Figure 1
Search strategy.
Figure 2
PRISMA flow-diagram of the study selection process of identification, screening, and inclusion criteria.
Table 1
PCC Framework.
| CRITERIA | DETERMINANTS |
|---|---|
| Population | The article had to focus on individuals with NCDs (DM or hypertension) and/or HIV, without restrictions on age or sex. |
| Concept | The article had to describe, evaluate, or propose how NCD management can be integrated with HIV management to improve patient outcomes. |
| Context | The article had to focus on the integration of NCD management with HIV management in the context of SSA. |
Table 3
Descriptive characteristics of final included studies (Intervention, Outcomes Measured, Findings).
| AUTHOR, YEAR | DESCRIPTION OF INTERVENTION | OUTCOMES MEASURED | FINDINGS |
|---|---|---|---|
| Anand et al., 2019 [30] | Task-sharing: sharing of tasks with other healthcare professionals with some supervision/referral to physicians | Population, interventions, blood pressure, and task sharing groups | (Task sharing in LMICs has been useful in managing HIV/AIDS) Task-sharing interventions for managing hypertension in LMICs show potential in reducing blood pressure |
| Chang et al., 2019 [31] | Integrated chronic disease management model for managing multimorbidity | Relationship between type of multimorbidity and progression along the care continuum; Effect of type of multi-morbidity on HIV care among HIV patients | Among HIV patients, presence of cardiometabolic conditions was associated with less progress in HIV care. The findings imply that the objective of the ICDM model may not yet be realised |
| George et al., 2019 [32] | n/a | Association between detectable HIV viral load and NCD comorbidity | There is an underdiagnosis of NCDs in HIV patients. An integrated chronic care system would allow enhanced detection, and dual management of HIV and NCDs |
| Iwelunmor et al., 2019 [33] | Integrating evidence-based hypertension interventions within HIV clinics for PLHIV in Nigeria | Capabilities, Opportunities and Motivations for integrating evidence-based hypertension interventions within HIV clinics for PLHIV in Nigeria | Relative capabilities and opportunities were minimal. There is a need to strengthen the HIV clinics in Lagos for the implementation of these interventions to improve patient outcomes and service delivery in Southwest Nigeria |
| Kwarisiima et al., 2019 [34] | Integrated chronic care delivery model at local health facilities that offered treatment for both HIV and hypertension | Primary: Hypertension control at follow-up clinic visits Secondary: Blood pressure control at 2 consecutive visits separated by at least 1 month | Integrated HIV and hypertension care provided under the same roof enabled “one-stop” shopping for patients. As hypertension and chronic care for other NCDs is integrated with HIV chronic care across SSA, co-located services, a well-trained workforce, and clinic infrastructure will likely be crucial to successful treatment of both |
| Ojo et al., 2019 [35] | Integrated CVD-HIV care | Concept, taxonomy and alignment of feasibility; Specific metrics used in feasibility assessment | Several feasible interventions that integrated multilevel CVD and HIV care were identified: Multi-disease screening; Referral and linkage to care. Treatment assessment of feasibility was not conducted in a consistent fashion across studies |
| Ansbro et al, 2018 [36] | Staff training; locally adapted protocols; chronic care files; a revised appointment system and patient flow; and a new database | Program processes, effectiveness and costs | NCD care can be integrated into a HIV department and outpatient setting in an MSF-supported primary care centre by utilising pre-existing structures, and can achieve acceptable intermediate clinical outcomes and retention rates at a cost that is similar to HIV programs. |
| Ekrikpo et al., 2018 [37] | n/a | Prevalence and correlates of hypertension, DM, obesity and dyslipidaemia | High prevalence of CVD risk factors makes it imperative to ensure detailed screening for CVD in HIV patients at care initiation and at regular intervals during follow-up. An integrated approach to NCD/HIV care may be the answer to this double disease burden |
| Golovaty et al., 2018 [38] | Integrated home-based HIV–NCD testing and counselling conducted by lay counsellors trained by a study nurse in HIV testing, anthropometric measurement, and point-of-care NCD screening | Program micro-costing, no of persons tested per day | Comprehensive home-based HIV-NCD testing and counselling results in modest increase in costs with the potential to avert NCD death and disability |
