Opportunities and challenges for evidence-informed HIV-noncommunicable disease integrated care policies and programs

Mwagomba, Beatrice L. Matanje; Ameh, Soter; Bongomin, Pido; Juma, Pamela A.; MacKenzie, Rachel K.; Kyobutungi, Catherine; Lukhele, Nomthandazo; Mwangi, Kibachio Joseph; Amberbir, Alemayehu; Klipstein‐Grobusch, Kerstin; Gómez‐Olivé, Francesc Xavier; Berman, Josh

doi:10.1097/qad.0000000000001885

Cited by 55 publications

(45 citation statements)

References 13 publications

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“…A recent systematic review [16], which incorporated prior findings from SEARCH, demonstrated the resources and strategies most conducive to integrated care for HIV/AIDS and chronic disease-for example, patientcentered delivery models and a clear implementation strategy-and called for standardized care checklists and service coordinators to achieve it. However, other recent reviews of lowresource CVD care-including those leveraging HIV programs-report unclear and incompletely implemented treatment protocols, which impairs measuring and achieving consistent outcomes [16,16,20,21].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Heller¹,

Balzer

Kazi

et al. 2020

PLoS ONE

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Background Hypertension (HTN) is the single leading risk factor for human mortality worldwide, and more prevalent in sub-Saharan Africa than any other region [1]-although resources for HTN screening, treatment, and control are few. Most regional pilot studies to leverage HIV programs for HTN control have achieved blood pressure control in half of participants or fewer [2,3,4]. But this control gap may be due to inconsistent delivery of services, rather than ineffective underlying interventions. Methods We sought to evaluate the consistency of HTN program delivery within the SEARCH study (NCT01864603) among 95,000 adults in 32 rural communities in Uganda and Kenya from 2013-2016. To achieve this objective, we designed and performed a fidelity evaluation of the step-by-step process (cascade) of HTN care within SEARCH, calculating rates of HTN screening, linkage to care, and follow-up care. We evaluated SEARCH's assessment of each participant's HTN status against measured blood pressure and HTN history. Findings SEARCH completed blood pressure screens on 91% of participants. SEARCH HTN screening was 91% sensitive and over 99% specific for HTN relative to measured blood pressure and patient history. 92% of participants screened HTN+ received clinic appointments, and

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Heller¹,

Balzer

Kazi

et al. 2020

PLoS ONE

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“…Integrated care cascades require clinical space and skilled personnel, and it is necessary to leverage the existing infrastructure and build integrated care capacity of staff who have supported unilateral HIV programmes 16. While integration of HIV with other programmes, such as reproductive health and TB, has occurred through the establishment of inclusive national policies, evidence of HIV-NCD integration in clinical practice is scarce 63–65. Five studies within LMICs which integrated an additional health service component into an existing service (eg, adding family planning or HTS to routine services) indicated that adding on services probably increases service utilisation and outputs of healthcare delivery.…”

Section: Discussionmentioning

confidence: 99%

Demographics and health profile on precursors of non-communicable diseases in adults testing for HIV in Soweto, South Africa: a cross-sectional study

et al. 2019

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ObjectivesThis cross-sectional study investigated the burden of HIV-non-communicable disease (NCD) precursor comorbidity by age and sex. Policies stress integrated HIV-NCD screenings; however, NCD screening is poorly implemented in South African HIV testing services (HTS).SettingWalk-in HTS Centre in Soweto, South Africa.Participants325 voluntary adults, aged 18+ years, who provided written or verbal informed consent (with impartial witness) for screening procedures were enrolled.Primary and secondary outcomesData on sociodemographics, tuberculosis and sexually transmitted infection symptoms, blood pressure (BP) (≥140/90=elevated) and body mass index (<18.5 underweight; 18.5–25.0 normal; >25 overweight/obese) were stratified by age-group, sex and HIV status.ResultsOf the 325 participants, the largest proportions were female (51.1%; n=166/325), single (71.5%; n=231/323) and 25–34 years (33.8%; n=110/325). Overall, 20.9% (n=68/325) were HIV infected, 27.5% (n=89/324) had high BP and 33.5% (n=109/325) were overweight/obese. Among HIV-infected participants, 20.6% (14/68) had high BP and 30.9% (21/68) were overweight/obese, as compared with 29.3% (75/256) and 12.1% (31/256) of the HIV-uninfected participants, respectively. Females were more likely HIV-infected compared with males (26.5% (44/166) vs 15.1% (24/159); p=0.012). In both HIV-infected and uninfected groups, high BP was most prevalent in those aged 35–44 years (25% (6/24) vs 36% (25/70); p=0.3353) and >44 years (29% (4/14) vs 48% (26/54); p=0.1886). Males had higher BP than females (32.9% (52/158) vs 22.3% (37/166); p=0.0323); more females were overweight/obese relative to males (45.8% (76/166) vs 20.8% (33/159); p<0.0001). Females were more likely to be HIV infected and overweight/obese.ConclusionAmong HTS clients, NCD precursors rates and co-morbidities were high. Elevated BP occurred more in older participants. Targeted integrated interventions for HIV-infected females and HIV-infected people aged 18–24 and 35–44 years could improve HIV public health outcomes. Additional studies on whether integrated HTS will improve the uptake of NCD treatment and improve health outcomes are required.

