Patient outcomes in integrated HIV and non-communicable disease models of care: a scoping review

Abstract

Background High rates of non-communicable diseases (NCD) among people living with human immunodeficiency virus (HIV) have been reported in high HIV burden, low-resource settings. The growing dual burden of HIV and NCD epidemics has necessitated introduction of integrated models of HIV and NCD care in order to leverage existing HIV care infrastructure for NCDs. There is a paucity of evidence on the effects of integrated care on long-term patient outcomes. We sought to review literature that described effects of integration on long-term patient outcomes. Methods We reviewed literature published between 01 Jan 2000 to 25 September 2019, that described long-term patient outcomes in HIV and NCD integrated models of care in order to understand the effects of integration on long-term patient outcomes. Relevant literature was searched in PubMed, Scopus, EBSCOhost and Web of Science. A manual search of abstracts in the International AIDS Society and the Journal of Acquired Immunodeficiency Syndrome was also conducted. Results One thousand six hundred and sixty articles were identified, 31 of which were read in full, with 11 meeting eligibility criteria. Patient outcomes in four models of integrated care were identified: (i) integration of NCD screening and treatment services into established HIV centres; (ii) integration of HIV screening and treatment services into established NCD centres; (iii) simultaneous integration of HIV and NCD services at health facilities; and (iv) integrated HIV and NCD care specifically for multi-morbid patients. Studies reported high rates of control of HIV and NCD across the various models of integrated care. However, majority of studies lacked comparator groups required to ascertain non-inferiority of integrated care over non-integrated care. Conclusions There is limited evidence on the effect of integrated HIV and NCD models of care on long-term patient outcomes especially in low-resource, high-burden settings. Randomized clinical trials with clearly defined comparator groups and standardized measures of HIV and NCD outcomes are needed to demonstrate non-inferiority of integrated against non-integrated care.