Non‐communicable diseases and HIV care and treatment: models of integrated service delivery

• Published in: Tropical medicine & international health 2017-08, Vol.22 (8), p.926-937
• Main Authors: Duffy, Malia, Ojikutu, Bisola, Andrian, Soa, Sohng, Elaine, Minior, Thomas, Hirschhorn, Lisa R.
• Format: Article
• Language: English
• Subjects: Adapters; Chronic Disease - therapy; Comorbidity; Delivery of Health Care, Integrated; Developing Countries; enfermedades no transmisibles; entrega de atención sanitaria; Health care; Health care delivery; healthcare delivery; HIV; HIV Infections - complications; HIV services; Human immunodeficiency virus; Human resources; Humans; Income; integración; Integration; intégration; Literature reviews; Low income groups; maladies non transmissibles; modelos de atención para el VIH; models of HIV care; Models, Theoretical; modèles de soins VIH; Morbidity; non‐communicable diseases; Patients; prestation des soins de santé; Primary Health Care; services VIH; servicios de VIH; Viruses
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.12901

Objectives Non‐communicable diseases (NCD) are a growing cause of morbidity in low‐income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. We describe models of NCD and HIV integration, challenges and lessons learned. Methods A literature review of published articles on integrated NCD and HIV programs in low‐income countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration. Results Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models. Conclusions Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. Operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled‐up by managers and policymakers seeking to address all the chronic care needs of their patients. Objectifs Les maladies non transmissibles (MNT) sont une cause croissante de morbidité dans les pays à faible revenu, y compris chez les personnes vivant avec le virus de l'immunodéficience humaine (VIH). L'intégration des services de lutte contre les MNT et le VIH peut s'appuyer sur l'expérience acquise dans les modèles de soins chroniques à partir des programmes de lutte contre le VIH. Nous décrivons des modèles d'intégration entre MNT et VIH, les défis et de leçons apprises. Méthodes Revue littéraire des articles sur les programmes intégrés de lutte contre les MNT et le VIH dans les pays à faible revenu et interviews d'informations clés avec des leaders des programmes intégrés de lutte contre les MNT et le VIH. L'information a été synthétisée pour identifier les modèles d'intégration de la prestation des services de lutte contre