Non‐communicable diseases and HIV care and treatment: models of integrated service delivery

Abstract

Abstractobjectives Non-communicable diseases (NCD) are a growing cause of morbidity in low-income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. We describe models of NCD and HIV integration, challenges and lessons learned.methods A literature review of published articles on integrated NCD and HIV programs in lowincome countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration.results Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models.conclusions Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. Operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled-up by managers and policymakers seeking to address all the chronic care needs of their patients.

Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda

“…We found that older patients (50 years and above) who had well-controlled sugar levels or blood pressure and were also stable on ART were still required to make monthly clinic visits regardless of the DSD provision of 3-monthly visits. This calls for the integrated management of HIV and other co-morbidities that is becoming increasingly important priority due to ageing cohorts of clients and the need to revisit treatment guidelines even in non-HIV services [42][43][44].…”

Understanding implementation barriers in the national scale-up of Differentiated ART delivery in Uganda

“…We found that older patients (50 years and above) who had well-controlled sugar levels or blood pressure and were also stable on ART were still required to make monthly clinic visits regardless of the DSD provision of 3-monthly visits. This calls for the integrated management of HIV and other comorbidities that is becoming increasingly important priority due to ageing cohorts of clients and the need to revisit treatment guidelines even in non-HIV services [36], [37], [45].…”

Recommendations for the use of mathematical modelling to support decision‐making on integration of non‐communicable diseases into HIV care

“…Despite being an infectious disease, care for HIV has evolved into a chronic care model, that involves patient follow-up, continuity of care, monitoring and auxiliary services to maintain patients' health and quality of life. HIV/AIDS prevention and treatment services have been successfully integrated with services focused on maternal and child health, TB, nutritional advice, family planning services, lifestyle advice services and screening programmes for NCDs [21][22][23], and has established strong health systems, financing and infrastructure across many LMIC settings.…”