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Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study

Birungi, Josephine, Kivuyo, Sokoine, Garrib, Anupam ORCID:, Mugenyi, Levicatus, Mutungi, Gerald, Namakoola, Ivan, Mghamba, Janneth, Ramaiya, Kaushik, Wang, Duolao ORCID:, Maongezi, Sarah, Musinguzi, Joshua, Mugisha, Kenneth, Etukoit, Bernard M, Kakande, Ayoub, Niessen, Louis ORCID:, Okebe, Joseph ORCID:, Shiri, Tinevimbo ORCID:, Meshack, Shimwela, Lutale, Janet, Gill, Geoff, Sewankambo, Nelson, Smith, Peter G, Nyirenda, Moffat J, Mfinanga, Sayoki and Jaffar, Shabbar ORCID: (2021) 'Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study'. BMJ Open, Vol 11, Issue 11, e053412.

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Background HIV, diabetes and hypertension have a high disease burden in sub-Saharan Africa. Healthcare is organised in separate clinics, which may be inefficient. In a cohort study, we evaluated integrated management of these conditions from a single chronic care clinic.

Objectives To determined the feasibility and acceptability of integrated management of chronic conditions in terms of retention in care and clinical indicators.

Design and setting Prospective cohort study comprising patients attending 10 health facilities offering primary care in Dar es Salaam and Kampala.

Intervention Clinics within health facilities were set up to provide integrated care. Patients with either HIV, diabetes or hypertension had the same waiting areas, the same pharmacy, were seen by the same clinical staff, had similar provision of adherence counselling and tracking if they failed to attend appointments.

Primary outcome measures Retention in care, plasma viral load.

Findings Between 5 August 2018 and 21 May 2019, 2640 patients were screened of whom 2273 (86%) were enrolled into integrated care (832 with HIV infection, 313 with diabetes, 546 with hypertension and 582 with multiple conditions). They were followed up to 30 January 2020. Overall, 1615 (71.1%)/2273 were female and 1689 (74.5%)/2266 had been in care for 6 months or more. The proportions of people retained in care were 686/832 (82.5%, 95% CI: 79.9% to 85.1%) among those with HIV infection, 266/313 (85.0%, 95% CI: 81.1% to 89.0%) among those with diabetes, 430/546 (78.8%, 95% CI: 75.4% to 82.3%) among those with hypertension and 529/582 (90.9%, 95% CI: 88.6 to 93.3) among those with multimorbidity. Among those with HIV infection, the proportion with plasma viral load <100 copies/mL was 423(88.5%)/478.

Conclusion Integrated management of chronic diseases is a feasible strategy for the control of HIV, diabetes and hypertension in Africa and needs evaluation in a comparative study.

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
WH Hemic and Lymphatic Systems > WH 100 General works
WK Endocrine System > WK 810 Diabetes mellitus
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Rachel Dominguez
Date Deposited: 24 Nov 2021 15:39
Last Modified: 24 Nov 2021 15:39


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