Towards evidence‐based integration of services for HIV, non‐communicable diseases and substance use: insights from modelling

Dowdy, David W.; Powers, Kimberly A.; Hallett, Timothy B.

doi:10.1002/jia2.25525

Cited by 6 publications

(7 citation statements)

References 17 publications

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“…Across low- and middle-income countries (LMIC), integrating the screening and treatment of hypertension (HTN) into existing HIV clinical care is widely recommended [ 1 – 5 ], yet its implementation remains suboptimal [ 6 – 8 ]. Integrated HTN/HIV care involves provision of both services for HTN and HIV in synchronized visits to the same clinic.…”

Section: Introductionmentioning

confidence: 99%

Improved hypertension control at six months using an adapted WHO HEARTS-based implementation strategy at a large urban HIV clinic in Uganda

Martín

Semitala

Kimera

et al. 2022

BMC Health Serv Res

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Objectives To adapt a World Health Organization HEARTS-based implementation strategy for hypertension (HTN) control at a large urban HIV clinic in Uganda and determine six-month HTN and HIV outcomes among a cohort of adult persons living with HIV (PLHIV). Methods Our implementation strategy included six elements: health education, medication adherence, and lifestyle counseling; routine HTN screening; task shifting of HTN treatment; evidence-based HTN treatment protocol; consistent supply of HTN medicines free to patients; and inclusion of HTN-specific monitoring and evaluation tools. We conducted a pre-post study from October 2019 to March 2020 to determine the effect of this strategy on HTN and HIV outcomes at baseline and six months. Our cohort comprised adult PLHIV diagnosed with HTN who made at least one clinic visit within two months prior to study onset. Findings We enrolled 1,015 hypertensive PLHIV. The mean age was 50.1 ± 9.5 years and 62.6% were female. HTN outcomes improved between baseline and six months: mean systolic BP (154.3 ± 20.0 to 132.3 ± 13.8 mmHg, p < 0.001); mean diastolic BP (97.7 ± 13.1 to 85.3 ± 9.5 mmHg, p < 0.001) and proportion of patients with controlled HTN (9.3% to 74.1%, p < 0.001). The HTN care cascade also improved: treatment initiation (13.4% to 100%), retention in care (16.2% to 98.5%), monitoring (16.2% to 98.5%), and BP control among those initiated on HTN treatment (2.2% to 75.2%). HIV cascade steps remained high (> 95% at baseline and six months) and viral suppression was unchanged (98.7% to 99.2%, p = 0.712). Taking ART for more than two years and HIV viral suppression were independent predictors of HTN control at six months. Conclusions A HEARTS-based implementation strategy at a large, urban HIV center facilitates integration of HTN and HIV care and improves HTN outcomes while sustaining HIV control. Further implementation research is needed to study HTN/HIV integration in varied clinical settings among diverse populations.

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Section: Introductionmentioning

confidence: 99%

Improved hypertension control at six months using an adapted WHO HEARTS-based implementation strategy at a large urban HIV clinic in Uganda

Martín

Semitala

Kimera

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

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“…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 ].…”

Section: Dsd For Hypertension: What Would It Take?mentioning

confidence: 99%

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

et al. 2021

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Expanding hypertension services in low- and middle-income countries requires efficient and effective service delivery approaches that meet the needs and expectations of people living with hypertension within the resource constraints of existing national health systems. Ideally, a hypertension program will extend treatment coverage while maintaining service quality, maximizing efficient resource utilization and improving clinical outcomes. In this article, we discuss lessons learned from HIV differentiated service delivery initiatives, and make the case that the same approach should be adopted for hypertension programs.

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“…Integration of health service delivery is a health reform recommended for achieving ambitious targets set for controlling the rising burden of NCDs (including mental health disorders), and comorbidity of other disease in people living with long-term communicable disease, like HIV and TB [ 7 , 11 – 14 ]. Against a background of constraints of resources, and the rise of NCDs and other disease priorities (such as HIV, TB and reproductive, maternal, child and adolescent health), integrated delivery of NCDs at primary care level is potentially a valuable tool in LMICs [ 11 ]. This is because in LMICs, underfunded health care systems may be further weakened by fragmented, uncoordinated services that risk being overburdened by the burgeoning NCD epidemic [ 8 , 11 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Against a background of constraints of resources, and the rise of NCDs and other disease priorities (such as HIV, TB and reproductive, maternal, child and adolescent health), integrated delivery of NCDs at primary care level is potentially a valuable tool in LMICs [ 11 ]. This is because in LMICs, underfunded health care systems may be further weakened by fragmented, uncoordinated services that risk being overburdened by the burgeoning NCD epidemic [ 8 , 11 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…While the aim is for integrated services to create synergistic use of the available resources and reducing duplication, reconfiguration or reform of health services may face barriers [ 8 , 13 , 15 , 16 ]. Challenges associated with integrating NCD with other PHC services, include problems related to supply chain, human resources, referral systems, staff attitudes and skills, stigmatization, health information systems, and monitoring and evaluation [ 11 , 14 ]. There is no standard definition of integration—integration may take different forms and be influenced by different country level factors, including the country’s disease burden and health system configuration [ 8 , 11 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Implementation considerations for non-communicable disease-related integration in primary health care: a rapid review of qualitative evidence

Leon

2023

BMC Health Serv Res

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Background Integrated delivery of primary health care (PHC) services is a health reform recommended for achieving ambitious targets of the Sustainable Development Goals and Universal Health Coverage, responding to growing challenges of managing non-communicable and multimorbidity. However, more evidence is needed on effective implementation of PHC integration in different country settings. Objective This rapid review synthesized qualitative evidence on implementation factors affecting integration of non-communicable disease (NCD) into PHC, from the perspective of implementers. The review contributes evidence to inform the World Health Organizations’ guidance on integration of NCD control and prevention to strengthen health systems. Method The review was guided by standard methods for conducting rapid systematic reviews. Data analysis was guided by the SURE and WHO health system building blocks frameworks. We used Confidence in the Evidence of Reviews of Qualitative Research (GRADE-CERQual) to assess the confidence of the main findings. Results The review identified 81 records eligible for inclusion, from 595 records screened. We sampled 20 studies for analysis (including 3 from expert recommendations). Studies covered a wide range of countries (27 countries from 6 continents), the majority from low-and middle-income countries (LMICs), with a diverse set of NCD-related PHC integration combinations and implementation strategies. The main findings were categorised into three overarching themes and several sub-themes. These are, A: Policy alignment and governance, B: Health systems readiness, intervention compatibility and leadership, and C: Human resource management, development, and support. The three overarching findings were assessed as each having a moderate level of confidence. Conclusion The review findings present insights on how health workers responses may be shaped by the complex interaction of individual, social, and organizational factors that may be specific to the context of the intervention, the importance of cross-cutting influences such as policy alignment, supportive leadership and health systems constraints, knowledge that can inform the development of future implementation strategies and implementation research.

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Towards evidence‐based integration of services for HIV, non‐communicable diseases and substance use: insights from modelling

Cited by 6 publications

References 17 publications

Improved hypertension control at six months using an adapted WHO HEARTS-based implementation strategy at a large urban HIV clinic in Uganda

Improved hypertension control at six months using an adapted WHO HEARTS-based implementation strategy at a large urban HIV clinic in Uganda

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

Implementation considerations for non-communicable disease-related integration in primary health care: a rapid review of qualitative evidence

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