| Haldane et al., 2018 [39] | Service integration for HIV/AIDS with NCDs | Outcomes of service integration, barriers and facilitators to integration | Several innovative initiatives have been described for integrating CVD, hypertension and diabetes services with HIV/AIDS services. These highlight the importance of using communities as a locus of action for activism, advocacy, accountability and service delivery and the importance of partnerships to facilitate multidisciplinary collaborations |
| Juma et al., 2018 [40] | NCD behavioural change communication (BCC) interventions | Reach, Effectiveness, Adoption, Implementation, and Maintenance | Although data on integrated HIV/NCD health promotion efforts is limited, evidence is found to support the feasibility of integrating HIV/NCD within multi-disease screening campaigns in Uganda, Kenya and South Africa |
| Matanje et al., 2018 [41] | Integrated HIV/NCD care | Availability of policies and programs and ongoing interventional processes related to integrated HIV/NCD care | Leveraging highly funded and successful HIV programs in SSA that employ proven monitoring and evaluation systems will support effective HIV/NCD integration program monitoring and provide an opportunity to improve equity and access of NCD care |
| Njuguna et al, 2018 [19] | Models of integrated HIV/NCD care | Challenges/barriers, facilitators/successors of integrated care models, lessons learnt | Leveraging existing HIV infrastructure to provide NCD care to the SSA population is feasible, with various approaches possible depending on available program capacity. Future efforts will need to factor in descriptions of process metrics and cost-effectiveness to further guide implementation, as well as clinical outcomes to aid decision makers. |
| Nuche-Berenguer and Kupfer, 2018 [42] | Integration of diabetes care into existing HIV and TB platforms | Diagnostic and treatment capacity for diabetes; Interventions aimed to increase capacity; Integration of diabetes care into existing HIV platforms | Many challenges remain for chronic diabetes care provision. Optimizing existing resources by integrating diabetes care with other disease platforms e.g. HIV and TB care is a great opportunity to improve diabetes diagnostic systems, medicines provision, training of health personnel, patient empowerment, and tracking of disease burden |
| Patel et al., 2018 [43] | NCD-HIV integrated programs with screening and management approaches that are contextually appropriate for resource-limited settings | Burden of NCDs among PLHIV in LMICs; Current management of the diseases | Improved data collection and surveillance of NCDs among PLHIV in LMICs are necessary to inform integrated HIV/NCD care models. Although efforts to integrate care exist, further research is needed to optimize the efficacy of these programs |
| Pfaff et al., 2018 [44] | Integrated HIV-NCD care: blood pressure measured at every visit and random blood glucose determined every 2y in a large HIV clinic | Patients screened and diagnosed with hypertension/diabetes, mean duration of ART visits, mean number of patients seen a day, challenges of integrated HIV-NCD care | The experience in Zomba demonstrates that the strengths of the ART program may be used to provide integrated NCD care within HIV settings. Several challenges related to workload, patient flow, monitoring and evaluation and NCD drug shortages were encountered during pilot integration implementation that are currently being addressed and may serve as lessons for wider integration efforts |
| Rawat et al., 2018 [45] | Integration of HIV care into primary care clinics | Influence of integrating HIV-care into primary health care clinics (PHCCs) on quality of NCD care for diabetes and hypertension; how changes may relate to HIV patient numbers | The gains in infrastructure and investment in HIV-care could be leveraged to strengthen, not erode, NCD care. By harmonizing preventive efforts to reduce and treat NCDs within the context of HIV-care, countries can synergistically advance health and social benchmarks. The growing burden of other NCDs combined with the greater life expectancy of people living with HIV demand that health systems remain strong to ensure that comprehensive HIV-care does not come at the expense of screening and treatment for NCDs, especially in PHC settings |
| Ameh et al, 2017 [46] | Integrated chronic disease management (ICDM) model in Primary health care facilities | Health outcomes including patients’ CD4 counts and blood pressure | Application of the model had a small effect in controlling patients’ CD4 counts and BP, but showed no overall clinical benefit for the patients; hence, the need to more extensively leverage the HIV program for hypertension treatment |
| Mosha et al., 2017 [47] | Integrating blood pressure screening into a community-based HIV screening program | Prevalence of hypertension and the associated factors | Integration of hypertension screening into routine clinics for HIV allowed many undiagnosed cases of diabetes and other chronic diseases to be identified. If combined with proper hypertension treatment, consequences such as CVD and stroke can be avoided, but this requires improvements of the clinical services in health facilities |
