Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care

Josefien Van Olmen,Wim Van Damme,François Schellevis,Guy Kegels,Freya Rasschaert

doi:10.1155/2012/349312

Abstract

There is growing attention for chronic diseases in sub-Saharan Africa (SSA) and for bridges between the management of HIV/AIDS and other (noncommunicable) chronic diseases. This becomes more urgent with increasing numbers of people living with both HIV/AIDS and other chronic conditions. This paper discusses the commonalities between chronic diseases by reviewing models of care, focusing on the two most dominant ones, diabetes mellitus type 2 (DM2) and HIV/AIDS. We argue that in order to cope with care for HIV patients and diabetes patients, health systems in SSA need to adopt new strategies taking into account essential elements of chronic disease care. We developed a “chronic dimension framework,” which analyses the “disease dimension,” the “health provider dimension,” the patient or “person dimension,” and the “environment dimension” of chronic diseases. Applying this framework to HIV/AIDS and DM2 shows that it is useful to think about management of both in tandem, comparing care delivery platforms and self-management strategies. A literature review on care delivery models for diabetes and HIV/AIDS in SSA revealed potential elements for cross-fertilisation: rapid scale-up approaches through the public health approach by simplification and decentralisation; community involvement, peer support, and self-management strategies; and strengthening health services.

Highlights

There is growing attention for chronic life-long conditions (CLLCs) in sub-Saharan Africa (SSA) and for the challenge that these countries face in coping with rising numbers of patients with such diseases
We argue that in order to cope with care for HIV patients and diabetes patients, health systems in SSA need to adopt new strategies taking into account essential elements of chronic disease care
We focus on diabetes mellitus type 2 (DM2) and HIV/AIDS, because these, individually and in combination, are becoming increasingly important in SSA

Summary

Introduction

There is growing attention for chronic life-long conditions (CLLCs) in sub-Saharan Africa (SSA) and for the challenge that these countries face in coping with rising numbers of patients with such diseases. The individual management of and care for NCD has been an almost exclusively High Income Countries’ (HIC) affair until very recently; care models for diabetes mellitus and other chronic diseases were developed for these countries and included a strong emphasis on self-management and patient empowerment. These models are difficult to export to low-resource contexts, because of their focus on individual care and reliance on multidisciplinary teams and collaboration between primary and secondary health care institutions [5]. What are the factors of success? What is the experience in practice? In the last part, we discuss the possibilities of cross-fertilisation and improvement of care for diabetes and HIV chronic care in SSA

Methods

A Framework for Chronicity

Present Models of Care for Diabetes and HIV AIDS for SSA

Findings

Lessons to Improve Chronic Care