INTE-AFRICA researchers have published a protocol in BMJ Open entitled “Strengthening integration of chronic care in Africa: a protocol for the qualitative process evaluation of integrated HIV, diabetes and hypertension care in a cluster randomised controlled trial in Tanzania and Uganda ”. The authors present a protocol for a study that seeks to put in place the integration of services for HIV and non-communicable diseases (NCDs) in Tanzania and Uganda.
The study specifically will implement and assess the effectiveness of an integrated care clinic for HIV, diabetes, and hypertension at primary health centers in two sub-Sahara African countries. Characteristics of implemented care will include managing HIV, hypertension and diabetes concurrently by the same healthcare staff; integrated clinician training; and integrated health education about each condition. During programme implementation, the qualitative process evaluation will examine the experience, attitudes, and practices of stakeholders to understand structural and contextual factors that affect the process. To inform wider implementation, particular attention will be paid to identifying contextually relevant strategies for successful integration and understanding difficulties in adoption, delivery, and maintenance.
“In comparison to HIV services, health service coverage for NCDs remains low in the region” says Prof Marie-Claire Van Hout, lead author of the protocol article and the process evaluation work package leader of the INTE-AFRICA partnership. In this way, the study will address the rising dual HIV and NCD epidemic in Tanzania and Uganda. In particular, the study will address diabetes and hypertension, which have a prevalence of 5% and 25%, respectively, in sub-Saharan Africa.
The authors outline various benefits of integrating services for both HIV and hypertension and diabetes control beyond linkage and retention in care. “For diabetes and hypertension care benefits include greater service provision, reduction and duplication of fragmented services, and cost-savings for both patients and health services,” adds Prof Van Hout. For HIV care, benefits include reduction of HIV-related stigma and increased rates of access to HIV services, HIV testing, and viral suppression.
The results of this study will provide evidence to effectively scale up and sustain integrated provision of chronic disease management services in sub-Saharan Africa. In particular, the study will support HIV and NCD service integration while also informing monitoring, policy, and practice development efforts through involving and educating communities in Tanzania and Uganda. The model of care and platform of good practices created through this research can potentially be used throughout the region to improve HIV and NCD care in future.
Van Hout M-C, Bachmann M, Lazarus JV, et al. Strengthening integration of chronic care in Africa: protocol for the qualitative process evaluation of integrated HIV, diabetes and hypertension care in a cluster randomised controlled trial in Tanzania and Uganda. BMJ Open 2020;10:e039237. doi:10.1136/ bmjopen-2020-039237