| Pfaff et al., 2017 [48] | NCD care at EQUIP-affiliated facilities (Extending Quality Improvement for HIV/AIDS in Malawi) | Current capacity of NCD program, using hypertension and diabetes as tracer conditions; Extent of integration with HIV and ART care | There is much potential to use lessons from the ART program to strengthen NCD care as ART clinics represent one of the first screening and primary care delivery models for chronic disease in Africa, supported by health information, short course training and supervision |
| Shankalala et al., 2017 [49] | n/a | Proportion with impaired fasting glucose or DM | High levels of impaired fasting glucose or DM among cART patients compared to what is reported, suggesting missed care and support opportunities. There is a need to repackage HIV programming to include integration of diabetes screening as part of the overall care and support strategy |
| Divala et al, 2016 | n/a | Proteinuria, non-fasting lipids and cardio/cerebro-vascular disease (CVD) risk scores | Integrated HIV-hypertension-diabetes care may be individually beneficial but increases the burden of care for busy HIV clinics. Excluding patients with mild hypertension and low CVD risk from drug treatment would half the overall burden of HIV patients in need of integrated pharmacotherapy for diabetes and/or hypertension |
| Fairall et al., 2016 [50] | Primary Care 101 (PC101) leveraging health system reforms accompanying the scale-up of antiretroviral therapy (ART) to improve quality of primary care for other priority conditions e.g. NCDs | Treatment intensification for hypertension, diabetes, and chronic respiratory disease; case detection of depression | Educational outreach to primary care nurses to train them in the use of a management tool involving an expanded role in managing NCDs was feasible and safe but was not associated with treatment intensification or improved case detection for index diseases. However, the intervention, with adjustments to improve its effectiveness, has been adopted for implementation in primary care clinics throughout South Africa |
| Rachlis et al., 2016 [51] | Chronic disease care for HIV, TB and hypertension as part of the Academic Model Providing Access to Healthcare (AMPATH) program | Barriers and facilitators to linkage and retention | Integrated service delivery for chronic diseases may support timely engagement in care given the increasing prevalence of NCDs among the general population and HIV patients. However, such models should be rigorously evaluated to explore their acceptability and potential negative impacts, and should be tailored for specific contexts and settings, and support individuals with logistical and financial challenges |
| Some et al., 2016 [52] | Task-shifting the management of NCDs from clinical officers to nurses who also manage routine primary and HIV care | Adherence to Médecins Sans Frontières clinical protocols | Nurses working within a resource-constrained, primary care and HIV setting, can successfully follow protocols managing stable patients with multiple NCDs. This approach could be applied in other similar HIV-based programs to extend access to areas with increasing need of NCD care and limited resources |
| Edwards et al, 2015 [53] | n/a | Patient demographics, clinical characteristics, disease prevalence | PLHIV are at higher risk of developing concurrent NCDs at a younger age and would benefit from routine screening and treatment. Treatment appears to produce results comparable to patients without HIV. It also demonstrates that it is possible to integrate both HIV and NCD care together in a primary care program that is largely run by clinical |
| officers and nursing staff within significant resource constraints. This model may be useful in the scale-up of NCD care in sub-Saharan Africa in the future | |||
| Haregu et al., 2015 [54] | HIV-NCD integration | Rationale, policy bases and models of HIV-NCD integration | Models of HIV-NCD integration that were “tested” in the context of developing countries vary but all models indicated that the integrated approach was feasible, effective, efficient and acceptable. However, overall evidence is limited and context-specific evidence is lacking |
| Khabala et al, 2015 [55] | Combined MACs: Nurse-facilitated groups of 25-35 stable hypertension, diabetes and HIV patients with quarterly follow-ups | Correctly completed blood pressure, weight and laboratory testing during MAC attendance, adherence, referral to clinic, retention | This study demonstrates the feasibility and early efficacy of Medication Adherence Clubs as a novel group treatment model to care for stable patients with mixed chronic diseases in an urban, resource-constrained, informal settlement. It supports reducing the burden of regular clinical follow-up among stable patients and improves the flexibility of care delivery |
