Abstract
IntroductionDespite growing enthusiasm for integrating treatment of non‐communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub‐Saharan Africa, there is little evidence on the potential health and financial consequences of such integration. We aim to study the cost‐effectiveness of basic NCD‐HIV integration in a Ugandan setting.MethodsWe developed an epidemiologic‐cost model to analyze, from the provider perspective, the cost‐effectiveness of integrating hypertension, diabetes mellitus (DM) and high cholesterol screening and treatment for people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Uganda. We utilized cardiovascular disease (CVD) risk estimations drawing from the previously established Globorisk model and systematic reviews; HIV and NCD risk factor prevalence from the World Health Organization’s STEPwise approach to Surveillance survey and global databases; and cost data from national drug price lists, expert consultation and the literature. Averted CVD cases and corresponding disability‐adjusted life years were estimated over 10 subsequent years along with incremental cost‐effectiveness of the integration.ResultsIntegrating services for hypertension, DM, and high cholesterol among ART patients in Uganda was associated with a mean decrease of the 10‐year risk of a CVD event: from 8.2 to 6.6% in older PLWH women (absolute risk reduction of 1.6%), and from 10.7 to 9.5% in older PLWH men (absolute risk reduction of 1.2%), respectively. Integration would yield estimated net costs between $1,400 and $3,250 per disability‐adjusted life year averted among older ART patients.ConclusionsProviding services for hypertension, DM and high cholesterol for Ugandan ART patients would reduce the overall CVD risk among these patients; it would amount to about 2.4% of national HIV/AIDS expenditure, and would present a cost‐effectiveness comparable to other standalone interventions to address NCDs in low‐ and middle‐income country settings.
Highlights
Despite growing enthusiasm for integrating treatment of non-communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub-Saharan Africa, there is little evidence on the potential health and financial consequences of such integration
We examined the potential costs and health benefits associated with the integration of screening and treatment for hypertension, diabetes mellitus (DM) and hypercholesterolaemia, into HIV treatment services among people living with HIV (PLWH) receiving antiretroviral therapy (ART), compared to the current status quo in Uganda
Examining the 10-year cardiovascular disease (CVD) risk per age group and sex, we estimated a mean risk of 8.2% in 45-69 year-old PLWH women compared with 10.7% in 45-69 year-old PLWH men, in the status quo
Summary
Despite growing enthusiasm for integrating treatment of non-communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub-Saharan Africa, there is little evidence on the potential health and financial consequences of such integration. Non-communicable diseases (NCDs) have become a major cause of disability and mortality among people living with HIV (PLWH) in sub-Saharan Africa (SSA) [1] This is largely due to rapidly increasing rates of risk factors, like hypertension, in PLWH [2,3]. Previous cohort studies in SSA have shown that about 21% of PLWH were hypertensive, 22% had hypercholesterolaemia and 3% were diabetic [4,5] These high levels of risk factors increase the likelihood of cardiovascular diseases (CVD) such as stroke and ischaemic heart disease (IHD), jointly, and together with the likely direct effect of HIV infection on CVD outcomes [5,6,7,8].
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