Recommendations for the use of mathematical modelling to support decision‐making on integration of non‐communicable diseases into HIV care

Abstract

Introduction: Integrating services for non-communicable diseases (NCDs) into existing primary care platforms such as HIV programmes has been recommended as a way of strengthening health systems, reducing redundancies and leveraging existing systems to rapidly scale-up underdeveloped programmes. Mathematical modelling provides a powerful tool to address questions around priorities, optimization and implementation of such programmes. In this study, we examine the case for NCD-HIV integration, use Kenya as a case-study to highlight how modelling has supported wider policy formulation and decision-making in healthcare and to collate stakeholders' recommendations on use of models for NCD-HIV integration decisionmaking. Discussion: Across Africa, NCDs are increasingly posing challenges for health systems, which historically focused on the care of acute and infectious conditions. Pilot programmes using integrated care services have generated advantages for both provider and user, been cost-effective, practical and achieve rapid coverage scale-up. The shared chronic nature of NCDs and HIV means that many operational approaches and infrastructure developed for HIV programmes apply to NCDs, suggesting this to be a cost-effective and sustainable policy option for countries with large HIV programmes and small, un-resourced NCD programmes. However, the vertical nature of current disease programmes, policy financing and operations operate as barriers to NCD-HIV integration. Modelling has successfully been used to inform health decision-making across a number of disease areas and in a number of ways. Examples from Kenya include (i) estimating current and future disease burden to set priorities for public health interventions, (ii) forecasting the requisite investments by government, (iii) comparing the impact of different integration approaches, (iv) performing cost-benefit analysis for integration and (v) evaluating health system capacity needs. Conclusions: Modelling can and should play an integral part in the decision-making processes for health in general and NCD-HIV integration specifically. It is especially useful where little data is available. The successful use of modelling to inform decision-making will depend on several factors including policy makers' comfort with and understanding of models and their uncertainties, modellers understanding of national priorities, funding opportunities and building local modelling capacity to ensure sustainability.

Tackling syndemics by integrating infectious and noncommunicable diseases in health systems of low- and middle-income countries: A narrative systematic review

“…For tuberculosis and diabetes integration there were few studies in low-income countries (LICs) and limited literature in middle income countries (MICs)–only 56 across the search period. This suggests that countries with greater resources have been relatively more proactive to integrate care for these conditions, whereas early LIC developments would appear to have focused on HIV (for which many examples exist), due to greater disease prevalence, resources, and–crucially—donor support to foster integration [ 9 – 13 , 127 , 128 ]. The onset of COVID-19 produced a surge of integration of COVID-19 and cardiometabolic disease, and COVID-19 and diabetes or tuberculosis, comprising almost half of all studies reviewed.…”

Prevalence and factors associated with hypertension among peoples living with HIV in East Africa, a systematic review and meta-analysis

“…Subgroup analysis by publication year showed no significant difference between studies published between (2014 and 2019) and those published between (2020 and 2022). In areas where the prevalence of hypertension is higher among PLHIV, integrating hypertension services into routine HIV care by capitalizing the preexisting health system and following multidisciplinary approaches will be key [ 45 ]. It is also important to recognize that the trend in the prevalence of hypertension might vary over time in different countries as ART exposure, severity of the disease in PLHIV and access to healthcare service changes.…”

Patient-Centered, Sustainable Hypertension Care: The Case for Adopting a Differentiated Service Delivery Model for Hypertension Services in Low- and Middle-Income Countries

“…The design of additional studies will depend on evidence gaps identified. These can include mixed methods implementation studies to document quality, coverage, impact, and acceptability, qualitative explorations of user and health care worker experiences, time-motion studies to estimate health workforce need and to identify areas for increasing efficiencies, and costing and economic analyses, including mathematical models to assess cost-effectiveness or help in budget planning [ 33 34 ].…”