Integrated care experiences and out-of-pocket expenditures: a cross-sectional survey of adults receiving treatment for HIV and hypertension in Malawi

Moucheraud, Corrina; Hing, Matthew; Seleman, Juliet; Phiri, Khumbo; Chibwana, Florence; Kahn, Daniel; Schooley, Alan; Moses, Agnes; Hoffman, Risa M.

doi:10.1136/bmjopen-2019-032652

Cited by 10 publications

(11 citation statements)

References 48 publications

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“…A majority of the studies (n=7) had their origin/geographical focus in South Africa (SA). One study was conducted in Kenya, 22 Tanzania, 31 Uganda, 30 Malawi, 29 Northern Thailand 27 and North Carolina (USA), respectively 28 ( table 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…► A desire for an integrated care model where all their care was consolidated in one place, with one provider. ► Positive towards increased participation from HIV clinic support staff Moucheraud et al 29 Fragmented and integrated care Fragmented (non-integrated care) ► Additional costs (ie, beyond costs already incurred for ART visits), costs of transportation to refill visits and lost wages during refill visits. ► Refill location for medicines chosen primarily due to perceived lower medication costs and proximity/convenience (eg, distance to home).…”

Section: Continuity Of Care and Appointment Systemsmentioning

confidence: 99%

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Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

et al. 2021

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IntroductionAntiretroviral therapy has reduced mortality and led to longer life expectancy in people living with HIV. These patients are now at an increased risk of non-communicable diseases (NCDs). Integration of care for HIV and NCDs has become a focus of research and policy. In this article, we aim to review patient perspectives on integration of healthcare for HIV, type 2 diabetes and hypertension.MethodsThe framework for scoping reviews developed by Arksey and O'Malley and updated by Peter et al was applied for this review. The databases PubMed, Web of Science and Cochrane library were searched. Broad search terms for HIV, NCDs (specifically type 2 diabetes and hypertension) and healthcare integration were used. As the review aimed to identify definitions of patient perspectives, they were not included as an independent term in the search strategy. References of included publications were searched for relevant articles. Titles and abstracts for these papers were screened by two independent reviewers. The full texts for all the publications appearing to meet the inclusion criteria were then read to make the final literature selection.ResultsOf 5502 studies initially identified, 13 articles were included in this review, of which 11 had a geographical origin in sub-Saharan Africa. Nine articles were primarily focused on HIV/diabetes healthcare integration while four articles were focused on HIV/hypertension integration. Patient’s experiences with integrated care were reduced HIV-related stigma, reduced travel and treatment costs and a more holistic person-centred care. Prominent concerns were long waiting times at clinics and a lack of continuity of care in some clinics due to a lack of healthcare workers. Non-integrated care was perceived as time-consuming and more expensive.ConclusionPatient perspectives and experiences on integrated care for HIV, diabetes and hypertension were mostly positive. Integrated services can save resources and allow for a more personalised approach to healthcare. There is a paucity of evidence and further longitudinal and interventional evidence from a more diverse range of healthcare systems are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Continuity Of Care and Appointment Systemsmentioning

confidence: 99%

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

et al. 2021

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“…A pilot study in Tanzania and Uganda found that managing two or more conditions in a single participant was cheaper (for both the health system and the patient) than managing multiple conditions separately [62]. A study in Malawi similarly found lower out-of-pocket costs for patients in integrated care, compared to non-integrated care [63]. Intersectoral financing and/or community-based micro-financing to address both multiple determinants of health are also being explored as options to support the scale-up of integrated care [64,65].…”

Section: Integrated Service Deliverymentioning

confidence: 99%

Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa

Brault

Vermund

Aliyu

et al. 2021

IJERPH

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In Sub-Saharan Africa, communicable and other tropical infectious diseases remain major challenges apart from the continuing HIV/AIDS epidemic. Recognition and prevalence of non-communicable diseases have risen throughout Africa, and the reimagining of healthcare delivery is needed to support communities coping with not only with HIV, tuberculosis, and COVID-19, but also cancer, cardiovascular disease, diabetes, and depression. Many non-communicable diseases can be prevented or treated with low-cost interventions, yet implementation of such care has been limited in the region. In this Perspective piece, we argue that deployment of an integrated service delivery model is an urgent next step, propose a South African model for integration, and conclude with recommendations for next steps in research and implementation. An approach that is inspired by South African experience would build on existing HIV-focused infrastructure that has been developed by Ministries of Health with strong support from the U.S. President’s Emergency Response for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. An integrated chronic healthcare model holds promise to sustainably deliver infectious disease and non-communicable disease care. Integrated care will be especially critical as health systems seek to cope with the unprecedented challenges associated with COVID-19 and future pandemic threats.

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“…While patients can travel to a government clinic to obtain free medications, the additional time (including time away from work, childcare, or other responsibilities) and cost of transport may serve as a significant barrier to obtaining refills elsewhere. Previous research by our group showed that despite the costs of medications, integrated care in which medications for hypertension are purchased at the point of care does provide cost savings for people living with HIV due to the efficiencies created by avoiding the time and opportunity costs of seeking free medications elsewhere [ 24 ]. Real world and cost-modeling data have also shown that integrated care reduces costs from the health system perspective [ 25 26 ], and additional cost modeling work will be important to help inform policy around the implementation of NCD care for people with and without HIV.…”

Section: Discussionmentioning

confidence: 99%

High Rates of Uncontrolled Blood Pressure in Malawian Adults Living with HIV and Hypertension

Hoffman

Chibwana

Kahn

et al. 2021

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Background: Hypertension is among the most commonly diagnosed non-communicable diseases in Africa, and studies have demonstrated a high prevalence of hypertension among individuals with HIV. Despite high prevalence, there has been limited attention on the clinical outcomes of hypertension treatment in this population. Objective: We sought to characterize rates of and factors associated with blood pressure control over one year among individuals on antiretroviral therapy (ART) and antihypertensive medications. Methods: We performed a prospective observational cohort study at an HIV clinic in Malawi. We defined uncontrolled hypertension as a systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg at two or more follow-up visits during the year, while controlled hypertension was defined as <140 mm Hg systolic and <90 mm Hg diastolic at all visits, or at all but one visit. We calculated an antihypertensive non-adherence score based on self-report of missed doses at each visit (higher score = worse adherence) and used rank sum and chi-square tests to compare sociodemographic and clinical factors (including adherence) associated with blood pressure control over the year. results: At study entry, 158 participants (23.5%) were on antihypertensive medication; participants had a median age of 51.0 years, were 66.5% female, and had a median of 6.9 years on ART. 19.0% (n = 30) achieved blood pressure control over the year of follow-up. Self-reported non-adherence to hypertension medications was the only factor significantly associated with uncontrolled blood pressure. The average non-adherence score for those with controlled blood pressure was 0.22, and for those with uncontrolled blood pressure was 0.61 (p = 0.009). conclusions: Adults living with HIV and hypertension in our cohort had low rates of blood pressure control over one year associated with self-reported non-adherence to antihypertensive medications. Given the high prevalence and incidence of hypertension, interventions to improve blood pressure control are needed to prevent associated long-term cardio-and cerebrovascular morbidity and mortality.

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Integrated care experiences and out-of-pocket expenditures: a cross-sectional survey of adults receiving treatment for HIV and hypertension in Malawi

Cited by 10 publications

References 48 publications

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa

High Rates of Uncontrolled Blood Pressure in Malawian Adults Living with HIV and Hypertension

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