Lessons Learnt from HIV and Noncommunicable Disease Healthcare Integration in Sub-Saharan Africa

Jessica S van der Mannen; Martin Heine; Samanta T Lalla-Edward; Dike B Ojji; Ana O Mocumbi; Kerstin Klipstein-Grobusch

doi:10.5334/gh.1370

Lessons Learnt from HIV and Noncommunicable Disease Healthcare Integration in Sub-Saharan Africa

Glob Heart. 2024 Nov 12;19(1):85. doi: 10.5334/gh.1370. eCollection 2024.

Authors

Jessica S van der Mannen^{1

2}, Martin Heine^{1

3}, Samanta T Lalla-Edward⁴, Dike B Ojji⁵, Ana O Mocumbi^{6

7}, Kerstin Klipstein-Grobusch^{1

8}

Affiliations

¹ Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
² Division of Biology of Disease, Department of Biomedical Sciences, Faculty of Medicine, Utrecht University, Utrecht, the Netherlands.
³ Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁴ Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵ Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Nigeria.
⁶ Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique.
⁷ Instituto Nacional de Saúde, Marracuene, Moçambique.
⁸ Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

In sub-Saharan Africa (SSA), a rising burden of noncommunicable diseases (NCDs) coexists with a persistent high burden of human immunodeficiency virus (HIV). Integrating care for chronic conditions is potentially beneficial, but the optimal approach remains unclear. By use of a narrative review of 14 recent case studies from different SSA countries, examples of NCD and HIV healthcare integration were described. Case studies were categorized into three models: integrating NCD care into existing HIV care (n = 8), integrating HIV care into existing NCD care (n = 2), and simultaneous implementation of HIV and NCD services (n = 4). Facilitators include staff and patient education, while barriers encompass the lack of guidelines and inadequate infrastructure. Providers, patients, and policymakers support integrated care but note several challenges. Available health economics data suggest cost-effectiveness in the long run. Concluding, NCD and HIV healthcare integration in SSA was deemed feasible with models of service integration related to the implementation context.

Keywords: Africa; human immunodeficiency virus; integrated care; low- and middle-income countries; noncommunicable diseases.

Publication types

Review

MeSH terms

Africa South of the Sahara / epidemiology
Delivery of Health Care, Integrated* / organization & administration
HIV Infections* / epidemiology
HIV Infections* / therapy
Humans
Noncommunicable Diseases* / epidemiology
Noncommunicable Diseases* / therapy

Grants and funding

KKG, STL-E, and MH have been supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number UG3HL156388 and Fogarty International Center (FIC).