes; 11% occurred in children <15 years old. Homicide, road traffic injuries and suicide were the major causes. The estimated crude injury mortality rate was 142.4 (134.0, 151.4)/100 000 pyo; 116.9 (108.1, 126.5)/100 000 pyo among residents and 216.8 (196.5, 239.2)/100 000 pyo among non-residents. In multivariable analyses, the differences between residents and non-residents remained but were no longer significant for women. In men and women, full-time employment was significantly associated with lower mortality [adjusted rate ratios 0.6 (0.4, 0.9); 0.4 (0.2, 0.9)]; in men, higher asset ownership was independently associated with increased mortality [adjusted rate ratio 1.5 (1.1, 1.9)].ConclusionsReducing the high levels of injury-related mortality in South Africa requires intersectoral primary prevention efforts that redress the root causes of violent and accidental deaths: social inequality, poverty and alcohol abuse.

The rising burden from non-communicable diseases (NCDs) poses a huge challenge for health care delivery in Africa, where health systems are already struggling with the long-term care requirements for the millions of people now on antiretroviral therapy requiring regular visits to health facilities for monitoring, adherence support and drugs. The HIV chronic disease management programme is comparatively well-funded, well-organised and well-informed and offers many insights and opportunities for the expansion of NCD prevention and treatment services. Some degree of human immunodeficiency virus (HIV) and NCD service integration is essential, but how to do this without risking the HIV treatment gains is unclear. Both HIV and NCD services must expand within a resource-constrained environment and policymakers are in urgent need of evidence to guide cost-effective and acceptable changes in these health services.

Summary Objective  To determine child mortality rates in a rural area of South Africa with high HIV prevalence. Methods  A community‐based survey was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children were followed up through four monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson regression. Results  Mortality ratios were 59.6 deaths per 1000 live births for infants and 97.1 for children under 5 years of age. Infant and under‐5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 person‐years. HIV/AIDS was attributed to 41% of deaths in the under‐5 age group, with a mortality rate of 8.6 per 1000 person‐years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person‐years in children under 1 year of age. Conclusions  In rural South Africa, infant and child mortality levels are high, with HIV/AIDS estimated as the single largest cause of death. Interventions to reduce child mortality are required urgently.