| Mahomed and Asmall, 2015 [56] | Integrated chronic disease management (ICDM) model using a health systems approach | Feasibility of integration, Challenges | The implementation of the integrated chronic disease management model is feasible at primary care in South Africa provided that systemic challenges and change management are addressed during the implementation process |
| Joshi et al., 2014 [57] | Task-shifting the management of NCDs from physicians to non-physician healthcare workers (NPHWs) | Viability, Cost-effectiveness, Clinical effectiveness | Task shifting has proved to be a viable and cost-effective option for the management of HIV-AIDS in SSA. Task-shifting, if accompanied by health system restructuring, is a viable and potentially effective and affordable strategy for the management of NCDs |
| Govindasamy et al, 2013 [58] | n/a | Yield of new diagnosis, CD4 count testing, linkage to care, correlates of linkage and barriers to care | Integrated HIV, TB symptoms and NCD screening in mobile units holds promise for expanding the scope of HIV services and the reach of primary healthcare |
| Chamie et al, 2012 [59] | A five-day, multi-disease campaign, offering diagnostic, preventive, treatment and referral services Community-based HIV and NCD testing campaigns offering diagnostic, preventive, treatment and referral services compared with routine service delivery methods | Community participation, case-finding yield, and linkage to care Feasibility and diagnostic yield of integrating NCD into a rapid community-based multidisease screening campaign | In an integrated campaign engaging 74% of adult residents, a high burden of undiagnosed HIV, hypertension and diabetes was identified. The campaign demonstrates the feasibility of integrating hypertension, diabetes and communicable diseases into HIV initiatives |
| Rabkin et al., 2012 [18] | Intervention package adapted and implemented from HIV program to support diabetes services in the outpatient department. | Site assessments, chart review, and health care worker questionnaires. | Countries which have successfully scaled up HIV services have already learnt profound lessons about chronic care delivery. Using locally owned and contextually appropriate resources may be an efficient and effective way to “jumpstart” NCD programs and to strengthen health systems |
| Van Olmen et al., 2012 [60] | Models of care delivery and treatment of diabetes and HIV/AIDS | The disease dimension,” the “health provider dimension,” the patient or “person dimension,” and the “environment dimension” of chronic diseases. | Lessons from present care models for HIV/AIDs and DM show potential for cross-fertilization between models: rapid scale-up approaches through the public health approach by simplification and decentralisation; community involvement, peer support and self-management strategies; and strengthening health services |
| Levitt et al., 2011 [61] | Integration of primary level care for people with NCDs and those receiving ART | Health care implications of colliding HIV/NCD epidemics, Argument for an integrated model of care | The current vertical program for HIV/AIDS care and that for NCDs, which take place within a chaotic primary care system, should be replaced by integrated care for patients with any chronic disease, in a coherent patient-centred program Integrated chronic disease care services in primary care facilities should be separated from acute care services, naturally with sufficient coordination between the two forms of care to ensure that patients can move freely between acute and chronic care services when required |
| Lekoubou et al., 2010 [62] | Task shifting to nurses: Nurse-led strategies for chronic disease management | Surrogates of disease control | Task sharing in LMICs has been useful in managing HIV/AIDS. Task-shifting has been implemented in a few countries in SSA with some indicators of success in chronic disease care. With regard to hypertension and diabetes, limited available evidence suggests that acceptably designed task-shifting interventions are feasible and useful for their care in SSA |
| Maher et al., 2010 [63] | Primary care-delivery for both CDs and NCDs | Ways primary care can respond to the health transition to a double burden of CDs and NCDs in Africa | Primary care is well placed to offer a coherent response to the problems of both CDs and NCDs. National and international alliances have a key role to play in mobilizing necessary investments for an effective primary-care response to the health transition in Africa. |
[i] * PLHIV – People living with HIV.
