Integrating care for non-communicable diseases into routine HIV services: key considerations for policy design in sub-Saharan Africa
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Date
2020
Authors
Kintu, Alexander
Sando, David
Okello, Samson
Mutungi, Gerald
Guwatudde, David
Menzies, Nicolas A.
Danaei, Goodarz
Verguet, Stephane
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of the International AIDS Society
Abstract
There is great interest for integrating care for non-communicable diseases (NCDs) into routine HIV services in
sub-Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system
approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the
general population. We summarize opportunities and challenges related to leveraging HIV treatment platforms to address
NCDs among PLHIV. We emphasize key considerations that can guide integrated care in SSA and point to possible interventions for implementation.
Discussion: Integrating care offers an opportunity for effective delivery of NCD services to PLHIV, but may be viewed to unfairly
ignore the larger number of NCD cases in the general population. Integration can also help maintain the substantial health and
economic benefits that have been achieved by the global HIV/AIDS response. Implementing interventions for integrated care will
require assessing the prevalence of common NCDs among PLHIV, which can be achieved via increased screening during routine
HIV care. Successful integration will also necessitate earmarking funds for NCD interventions in national budgets.
Conclusions: An expanded agenda for addressing HIV-NCD comorbidities in SSA may require adding selected NCDs to conditions that are routinely monitored in PLHIV. Attention should be given to mitigating potential tradeoffs in the quality of HIV
services that may result from the extra responsibilities borne by HIV health workers. Integrated care will more likely be effective in the context of concurrent health system reforms that address NCDs in the general population, and with synergies with
other HIV investments that have been used to strengthen health systems.
Description
Keywords
HIV/AIDS, Non-communicable diseases, Antiretroviral therapy, Integrated care, Sub-Saharan Africa
Citation
Kintu, A., Sando, D., Okello, S., Mutungi, G., Guwatudde, D., Menzies, NA, ... & Verguet, S. (2020). Integrating care for non‐communicable diseases into routine HIV services: key considerations for policy design in sub‐Saharan Africa. Journal of the International AIDS Society , 23 , e25508. https://doi.org/10.1002/jia2.25508