Abstract
BackgroundAlthough 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. The aim of this study was to identify key components, outcomes, and best practice in integrated service provision for the prevention, identification and treatment of HIV, hypertension and diabetes.MethodsAn international, multi stakeholder e-Delphi consensus study was conducted over two successive rounds. In Round 1, 24 participants were asked to score 27 statements, under the headings ‘Service Provision’ and ‘Benefits of Integration’, by importance. In Round 2, the 16 participants who completed Round 1 were shown the distribution of scores from other participants along with the score that they attributed to an outcome and were asked to reflect on the score they gave, based on the scores of the other participants and then to rescore if they wished to. Nine participants completed Round 2.ResultsBased on the Round 1 ranking, 19 of the 27 outcomes met the 70% threshold for consensus. Four additional outcomes suggested by participants in Round 1 were added to Round 2, and upon review by participants, 22 of the 31 outcomes met the consensus threshold. The five items participants scored from 7 to 9 in both rounds as essential for effective integrated healthcare delivery of health services for chronic conditions were improved data collection and surveillance of NCDs among people living with HIV to inform integrated NCD/HIV programme management, strengthened drug procurement systems, availability of equipment and access to relevant blood tests, health education for all chronic conditions, and enhanced continuity of care for patients with multimorbidity.ConclusionsThis study highlights the outcomes which may form key components of future complex interventions to define a model of integrated healthcare delivery for diabetes, hypertension and HIV in sub-Saharan Africa.
Highlights
While HIV continues to have a high prevalence in subSaharan Africa (SSA) among adults, the burden of noncommunicable diseases (NCD) is increasing rapidly, in particular diabetes and hypertension [1]
Health education should be available for all chronic conditions within an integrated care clinic
This study has identified the key components/outcomes that are most important to a range of key stakeholders in the field including researchers, policymakers, academics
Summary
While HIV continues to have a high prevalence in subSaharan Africa (SSA) among adults, the burden of noncommunicable diseases (NCD) is increasing rapidly, in particular diabetes and hypertension [1]. It is estimated that of approximately 650 million people in SSA, 10–20 million may have hypertension [4]. These estimations are based on scarce heterogenous studies and many countries in SSA still lack detailed up-to-date basic data on the prevalence of hypertension [5]. 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. The aim of this study was to identify key components, outcomes, and best practice in integrated service provision for the prevention, identification and treatment of HIV, hypertension and diabetes
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