Published: 10 September 2021
Integrating the care of HIV, diabetes, and hypertension into a ‘one-stop clinic’ can reduce the costs for both patients and healthcare services, according to a new NIHR-funded global health research study.
The burden of non-communicable diseases (NCDs) has risen rapidly in Africa, with these diseases typically affecting younger working populations than seen in developed countries. Diabetes and hypertension alone lead to about two million deaths a year on the continent. Health care services for diabetes and hypertension, which are also often organised separately, are patchy with only about 10-20% of people with these conditions estimated to be in care.
In a new paper published in BMC Medicine, a team from the NIHR Global Health Research Group on prevention and management of non-communicable diseases and HIV-infection in Africa, (RESPOND-Africa consortium) led by The Liverpool School for Tropical Medicine (LSTM) with partners in Tanzania and Uganda, found that integrating these services with existing high-quality HIV care services has resulted in greatly improved patient outcomes and cost savings.
The RESPOND-Africa study details the socio-economic impact of installing 10 new integrated care clinics across Uganda and Tanzania, and is the first such study to report the detailed economics on real-life integrated care across all disease programmes.
LSTM’s Honorary Professor Sayoki Mfinanga, Chief Research Scientist at National Institute for Medical Research, Tanzania said: “After a year of the integrated clinics being in place, they found that integration of HIV services with diabetes and hypertension control reduces both health service and household costs. They saw a 22% reduction of the service cost across all patients with more than one condition, and health cost to patient households were kept to, on average, 12% of households’ monthly income. Therefore, this initial, explorative, non-randomised study suggests that integrated care of these chronic conditions is likely both an efficient and equitable way to address the increasing burden for the financially vulnerable patient groups with multiple conditions among Africa’s ageing populations.”
Dr Josephine Birungi, Senior Research Scientist at MRC/UVRI and LSHTM Uganda Research Unit, said: “Before integrating care for the three conditions, a patient with two or more conditions used to attend two separate clinics on different days of the week with duplication of some of the laboratory investigations. The patient therefore had to have transport fares for two appointments to the same facility, sometimes take two days off work (for those employed) not forgetting that some had to travel with the care givers too – such a huge cost to the household!”.
RESPOND-Africa is now working on a longer-term larger-scale implementation trial to compare extended integrated care packages with standard care in a cluster randomised trial to include more evidence on clinical benefits. The research teams work in partnership with patients, community groups, civil society and policy makers to ensure the research is relevant and that evidence is used to inform policy and practice.
Professor Kaushik Ramaiya, Hon. General Secretary of the East African NCD Alliance said: “The Respond-Africa partnership, which led this research, engages people living with NCDs in sharing research findings and shaping future research. This approach is fundamental to the Global Charter on Meaningful Involvement of People Living with NCDs launched by the NCD Alliance this week.”
Find out more information about the RESPOND AFRICA group and its work.