Gerald Mutungi, Ivan Arinaitwe and Mina Nakawuka from the AIDS Control Program at the Ministry of Health in Uganda write:
Uganda has embraced the World Health Organization’s updated framework, which now includes chronic illnesses, such as non-communicable diseases (NCDs), in its categorization of Rapid Initiation of Antiretroviral Therapy. The country has undertaken a comprehensive review of its 2022 consolidated guidelines, integrating all these changes into the updated version.
This revision has expanded the eligibility criteria for DSD, emphasizing client-centred approaches.
To address the challenge of individuals with co-morbidities having to access HIV services separately from other essential healthcare services, Uganda is currently developing integration guidelines and standard operating procedures. These guidelines aim to seamlessly incorporate services, such as pre-exposure prophylaxis, family planning, NCD management and tuberculosis (TB) services, into community pharmacies, transforming them into holistic one-stop centres.
This integrated approach ensures that all eligible individuals with co-morbidities receive comprehensive care without having to visit multiple healthcare facilities. It also aims to address the unmet need for family planning, enhance TB case identification, improve access to PrEP services, and enhance screening and management of NCDs. Through these initiatives, Uganda is taking significant strides towards improving healthcare delivery and promoting client-centredness across its healthcare system.
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We spoke with Noel Kasomekera, Non-Communicable Disease Technical Assistant in Malawi’s Ministry of Health. The ministry, with support from Partners in Health (PIH), provides comprehensive, integrated healthcare and social support in rural Neno District and beyond.
Noel, please can you explain how the integrated chronic care model implemented by PIH works?
In Neno District, we work through a one-stop-shop model. The overall objective is to leverage the HIV service platform to improve non-communicable disease screening, treatment, care and follow up.
In the 14 facilities in the district, services for several chronic diseases – most commonly HIV, hypertension and diabetes – are provided in one chronic disease clinic. Screening and referral of clients encompasses HIV, tuberculosis, hypertension, diabetes, family planning and nutrition. In addition, we support routine bi-weekly scheduled clinical visits to all 14 health facilities.
What do clients think of this integrated model?
Clients often highlight the advantages of having one appointment for all conditions. This approach can also help reduce stigma. As one client explained: “When we are accessing care at this clinic, we do not hear any rumours outside that disgrace us... we just come here and receive our drugs [and] then off we go, we don’t hear any hearsay.”
What are other key takeaways and lessons learnt from implementing this model?
We conducted a prospective cohort study, which showed that integrating screening and treatment for chronic health conditions into Malawi’s HIV service delivery platform was financially feasible and associated with several positive clinical outcomes. Annualized total cost per client was reduced from USD 317 to USD 260 per capita. Over a 12-month period, client retention in the model was 80%, with 81% of clients living with HIV achieving viral suppression during the first year. The rate of controlled hypertension increased from 18% to 57% in their first year of treatment, and measures of controlled blood pressure, asthma severity and seizure frequency improved.
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