Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study

被引：27

作者：

Birungi, Josephine ^{[1
,2
]}

Kivuyo, Sokoine ^{[3
]}

Garrib, Anupam ^{[4
]}

Mugenyi, Levicatus ^{[2
]}

Mutungi, Gerald ^{[5
]}

Namakoola, Ivan ^{[1
]}

Mghamba, Janneth ^{[6
]}

Ramaiya, Kaushik ^{[7
]}

Wang, Duolao ^{[4
]}

Maongezi, Sarah ^{[6
]}

Musinguzi, Joshua ^{[8
]}

Mugisha, Kenneth ^{[2
]}

Etukoit, Bernard M. ^{[2
]}

Kakande, Ayoub ^{[1
]}

Niessen, Louis Wihelmus ^{[9
]}

Okebe, Joseph ^{[9
]}

Shiri, Tinevimbo ^{[9
]}

Meshack, Shimwela ^{[10
]}

Lutale, Janet ^{[11
]}

Gill, Geoff ^{[12
]}

Sewankambo, Nelson ^{[13
]}

Smith, Peter G. ^{[14
]}

Nyirenda, Moffat J. ^{[1
,15
,16
,17
]}

Mfinanga, Sayoki Godfrey ^{[3
,9
]}

Jaffar, Shabbar ^{[9
]}

机构：

[1] MRC UVRI & LSHTM Uganda Res Unit, Entebbe, Uganda

[2] AIDS Support Org, Kampala, Uganda

[3] Muhimbili Res Ctr, Muhimbili Med Res Ctr, Natl Inst Med Res, Dar Es Salaam, Tanzania

[4] Univ Liverpool Liverpool Sch Trop Med, Dept Clin Sci, Liverpool, Merseyside, England

[5] Minist Hlth, Noncommunicable Dis Control Programme, Kampala, Uganda

[6] Minist Hlth Community Dev Gender Elderly & Childr, Dodoma, Tanzania

[7] Shree Hindu Mandal Hosp, Dar Es Salaam, Tanzania

[8] Minist Hlth, AIDS Control Programme, Kampala, Uganda

[9] Univ Liverpool Liverpool Sch Trop Med, Dept Int Publ Hlth, Liverpool, Merseyside, England

[10] Amana Reg Referral Hosp, Dar Es Salaam, Tanzania

[11] Muhimbili Univ Hlth & Allied Sci, Dar Es Salaam, Tanzania

[12] Univ Liverpool Liverpool Sch Trop Med, Liverpool, Merseyside, England

[13] Makerere Univ, Coll Hlth Sci, Kampala, Uganda

[14] London Sch Hyg & Trop Med, MRC Int Stat & Epidemiol Grp, London, England

[15] Malawi Epidemiol & Intervent Res Unit MEIRU, Lilongwe, Malawi

[16] Malawi Epidemiol & Intervent Res Unit MEIRU, Karonga, Malawi

[17] London Sch Hyg & Trop Med, Fac Epidemiol & Publ Hlth, London, England

来源：

BMJ OPEN | 2021年 / 11卷 / 11期

关键词：

health policy; hypertension; diabetes & endocrinology; HIV & AIDS; PRIMARY-CARE; PREVALENCE; RETENTION; DISEASES; MODELS;

D O I：

10.1136/bmjopen-2021-053412

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background HIV, diabetes and hypertension have a high disease burden in sub-Saharan Africa. Healthcare is organised in separate clinics, which may be inefficient. In a cohort study, we evaluated integrated management of these conditions from a single chronic care clinic. Objectives To determined the feasibility and acceptability of integrated management of chronic conditions in terms of retention in care and clinical indicators. Design and setting Prospective cohort study comprising patients attending 10 health facilities offering primary care in Dar es Salaam and Kampala. Intervention Clinics within health facilities were set up to provide integrated care. Patients with either HIV, diabetes or hypertension had the same waiting areas, the same pharmacy, were seen by the same clinical staff, had similar provision of adherence counselling and tracking if they failed to attend appointments. Primary outcome measures Retention in care, plasma viral load. Findings Between 5 August 2018 and 21 May 2019, 2640 patients were screened of whom 2273 (86%) were enrolled into integrated care (832 with HIV infection, 313 with diabetes, 546 with hypertension and 582 with multiple conditions). They were followed up to 30 January 2020. Overall, 1615 (71.1%)/2273 were female and 1689 (74.5%)/2266 had been in care for 6 months or more. The proportions of people retained in care were 686/832 (82.5%, 95% CI: 79.9% to 85.1%) among those with HIV infection, 266/313 (85.0%, 95% CI: 81.1% to 89.0%) among those with diabetes, 430/546 (78.8%, 95% CI: 75.4% to 82.3%) among those with hypertension and 529/582 (90.9%, 95% CI: 88.6 to 93.3) among those with multimorbidity. Among those with HIV infection, the proportion with plasma viral load <100 copies/mL was 423(88.5%)/478. Conclusion Integrated management of chronic diseases is a feasible strategy for the control of HIV, diabetes and hypertension in Africa and needs evaluation in a comparative study.

引用

页数：10

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