Lessons Learnt from HIV and Noncommunicable Disease Healthcare Integration in Sub-Saharan Africa

Abstract

In sub-Saharan Africa (SSA), a rising burden of noncommunicable diseases (NCDs) coexists with a persistent high burden of human immunodeficiency virus (HIV). Integrating care for chronic conditions is potentially beneficial, but the optimal approach remains unclear. By use of a narrative review of 14 recent case studies from different SSA countries, examples of NCD and HIV healthcare integration were described. Case studies were categorized into three models: integrating NCD care into existing HIV care (n = 8), integrating HIV care into existing NCD care (n = 2), and simultaneous implementation of HIV and NCD services (n = 4). Facilitators include staff and patient education, while barriers encompass the lack of guidelines and inadequate infrastructure. Providers, patients, and policymakers support integrated care but note several challenges. Available health economics data suggest cost-effectiveness in the long run. Concluding, NCD and HIV healthcare integration in SSA was deemed feasible with models of service integration related to the implementation context.

Keywords: Africa; human immunodeficiency virus; integrated care; low- and middle-income countries; noncommunicable diseases.

Figure 1

Lessons learnt from HIV and noncommunicable disease healthcare integration in sub-Saharan Africa. Graphical overview of the narrative review with the main findings. Several facilitators and barriers, combined with the perspective of providers, patients, and policymakers resulted in the recommendation for the development of future healthcare integration programmes in sub-Saharan Africa (SSA). The goal of successful integrated health is to detect novel cases and improve patient adherence to reduce the NCD burden and overall health in SSA. HIV = human immunodeficiency virus; NCD = noncommunicable disease.