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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

Van Hout, Marie-Claire, Bachmann, Max, Lazarus, Jeffrey V, Shayo, Elizabeth Henry, Bukenya, Dominic, Picchio, Camila A, Nyirenda, Moffat, Mfinanga, Sayoki Godfrey, Birungi, Josephine, Okebe, Joseph ORCID: https://orcid.org/0000-0001-5466-1611 and Jaffar, Shabbar ORCID: https://orcid.org/0000-0002-9615-1588 (2020) '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, Vol 10, Issue 10, e039237.

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Abstract

Introduction
In sub-Saharan Africa, the burden of non-communicable diseases (NCDs), particularly diabetes mellitus (DM) and hypertension, has increased rapidly in recent years, although HIV infection remains a leading cause of death among young-middle-aged adults. Health service coverage for NCDs remains very low in contrast to HIV, despite the increasing prevalence of comorbidity of NCDs with HIV. There is an urgent need to expand healthcare capacity to provide integrated services to address these chronic conditions.

Methods and analysis
This protocol describes procedures for a qualitative process evaluation of INTE-AFRICA, a cluster randomised trial comparing integrated health service provision for HIV infection, DM and hypertension, to the current stand-alone vertical care. Interviews, focus group discussions and observations of consultations and other care processes in two clinics (in Tanzania, Uganda) will be used to explore the experiences of stakeholders. These stakeholders will include health service users, policy-makers, healthcare providers, community leaders and members, researchers, non-governmental and international organisations. The exploration will be carried out during the implementation of the project, alongside an understanding of the impact of broader structural and contextual factors.

Ethics and dissemination
Ethical approval was granted by the Liverpool School of Tropical Medicine (UK), the National Institute of Medical Research (Tanzania) and TASO Research Ethics Committee (Uganda) in 2020. The evaluation will provide the opportunity to document the implementation of integration over several timepoints (6, 12 and 18 months) and refine integrated service provision prior to scale up. This synergistic approach to evaluate, understand and respond will support service integration and inform monitoring, policy and practice development efforts to involve and educate communities in Tanzania and Uganda. It will create a model of care and a platform of good practices and lessons learnt for other countries implementing integrated and decentralised community health services.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WG Cardiovascular System > WG 100 General works
WG Cardiovascular System > WG 20 Research (General)
WK Endocrine System > WK 810 Diabetes mellitus
WK Endocrine System > WK 835 Complications of diabetes
WK Endocrine System > WK 840 Diabetes as a complication in other conditions
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjopen-2020-039237
Depositing User: Rachel Dominguez
Date Deposited: 20 Nov 2020 12:59
Last Modified: 14 Dec 2020 11:02
URI: https://archive.lstmed.ac.uk/id/eprint/16166

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