HIV, Tuberculosis, and Noncommunicable Diseases

Abstract

Unprecedented investments in health systems low- and middle-income countries (LMICs) have resulted in more than eight million individuals on antiretroviral therapy (ART). Such individuals experience dramatically increased survival, but are increasingly at risk of developing common non-communicable diseases (NCDs). Integrating clinical care for HIV, other infectious diseases, and NCDs could make health services more effective and provide greater value. Cost-effectiveness analysis is a method to evaluate the clinical benefits and costs associated with different healthcare interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as one example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as two examples of NCDs for which integrating care with HIV services could offer excellent value. Direct evidence of the benefits of integrated services generally remains scarce; however, data suggest that improved effectiveness and reduced costs may be attained by integrating additional services with existing HIV clinical care. Further investigation into clinical outcomes and costs of care for NCDs among people living with HIV (PLHIV) in LMICs will help to prioritize specific healthcare services by contributing to an understanding of the affordability and implementation of an integrated approach.

Developing and implementing national health identifiers in resource limited countries: why, what, who, when and how?

“…PLHIV will therefore increasingly need to use non-HIV services, especially in countries with successful HIV responses. To monitor and evaluate the HIV-response in these countries, the use, cost, outcome and impact of NCDs’ services used by PLHIV will also need to be tracked, especially as integrated HIV and non-HIV services are likely to be more cost-effective [14]. Such integration can contribute to the development of services for other chronic conditions in resource limited countries, especially as NCDs are an important cause of morbidity and mortality in their own right [15].…”

Noncommunicable Diseases In East Africa: Assessing The Gaps In Care And Identifying Opportunities For Improvement

“…35 While some efforts to integrate primary care within existing HIV infrastructure have shown potentially unintended consequences (longer wait times, increased cost of training and decreased efficacy of staff managing multiple conditions), the benefits of expanding NCD co-management among PLHWA may prove to be similarly cost-effective to the HIV/TB model in the long run. 36 Conversely, the adoption of innovative approaches to addressing HIV has the potential to revolutionize the expansion of NCD public health efforts across the wider population. Voluntary Counseling and Testing Programs for HIV created an infrastructure for opportunistic screening of patients presenting to health facilities.…”

Observational Research on NCDs in HIV-Positive Populations

“…Examples include developing and evaluating thresholds for intervening on metabolic abnormalities, strategies for modifying ART regimens to prevent alcohol-associated liver disease, adjuvant therapies for the treatment of HIV-associated nephropathy, and strategies for integrated service delivery on a wide range of NCDs. 15,17,18,48 However, realizing this potential requires that diagnostic tests, laboratory monitoring, and medications for treating both HIV and NCDs be available in clinics, and that their indications and use be reliably captured by data systems.…”

“…70,71 Such integration to date has been limited in SSA but may accelerate. 6,43,48,72 Further, in settings such as South Africa, with unique patient identifiers and electronic medical records, linkage of regional pharmacy or hospital data with HIV cohort data may provide powerful supplemental data.…”