Where do we stand today?
The 1st of December is World AIDS Day, aimed at increasing awareness for this devastating global epidemic and raising funds to continue the fight against it. There are nearly 38 million people living with HIV globally, of which almost 2 million are children. Much work still remains to be done. However, in over 30 years of efforts, several successes have been achieved:
- In 2020, the number of new HIV infections worldwide was 1.5 million: a 31% decline compared to 2010.
- Globally, as of the end of 2020, 73% of people living with HIV were accessing antiretroviral therapy (ART). Overall, 66% of all people estimated to be living with HIV are virally suppressed.
- HIV-related mortality has dropped 61% compared to the 2004 peak and 52% since 2010.
HIV/AIDS: the situation in Uganda
In the 1990s, Uganda was among the African countries hardest hit by the HIV/AIDS pandemic and also one of the first African countries to establish a national AIDS control program, including a national blood transfusion service, national testing and care services, and a national STD control program. This contributed to a decrease in HIV incidence from approximately 110,000 new cases in 1990 to around 38,000 new cases in 2020. Due to these efforts, Uganda has reached 91% of people living with HIV being aware of their status, of which 90% are on ART, and 93% are virally suppressed.
There are nearly 38 million people living with HIV globally, of which almost 2 million are children
Leveraging the HIV-care model to improve care for chronic diseases in sub-Saharan Africa
Due to large global investments, care for HIV in sub-Saharan Africa is delivered vertically, in stand-alone clinics. However, for chronic diseases such as diabetes and hypertension, care is primarily centralized, if it is available at all. This is largely due to the significant gaps in funding and programme implementation. As a result, it is estimated that only around 5-10% of people living with diabetes or hypertension are receiving regular care.
The INTE-AFRICA project, part of the larger RESPOND-AFRICA collaboration, aims to investigate whether integrating services for diabetes and hypertension with HIV services will improve access to care. Therefore, the primary outcome measured in this study is retention in care for people living with any of these chronic conditions: diabetes, hypertension, and/or HIV after placing both services in a single location. The other main outcome of the study is plasma viral load suppression in HIV-positive people, to test if integrating healthcare delivery programs results in detrimental health outcomes for people living with HIV. The protocol for this study can be found here.
How will HIV patients benefit from integrated care?
This novel, integrated model of care will make it possible for HIV-positive people that also suffer from diabetes and/or hypertension to receive care for multiple chronic conditions at the same location at the same time, for example by reducing costs associated with travel to clinics and time needed to attend appointments.
This is the first cluster randomized control trial on integrated care in Africa, which draws on close collaborations with researchers, policy-makers, and patients living in Tanzania and Uganda
By creating a shared healthcare delivery infrastructure that coordinates services at every level of care, people living with HIV, diabetes, and/or hypertension will be able to reach health services for these conditions in the same facility, hopefully facilitating regular access to care and long-term management.
This is the first cluster randomized control trial on integrated care in Africa, which draws on close collaborations with researchers, policy-makers, and patients living in Tanzania and Uganda. If successful in demonstrating the effectiveness of this integrated model of care, the model can be considered for other similar contexts in the region, the continent, and beyond.
Written by Dr Joshua Musinguzi, Head of national AIDS programme, Uganda Ministry of Health.