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“…While integration of HIV with other programmes, such as reproductive health and tuberculosis (TB), has occurred through the establishment of inclusive national policies, both research and evidence-based data on the acceptability, effectiveness, feasibility and sustainability of HIV-NCD integration in clinical practice is scarce. [25][26][27] While integration of screening, prevention and referral services may be an intuitive solution for combating the morbidity and mortality associated with HIV and NCDs, there is minimal evidence regarding the patient-and service-level effect of such a strategy. [28] Competent care and health systems are necessary for achieving high-quality care.…”

Section: Introductionmentioning

confidence: 99%

Level of Adult Client Satisfaction with Clinic Flow Time and Services of an Integrated Non-Communicable Disease-HIV Testing Services Clinic in Soweto, South Africa: A Cross-Sectional Study

Hopkins

Hlongwane

Otwombe

et al. 2020

Preprint

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Background: While HIV Testing Services (HTS) have increased, many South Africans have not been tested. Non-communicable diseases (NCDs) are the top cause of death worldwide. Integrated NCD-HTS could be a strategy to control both epidemics. Healthcare service strategies depends partially on positive user experience. We investigated client satisfaction of services and clinic flow time of an integrated NCD-HTS clinic. Methods: This prospective, cross-sectional study evaluated HTS client satisfaction with an HTS clinic at two phases. Phase 1 (February–June 2018) utilised standard HTS services: counsellor-led height/weight/BP measurements, HIV rapid testing, and symptoms screening for sexually transmitted infections/Tuberculosis. Phase 2 (June 2018–March 2019) further integrated counsellor-led obesity screening (BMI/abdominal measurements), rapid cholesterol/glucose testing; and nurse-led Chlamydia and HPV/cervical cancer screening. Socio-demographics, proportion of repeat clients, clinic flow time, and client survey data (open/closed-ended questions using five-point Likert scale) are reported. Fisher’s exact test, chi-square analysis, Kruskal Wallis test conducted comparisons. Multiple linear regression determined predictors associated with clinic time. Content thematic analysis was conducted for free response data. Results: 284 and 333 participants were from Phase 1 and 2, respectively (N=617). Phase 1 participants were significantly older (median age 36.5 (28.0–43.0) years vs. 31.0 (25.0–40.0) years; p=0.0003), divorced/widowed (6.7%, [n=19/282] vs. 2.4%, [n=8/332]; p=0.0091); had tertiary education (27.9%, [n=79/283] vs. 20.1%, [n=67/333]; p=0.0234); and were less female (53.9%, [n=153/284] vs 67.6%, [n=225/333]; p=0.0005), compared to Phase 2. Phase 2 had 10.2% repeat clients (n=34/333), and 97.9% (n=320/327) were ‘ very satisfied’ with integrated NCD-HTS, despite standard HTS having significantly shorter median time for counsellor-led HTS (36.5, interquartile range [IQR]: 31.0-45.0 vs. 41.5, IQR: 35.0-51.0; p<0.0001). Phase 2 associations with longer clinic time were clients living together/married (est=6.548; p=0.0467), more tests conducted (est=3.922; p<0.0001), higher overall satisfaction score (est=1.210; p=0.0201). Matriculated clients experienced less clinic time (est=-7.250; p=0.0253). Conclusions: It is possible to integrate counsellor-led NCD rapid testing into standard HTS within historical HTS timeframes, yielding client satisfaction. Rapid cholesterol/glucose testing should be integrated into standard HTS. Research is required on the impact of cervical cancer/HPV screenings to HTS clinic flow to determine if it could be scaled up within the public sector.

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Opportunities and challenges for evidence-informed HIV-noncommunicable disease integrated care policies and programs

Cited by 55 publications

References 13 publications

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

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

Demographics and health profile on precursors of non-communicable diseases in adults testing for HIV in Soweto, South Africa: a cross-sectional study

Level of Adult Client Satisfaction with Clinic Flow Time and Services of an Integrated Non-Communicable Disease-HIV Testing Services Clinic in Soweto, South Africa: A Cross-Sectional Study

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