The overall goal of this project is to scale up provision for diabetes and hypertension in sub-Saharan Africa. To do so, the project will test the efficacy of integrating diabetes and hypertension services alone, or in combination with HIV-infection services.
The diseases affecting the sub-Saharan African population have drastically changed in the last decades. Although acute infections continue to constitute a high burden, chronic diseases, which require regular lifelong care, now have an equal or higher burden.
Two of the chronic conditions of major concern are hypertension (the single largest risk factor for death), and diabetes. This represents a major challenge for Africa, where coverage of health services remains low. Less than 5% of people with diabetes or hypertension are thought to receive regular care.
Scaling up care for diabetes and hypertension will require its integration into primary health care, and decentralising it from primary health care services to community-based care. A solid experience has been acquired over the years in managing HIV as a chronic disease, and many of these practices could be applied for the effective management of diabetes and hypertension.
The project will assess the effectiveness and feasibility of two approaches: scale up hypertension and diabetes integrated services alone, or in combination with HIV infection services. These approaches will be tested in Tanzania and Uganda, two countries where the INTE-AFRICA consortium has been conducting research and establishing a strong partnership for many years.
Over the course of three years, the project aims to:
- Reorganise primary health care services so that diabetes and hypertension can be diagnosed and treated in dedicated chronic care clinics in two large regions (one in Tanzania and one in Uganda).
- Reorganise HIV clinics into chronic care clinics in two large regions (different from the above) so that they can diagnose and treat all three conditions: HIV, diabetes and hypertension.
- Decentralise care from health facilities to community posts for patients stable on treatment.
- Evaluate these approaches in terms of acceptability (by patients and community), number of patients treated and retained, clinical outcomes, costs of integrated care delivery, and cost-effectiveness (compared to current standard care).
- Use the data generated to develop national and global clinical guidelines for the provision of diabetes and hypertension care in low-resource settings.
- Describe the challenges faced by health services in delivering the integration models and disseminate this knowledge to improve practices and facilitate further scale up.
- Develop sustainable partnerships between researchers, government policy makers, public-private partnerships to facilitate the scale-up nationally.
- Disseminate the knowledge generated to facilitate effective control of diabetes and hypertension in low-resource settings.
This project is expected to catalyse the scale up of diabetes and hypertension services in the two pilot countries and beyond. The model could also be replicated for other disease conditions, facilitating universal access to health care and optimising the use of resources.