TY - JOUR
T1 - Opportunities and challenges for evidence-informed HIV-noncommunicable disease integrated care policies and programs
T2 - Lessons from Malawi, South Africa, Swaziland and Kenya
AU - Matanje Mwagomba, Beatrice L.
AU - Ameh, Soter
AU - Bongomin, Pido
AU - Juma, Pamela A.
AU - Mackenzie, Rachel K.
AU - Kyobutungi, Catherine
AU - Lukhele, Nomthandazo
AU - Mwangi, Kibachio Joseph Muiruri
AU - Amberbir, Alemayehu
AU - Klipstein-Grobusch, Kerstin
AU - Gómez-Olivé, Francesc Xavier
AU - Berman, Josh
N1 - Publisher Copyright:
© Copyright 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Introduction: Countries in sub-Saharan Africa (SSA) are recognizing the growing dual burden of HIV and noncommunicable diseases (NCDs). This article explores the availability, implementation processes, opportunities and challenges for policies and programs for HIV/NCD integration in four SSA countries: Malawi, Kenya, South Africa and Swaziland. Methods: We conducted a cross-sectional analysis of current policies and programs relating to HIV/NCD care integration from January to April 2017 using document review and expert opinions. The review focussed on availability and content of relevant policy documents and processes towards implementating national HIV/NCD integration policies. Results: All four case study countries had at least one policy document including aspects of HIV/NCD care integration. Apart from South Africa that had a phased nation-wide implementation of a comprehensive integrated chronic disease model, the three other countries - Malawi, Kenya and Swaziland, had either pilot implementations or nation-wide single-disease integration of NCDs and HIV. Opportunities for HIV/NCD integration policies included: presence of overarching health policy documents that recognize the need for integration, and coordinated action by policymakers, researchers and implementers. Evidence gaps for cost-effectiveness, effects of integration on key HIV and NCD outcomes and funding mechanisms for sustained implementation of integrated HIV/NCD care strategies, were among challenges identified. Conclusion: Policymakers in Malawi, Kenya, South Africa and Swaziland have considered integration of NCD and HIV care but a lack of robust evidence hampers large-scale implementation of HIV/NCD integration. It is crucial for SSA Ministries of Health and throughout low-and-middle-income countries to utilize existing opportunities and advocate for evidence-informed HIV/NCD integration strategies.
AB - Introduction: Countries in sub-Saharan Africa (SSA) are recognizing the growing dual burden of HIV and noncommunicable diseases (NCDs). This article explores the availability, implementation processes, opportunities and challenges for policies and programs for HIV/NCD integration in four SSA countries: Malawi, Kenya, South Africa and Swaziland. Methods: We conducted a cross-sectional analysis of current policies and programs relating to HIV/NCD care integration from January to April 2017 using document review and expert opinions. The review focussed on availability and content of relevant policy documents and processes towards implementating national HIV/NCD integration policies. Results: All four case study countries had at least one policy document including aspects of HIV/NCD care integration. Apart from South Africa that had a phased nation-wide implementation of a comprehensive integrated chronic disease model, the three other countries - Malawi, Kenya and Swaziland, had either pilot implementations or nation-wide single-disease integration of NCDs and HIV. Opportunities for HIV/NCD integration policies included: presence of overarching health policy documents that recognize the need for integration, and coordinated action by policymakers, researchers and implementers. Evidence gaps for cost-effectiveness, effects of integration on key HIV and NCD outcomes and funding mechanisms for sustained implementation of integrated HIV/NCD care strategies, were among challenges identified. Conclusion: Policymakers in Malawi, Kenya, South Africa and Swaziland have considered integration of NCD and HIV care but a lack of robust evidence hampers large-scale implementation of HIV/NCD integration. It is crucial for SSA Ministries of Health and throughout low-and-middle-income countries to utilize existing opportunities and advocate for evidence-informed HIV/NCD integration strategies.
KW - HIV
KW - HIV–noncommunicable disease
KW - Kenya
KW - Malawi
KW - South Africa
KW - Swaziland
KW - challenges
KW - integration
KW - noncommunicable disease
KW - opportunities
KW - policies
KW - sub-Saharan Africa
UR - http://www.scopus.com/inward/record.url?scp=85050154082&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000001885
DO - 10.1097/QAD.0000000000001885
M3 - Article
C2 - 29952787
SN - 0269-9370
VL - 32 Suppl 1
SP - S21-S32
JO - AIDS
JF - AIDS
ER -