Evaluation of an integrated HIV and hypertension management model in rural South Africa: a mixed methods approach

Abstract

Background: A summary of Soter Ameh's PhD thesis titled, 'An integrated HIV and hypertension management model in rural South Africa: A mixed methods approach' is presented here. In responding to the dual high burden of non-communicable diseases (NCDs) and HIV in South Africa, the national government initiated an integrated chronic disease management (ICDM) model in health facilities as a pilot programme. The aim of the ICDM model is to leverage the successes of the innovative HIV treatment programme for NCDs to improve the quality of care and health outcomes of adult patients. Objectives: The specific objectives of this study were to: (1) determine the quality of care provided in the integrated model in 2013, (2) describe patients' and operational managers' perceptions of quality of care in the integrated model in 2013, and (3) assess effectiveness of the integrated model in controlling CD4 counts (>350 cells/mm3) and blood pressure (<140/ 90 mmHg) of patients from 2011 to 2013. Methods: A combination of quantitative and qualitative methods was used to assess and describe the quality of care in the model. Effectiveness of the model in controlling patients' blood pressure (BP) and CD4 counts was assessed in selected PHC facilities in the Bushbuckridge municipality in Mpumalanga province, South Africa. Results: The findings showed the suboptimal quality of care in five of the eight priority dimensions of care used as leverage for the NCD programme. The ICDM model had a small but significant effect on BP control for hypertension patients receiving treatment. Conclusions: The HIV programme needs to be more extensively leveraged for hypertension treatment to achieve an optimal BP control in the study area. These findings could have policy relevance for low-and middle-income countries currently undertaking proof of concept studies to demonstrate the feasibility of implementing an integrated chronic disease care model.

Care and management of a double burden of chronic diseases: Experiences of patients and perceptions of their healthcare providers

“…This was reiterated in the rural South African study where all patients with chronic diseases were managed in the same clinics with no separation of patients or consultation rooms [11]. Patients reported greater satisfaction and their CD4 counts and blood pressures were better controlled [12]. Integrated services thereby increased anonymity, reduced stigma and encourage their utilisation.…”

“…Changes are required in the healthcare system at the levels of policy, organisation, training and facilities. The major challenges for the delivery of integrated care are the shortage of healthcare providers with the appropriate training and skills, and an already overburdened workforce [21], as evident in South Africa from this and other studies [11,12,22,23].…”

“…Considering that the risk of NCDs has emerged as an important consideration in HIV-infected individuals and is likely to increase as they live longer [ 9 ], greater attention needs to be paid to the care of PLWHIV and NCD comorbidities. Seeing that the requirements for effective decentralised provision of therapy for HIV infection and for NCDs are closely aligned [ 10 ], the South African National Department of Health initiated the Integrated Chronic Disease Management Model in 2011 [ 11 , 12 ]. This model incorporates a diagonal approach that integrates the vertical HIV programme with the horizontal general healthcare system [ 13 , 14 ].…”

Hypertension among people living with HIV/AIDS in Cameroon: A cross-sectional analysis from Central Africa International Epidemiology Databases to Evaluate AIDS

“…Experiences from South Africa and Uganda where the government initiated an integrated chronic disease management model in health facilities confirmed that the model may have a significant effect on BP control [36,37]. Findings from these studies suggest that HIV programmes shall be more extensively leveraged for hypertension treatment to achieve an optimal BP control in Sub Saharan Africa.…”

Integrating HIV, diabetes and hypertension services in Africa: study protocol for a cluster randomised trial in Tanzania and Uganda

“…However, the study size was just 1432 patients, it was retrospective and done at a single site. 8 Limited evidence is also available from South Africa, 9 10 but the health system here is much stronger and findings difficult to generalise to other parts of sub-Saharan Africa.…”