Project Lead(s): Joep van Oosterhout
In Sub-Saharan Africa, health systems designed to provide disease-specific care are poorly equipped to respond to the rapidly rising burden of non-communicable diseases (NCDs).
Simultaneously, the use of antiretroviral therapy (ART) has increased the life expectancy of people living with HIV, to such an extent that HIV is now considered a chronic condition.
These dual trends require integrated healthcare models nimble enough to meet the long-term, complex population health needs of HIV and NCD patients.
Dignitas International (DI) has developed, evaluated and adapted an innovative health model to integrate screening and treatment of HIV and priority NCDs, which include hypertension (HTN), diabetes mellitus (DM) and cervical cancer at Tisungane HIV/AIDS Clinic in Zomba, Malawi.
The project reoriented the existing organizational system within the HIV clinic and strengthened capacity to deliver integrated HIV and NCD services in a ‘one-stop’ model.
Integrated guidelines and operating procedures for the management of DM and HTN in HIV clinics were developed and provided the basis for operationalizing integrated HIV–NCD health services.
The project team developed a training curriculum based on the guidelines, with teaching models for DM, HTN and cervical cancer screening.
A total of 78 healthcare workers (HCWs), including clinicians and nurses, participated in the training sessions.
The HIV–NCD integrated service delivery pilot model ran from October 2015 to the end of March 2016, with more than 4,800 and 3,100 adult HIV patients newly screened for HTN and DM respectively. Over 630 women underwent cervical cancer screening.
DI found that shifting to a more integrated healthcare model will assist health systems to adapt to emerging public health needs.
Results of a prevalence survey in the local area showed that 24% of patients in care had HTN and 4% had DM. Within this sample, 13% of patients needed integrated drug treatment for HIV and HTN and/or DM.
A total of 7,466 adult HIV patients were screened for HTN and 681 were diagnosed with HTN. Of 4,428 patients screened for DM, 37 were diagnosed with the condition.
It is anticipated that there will be 40% fewer strokes in the group of patients on HTN treatment, and long-term reductions in renal failure and death from cardiovascular disease are also anticipated.
A total of 930 women were referred from the ART clinic for cervical cancer screening. Of those who were screened, 26 were found to have pre-cancerous lesions and eight were treated with cryotherapy, thus preventing development of cervical cancer.
Knowledge about the project will be disseminated through conferences and publications.
DI intends to scale this project to 18 sites in six districts in the South East Zone (SEZ) of Malawi over the course of three years.
A scale-up of the integrated model will include a substantial research component, to compare and assess the integrated model and to demonstrate its efficacy against the status quo of vertical, disease-specific healthcare delivery.