Integrating Care for Diabetes and Hypertension with HIV Care in Sub-Saharan Africa: A Scoping Review.

Geoff Mccombe,Sayoki Mfinanga,Nelson K Sewankambo,Shabbar Jaffar,Walter Cullen,Kaushik Ramaiya,Max Bachmann,Anupam Garrib,Jeffrey V Lazarus,Jayleigh Lim,Marie Claire Van Hout

doi:10.5334/ijic.5839

Abstract

Introduction:Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. A scoping review mapped extant policy and evidence based literature on the feasibility of integrating NCD care with HIV in the region.Methods:A scoping review methodology was utilised to conduct a systematic search of peer-reviewed and grey literature published in English language and with no date limitation. A systematic search was conducted on PubMed, Embase, CINAHL, and the Cochrane library. The initial search identified 231 records considered for inclusion in this review. Twelve duplicate records were removed. The remaining 219 records were screened by title and abstract of which 165 records were excluded and 54 records were selected for full-text review. A further 16 records were excluded due to a lack of relevance or the unavailability of the full text article. Finally, 38 were charted and analysed thematically.Results:Thirty-eight studies were included. These comprised a range of different models to integrate NCD and HIV care in the region, reflecting differences in health system environments, and disease epidemiology. The studies provide a variety of evidence that integration of HIV and NCD care can be feasible and can improve clinical effectiveness and identify barriers and facilitators to integration and task shifting. The review confirms that integrated HIV and NCD care services is by-and-large feasible, being both clinically effective and cost-effective.Conclusion:The review may inform the understanding of how best to develop an integrated model of care service by reducing barriers to uptake, linkage and retention in HIV, diabetes and hypertension treatment in SSA countries.

Highlights

HIV continues to have a high prevalence among adults in subSaharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly
The Global Status Report on NCDs emphasizes that the negative impacts of NCDs are severe in poor and vulnerable populations such as those living in the sub-Saharan Africa (SSA) region [8], where poverty exacerbates many health conditions [9]
These, along with an additional 22 records suggested by the steering group which were not identified in the initial database search, gave a total of 231 records which were considered for inclusion in this review

Summary

Introduction

HIV continues to have a high prevalence among adults in subSaharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an increasing noncommunicable disease (NCD) burden globally, with an estimated 1 billion people living with hypertension and about 9.4 million NCD-related deaths annually [1]. Over three-quarters of global NCD deaths (28 million) and the majority of premature deaths (82%) occur in low- and middleincome countries (LMICs) [4]. HIV-infection is a leading cause of premature death among adults in sub-Saharan Africa (SSA), global NCD trends are mirrored in the region. The trend is evident from the rapidly increasing burden of NCDs such as DM and hypertension in SSA countries, giving rise to a dual HIV-NCD epidemic [8]. In SSA, the prevalence of hypertension is increasing with 78% of adults over 55 years living with hypertension [10] and prevalence of DM is anticipated to double between 2010 and 2030; with 28 million people in SSA predicted to be living with the disease [11]

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