Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Abstract

Health policies in Africa are shifting towards integrated care services for chronic conditions, but in parts of Africa robust evidence on effectiveness is limited. We assessed the integration of vertical health services for HIV, diabetes and hypertension provided in a feasibility study within five health facilities in Uganda. From November 2018 to January 2020, we conducted a series of three in-depth interviews with 31, 29 and 24 service users attending the integrated clinics within Kampala and Wakiso districts. Ten healthcare workers were interviewed twice during the same period. Interviews were conducted in Luganda, translated into English, and analysed thematically using the concepts of availability, affordability and acceptability. All participants reported shortages of diabetes and hypertension drugs and diagnostic equipment prior to the establishment of the integrated clinics. These shortages were mostly addressed in the integrated clinics through a drugs buffer. Integration did not affect the already good provision of anti-retroviral therapy. The cost of transport reduced because of fewer clinic visits after integration. Healthcare workers reported that the main cause of non-adherence among users with diabetes and hypertension was poverty. Participants with diabetes and hypertension reported they could not afford private clinical investigations or purchase drugs prior to the establishment of the integrated clinics. The strengthening of drug supply for non-communicable conditions in the integrated clinics was welcomed. Most participants observed that the integrated clinic reduced feelings of stigma for those living with HIV. Sharing the clinic afforded privacy about an individual’s condition, and users were comfortable with the waiting room sitting arrangement. We found that integrating non-communicable disease and HIV care had benefits for all users. Integrated care could be an effective model of care if service users have access to a reliable supply of basic medicines for both HIV and non-communicable disease conditions.

Understanding older peoples’ chronic disease self-management practices and challenges in the context of grandchildren caregiving: A qualitative study in rural KwaZulu-Natal, South Africa

“…Our findings resonate with other work in Malawi, Uganda, and South Africa showing how chronic patients experienced difficulty obtaining medicines from public healthcare facilities, leading to non-adherence to healthcare services [34,35,62]. The shortages of medicines in public healthcare facilities can also be regarded as the health systems barrier to support chronic disease self-management [34].…”

“…A qualitative research design located within an interpretive paradigm was adopted for this study because of the focus on exploring the experiences of grandparent caregivers and the meanings they attribute to self-management of chronic diseases whilst caring for grandchildren. This design has proven useful in previous research on chronic illness [34,35] and we PLOS GLOBAL PUBLIC HEALTH sought to generate depth accounts. Participants were selected using a purposive sampling method with the following criteria: grandparents aged 50 years and above who were primary caregivers of at least one adolescent child aged 13 to 19 years who participated in DREAMS programme.…”

Women living with HIV, diabetes and/or hypertension multi-morbidity in Uganda: a qualitative exploration of experiences accessing an integrated care service

“…Difficulties in having to pay for diabetes and hypertension medication (in contrast to HIV drugs) and transport, and choosing between food and medicine, are also reported in other integrated care evaluations (and also by male patients) (Haldane et al, 2016;Juma et al, 2018;Iwelunmor et al, 2019;Bukenya et al, 2021;Shayo et al, 2022).…”

“After all, we are all sick”: Multi-stakeholder understandings of stigma associated with integrated management of HIV, diabetes and hypertension at selected government clinics in Uganda

“…While at the integrated clinic, patients are able to hold informal conversations amongst themselves, freely open up about their conditions and seek advice and psycho-social support. Such a bene t shows how integration has given the most effective health education to patients and in return patients no longer see stigma as a problem [23]. However, to some extent, integrating NCDs into HIV care was associated with some form of stigma as patients with NCDs feared being seen receiving treatment from the ART clinic, a phenomenon widely known for offering HIV related services [24].With integration proving a long awaited move towards elimination of health care seeking stigma, it can be noted that the implementation and adoption of the model lies in the hands of every stakeholder.…”