* LMIC – Low-and-middle income countries.
Table 4
Barriers and facilitators to integrated HIV/NCD care.
| BARRIERS | FACILITATORS |
|---|---|
| The lack of diagnostic equipment and medication [18, 19, 31, 35, 36, 39, 42, 43, 44, 45, 46, 48, 53, 56] | Task-shifting/task-sharing [19, 42, 43] |
| Lack of trained staff or training [18, 31, 35, 36, 39, 41, 42, 43, 46, 48, 53, 56] | Utilization of existing trained staff or infrastructure [19, 31, 35, 39, 40, 42, 45, 48] |
| Overburden from an increased workload [19, 36, 39, 40, 43, 44, 45, 46, 48, 56] | The perceived benefits of integrated care [35, 43, 44, 48] |
| Evidence gaps [40, 41, 42, 43] | Favourable policy environment and governmental support [19, 35, 41] |
| Insufficient funding [19, 35, 40, 41, 48] | Reorganization of patient flow [19, 44] |
| Lack of guidelines and operating protocols [18, 53] | |
| Perceived threat of integration to existing HIV success [40, 41] |
Appendix 1
Table 2. Descriptive characteristics of final included studies (Setting, Design, Population).
| AUTHOR, YEAR | NAME OF STUDY | SETTING | STUDY DESIGN | TARGET POPULATION AND DISEASES |
|---|---|---|---|---|
| Anand et al., 2019 [30] | Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis | Low- and middle-income countries in Africa, Asia | Systematic review and meta-analysis | Intervention studies: trials (n = 43), before-and-after studies (n = 20) Hypertension, cardiovascular risk factors |
| Chang et al., 2019 [31] | Multimorbidity and care for hypertension, diabetes and HIV among older adults in rural South Africa | Agincourt, Mpumalanga, South Africa | Cross-sectional data analysis | Adults (n = 4,447) enrolled in the Health and Aging in Africa longitudinal study HIV, hypertension, diabetes, dyslipidemia, angina, depression, PTSD, alcohol dependence |
| George et al., 2019 [32] | The association between a detectable HIV viral load and non-communicable diseases comorbidity in HIV positive adults on antiretroviral therapy in Western Cape, South Africa | Khayelitsh, Cape Town, South Africa | Cross-sectional study | HIV-infected adults (n = 330) on ART who attend the HIV clinic within a primary health centre HIV, hypertension, diabetes, chronic respiratory disease, epilepsy |
| Iwelunmor et al., 2019 [33] | Capabilities, opportunities and motivations for integrating evidence-based strategy for hypertension control into HIV clinics in Southwest Nigeria | Lagos, Nigeria | Concurrent Quan-Qual study (Structured questionnaires followed by Stakeholder meetings) | HIV clinics (n = 29) HIV, hypertension |
| Kwarisiima et al., 2019 [34] | Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study | Rural Uganda | Cluster RCT | Residents (n = 34,704) of ten communities in rural Uganda HIV, hypertension |
| Ojo et al., 2019 [35] | Feasibility of integrated, multilevel care for cardiovascular diseases (CVD) and HIV in low and middle-income countries (LMICs): A scoping review | Sub-Saharan Africa, Southeast Asia, South America | Scoping review | Studies (n = 20): articles (n = 18), conference abstracts (n = 3) HIV, cardiovascular diseases |
| Ansbro et al, 2018 [36] | Evaluation of NCD service integrated into a general OPD and HIV service in Matsapha, Eswatini, 2017 | Swaziland | Retrospective descriptive cohort study | Patients (n = 895) enrolled at Matsapha Comprehensive Care Clinic Cardiovascular disease, hypertension, diabetes mellitus, chronic respiratory disease |
