Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review

Abstract

Non-communicable diseases (NCDs), including cardiovascular diseases (CVD), hypertension and diabetes together with HIV infection are among the major public health concerns worldwide. Health services for HIV and NCDs require health systems that provide for people's chronic care needs, which present an opportunity to coordinate efforts and create synergies between programmes to benefit people living with HIV and/or AIDS and NCDs. This review included studies that reported service integration for HIV and/or AIDS with coronary heart diseases, chronic CVD, cerebrovascular diseases (stroke), hypertension or diabetes. We searched multiple databases from inception until October 2015. Articles were screened independently by two reviewers and assessed for risk of bias. 11,057 records were identified with 7,616 after duplicate removal. After screening titles and abstracts, 14 papers addressing 17 distinct interventions met the inclusion criteria. We categorized integration models by diseases (HIV with diabetes, HIV with hypertension and diabetes, HIV with CVD and finally HIV with hypertension and CVD and diabetes). Models also looked at integration from micro (patient focused integration) to macro (system level integrations). Most reported integration of hypertension and diabetes with HIV and AIDS services and described multidisciplinary collaboration, shared protocols, and incorporating screening activities into community campaigns. Integration took place exclusively at the meso-level, with no micro-or macro-level integrations described. Most were descriptive studies, with one cohort study reporting evaluative outcomes. Several innovative initiatives were identified and studies showed that CVD and HIV service integration is feasible.Integration should build on existing protocols and use the community as a locus for advocacy and health services, while promoting multidisciplinary teams, including greater involvement of pharmacists. There is a need for robust and well-designed studies at all levels -particularly macrolevel studies, research looking at long-term outcomes of integration, and research in a more diverse range of countries.

Pharmacotherapy for hypertension in Sub-Saharan Africa: a systematic review and network meta-analysis

“…The widespread success of HIV treatment programmes demonstrates the capability to address complexity within a public health approach [67,68]. Innovative hypertension programmes are integrating care into existing HIV programmes [69], utilising mobile technology [70,71] and implementing multi-pronged community interventions [72]. Harmonising these with knowledge of local population epidemiology and outcome of intervention could lead to a much greater understanding of how best to deliver care.…”

Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation

“…Most successful models have leveraged nurses, community health workers, and other non-physicians [14,15,16,17]. Recent studies demonstrate that programs for control of HIV can be leveraged for the control of chronic diseases such as HTN [18,19], though quantitative data on care linkage, blood pressure control, and other operational outcomes are scarce [20,21,22]. Pilot projects to date have been small and local in scope, with mixed results in linking HTN patients to care and achieving blood pressure control [2,3,4,23,24,25,26].…”

The Implementation & Sustainment Facilitation Strategy improved implementation effectiveness and intervention effectiveness: Results from a cluster-randomized type 2 hybrid trial

“…We used a cluster-randomized, type 2 hybrid trial to simultaneously test the impact of the ISF strategy (as an adjunct to the ATTC strategy) on: (1) the integration of a MIBI for SUDs within HIV-CBOs across the United States, and (2) the effectiveness of the MIBI (as an adjunct to UC within HIV-CBOs). Contributing to the growing literature on the effectiveness of facilitation-based strategies (74)(75)(76)(77)(78)(79)(80)(81)(82) and the effectiveness of MIBIs for SUD within HIV service settings (18,(83)(84)(85)(86)(87)(88), we found at least two findings of significance. First, we found evidence that the ISF strategy had a significant impact on improving the integration of the MIBI for SUDs, at least in terms of significantly improving the consistency and quality of MIBI implementation during the implementation phase (i.e., implementation effectiveness).…”