Transforming healthcare in sub-Saharan Africa
Sub-Saharan Africa faces another health crisis caused by the increasing prevalence of chronic diseases such as diabetes and hypertension. The toll of these conditions alone claims nearly two million lives annually, further compounded by the persistent high burden of HIV. HIV care in the region has traditionally been provided through dedicated clinics, segregating patients from those with other conditions. Many primary healthcare facilities lack on-the-day services for diabetes and hypertension, necessitating care from higher-level facilities.
Integrating diabetes and hypertension management with that of HIV
The EU-funded INTE-AFRICA project proposed to revolutionise healthcare delivery by integrating the management of HIV with that of diabetes and hypertension. All three conditions require lifelong care, and cases with more than one chronic condition are increasing. “The aim of our study was to determine whether integrated management of HIV, diabetes, and hypertension from a single clinic could improve care overall,” explains project coordinator Shabbar Jaffar. The project conducted a pragmatic cluster-randomised trial in Uganda and Tanzania involving 32 health facilities and over seven thousand participants. Over a 12-month period, participants with HIV, diabetes or hypertension received integrated care in a single clinic, sharing resources such as healthcare workers, pharmacies, medical records and laboratory services. In the standard care group, these services were delivered vertically for each condition.
Enhanced detection and cost-effective management of chronic conditions
The study showed that in sub-Saharan Africa, integrated services could achieve a high standard of care for people with diabetes or hypertension without adversely affecting outcomes for people with HIV. Moreover, integrating health services for the management of all three conditions was more cost-effective compared with standard vertical care and offered valuable education. The trial’s conclusion demonstrated that an unprecedented proportion of patients with these conditions in sub-Saharan Africa now remained alive and retained in care. “This has the potential to transform how healthcare is delivered in sub-Saharan Africa,” emphasises Jaffar.
Shaping future health policies in Africa
As the burden of non-communicable conditions rises in sub–Saharan Africa and more people require care for multiple conditions, integrated management is likely to be an essential approach for the continent. INTE-AFRICA provided clear evidence for policy makers that integrated care for HIV, diabetes and hypertension is not only feasible but also economical. This groundbreaking initiative extends beyond its immediate impact, serving as a proof-of-concept for integrated management globally. The findings are expected to shape future health policies in Africa and inform research and clinical practices worldwide. The integration of HIV care into broader healthcare programmes is also poised to diminish the social stigma surrounding the condition. Despite the challenges encountered during the organisation of healthcare in Africa's low-resource settings, the collaborative efforts of the INTE-AFRICA consortium with African disease control programmes, patient bodies, and Ministry of Health policymakers have earned them recognition. In 2021, the team received the national Times Higher Education award for the International Partnership of the Year, acknowledging their equitable partnership that sparked a transformative shift in research and healthcare practices.
Keywords
INTE-AFRICA, diabetes, hypertension, HIV, healthcare, sub-Saharan Africa, chronic conditions, integrated care