| Ekrikpo et al., 2018 [37] | Prevalence and correlates of traditional risk factors for cardiovascular disease in a Nigerian ART-naive HIV population: a cross-sectional study | Southern Nigeria | Cross-sectional study | Antiretrovirals-naïve patients (n = 12,167) initiating care at the University of Uyo Teaching Hospital HIV clinic HIV, hypertension, DM, obesity, dyslipaedemia |
| Golovaty et al., 2018 [38] | Cost of Integrating Noncommunicable Disease Screening Into Home-Based HIV Testing and Counselling in South Africa | KwaZulu-Natal, South Africa | Cross-sectional costing analysis | People (n = 570) who received integrated HIV-NCD testing, counselling and referral to care in January 2015 HIV, diabetes, hypertension, hypercholesterolemia, obesity, depression |
| Haldane et al., 2018 [39] | Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review | Sub-Saharan Africa, Cambodia, UK, USA | Systematic review | Articles (n = 14) representing 17 studies HIV/AIDS, CVDs, hypertension, diabetes, cerebrovascular diseases |
| Juma et al., 2018 [40] | From HIV prevention to non-communicable disease health promotion efforts in sub-Saharan Africa: A Narrative Review | SSA | Narrative literature review | SSA-based studies (n = 20) on NCDs and dual HIV/NCD health promotion interventions HIV, cardiovascular disease, type 2 diabetes, cervical cancer, depression |
| Matanje et al., 2018 [41] | Opportunities and challenges for evidence-informed HIV-noncommunicable disease integrated care policies and programs: lessons from Malawi, South Africa, Swaziland and Kenya | Malawi, South Africa, Swaziland, Kenya | Cross-sectional analysis | Current policies and programs relating to HIV/NCD integration HIV, NCDs |
| Njuguna et al, 2018 [19] | Models of integration of HIV and noncommunicable disease care in sub-Saharan Africa: lessons learned and evidence gaps | SSA | Narrative review of the literature | N = 5 case studies HIV, non-communicable diseases |
| Nuche-Berenguer and Kupfer, 2018 [42] | Readiness of Sub-Saharan Africa Healthcare Systems for the New Pandemic, Diabetes: A Systematic Review | SSA | Systematic review | Articles (n = 55) on Embase, Scopus, PubMed Diabetes, HIV |
| Patel et al., 2018 [43] | Noncommunicable diseases among HIV-infected persons in low income and middle-income countries: a systematic review and meta-analysis | Low- and middle-income countries, with a focus on SSA | Systematic review and meta-analysis | Peer-reviewed literature (n = 141); 57 included in qualitative analysis HIV, CVD, cervical cancer, depression, diabetes |
| Pfaff et al., 2018 [44] | Early experiences integrating hypertension and diabetes screening and treatment in a human immunodeficiency virus clinic in Malawi | Zomba District, Malawi | Pilot study | Adults HIV patients (n = 6036) HIV, diabetes, hypertension |
| Rawat et al., 2018 [45] | Integrated HIV-care into primary care clinics and the influence on diabetes and hypertension care: an interrupted time series analysis in Free State, South Africa over four years | Free State, South Africa | Quasi-experimental design | Data from primary health care clinics (n = 131) with a catchment population of 1.5 million HIV, diabetes, hypertension |
| Ameh et al, 2017 [46] | Effectiveness of an Integrated Approach to HIV and Hypertension Care in Rural South Africa: Controlled Interrupted Time-Series Analysis | Bushbuckridge municipality, Mpumalanga, South Africa | Controlled interrupted time-series study | Patients (n = 443) from the primary healthcare facilities in Buckbuckridge HIV, hypertension |
| Mosha et al., 2017 [47] | North West Tanzania | Community-based cross-sectional study | Adults (n = 9,678) in Magu District in 2013 HIV, hypertension, diabetes, and other chronic diseases | |
| Pfaff et al., 2017 [48] | You can treat my HIV – But can you treat my blood pressure? Availability of integrated HIV and noncommunicable disease care in northern Malawi | Rural Northern Malawi | Sequential mixed methods: Cross-sectional survey and semi-structured interviews | Health centres (n = 25) and hospitals (n = 5); NCD coordinators (n = 3) HIV, hypertension, diabetes |
| Shankalala et al., 2017 [49] | Risk factors for impaired fasting glucose or diabetes among HIV infected patients on ART in the Copperbelt Province of Zambia | Copperbelt Province, Zambia | Cross-sectional study | HIV/AIDs patients (n = 270) on Combined Antiretroviral Treatment (cART) for more than 2 years HIV, diabetes |
| Divala et al, 2016 | The burden of hypertension, diabetes mellitus, and cardiovascular risk factors among adult Malawians in HIV care: consequences for integrated services | Malawi | Cross-sectional study | Patients (n = 952) at the HIV clinics of Zomba Central Hospital HIV, hypertension, diabetes |
| Fairall et al., 2016 [50] | Educational Outreach with an Integrated Clinical Tool for Nurse-Led Noncommunicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial | Rural and Urban South Africa | Cluster randomized controlled trial | Patients (n = 4,393) of public sector primary healthcare clinics (n = 38) Hypertension, diabetes, chronic respiratory disease, depression |
| Rachlis et al., 2016 [51] | Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya | Western Kenya | Exploratory qualitative study (in-depth interviews and focus group discussions) | Participants (n = 235) sampled from 3 AMPATH clinics: Individuals living with HIV (n = 50), TB (n = 39), hypertension (n = 21); caregivers (n = 24), community leaders (n = 10), healthcare providers (n = 62) HIV, tuberculosis (TB), hypertension |
| Some et al., 2016 [52] | Task Shifting the Management of Non- Communicable Diseases to Nurses in Kibera, Kenya: Does It Work? | Kenya, Kibera | Descriptive, retrospective review | Consultations (n = 725) by nurses with patients (n = 616) in 2 integrated primary health care facilities Hypertension, T2DM, epilepsy, asthma, sickle cell disease |
| Edwards et al, 2015 [53] | HIV with non-communicable diseases in primary care in Kibera, Nairobi, Kenya: characteristics and outcomes 2010–2013 | Kibera, Nairobi, Kenya | Retrospective descriptive cohort study | Patients (n = 2206) >14 years with hypertension and/or diabetes registered in the chronic diseases clinic from Jan 2010- June 2013 HIV, hypertension, diabetes |
| Haregu et al., 2015 [54] | Integration of HIV/AIDS and noncommunicable diseases in developing countries: rationale, policies and models | Developing countries in SSA region and Cambodia | Interpretative qualitative synthesis | References from PubMed and general search engines and websites of WHO, UNAIDS and the NCD alliance |
| HIV/AIDS, CVDs, cancers, diabetes, COPD | ||||
| Khabala et al, 2015 [55] | Medication Adherence Clubs: a potential solution to managing large numbers of stable patients with multiple chronic diseases in informal settlements | Kibera, Nairobi, Kenya | Retrospective, descriptive study | Patients (n = 1432) from 47 Medication Adherence Clubs (MACs) HIV, hypertension, diabetes, |
| Mahomed and Asmall, 2015 [56] | Development and implementation of an integrated chronic disease model in South Africa: lessons in the management of change through improving the quality of clinical practice | South Africa | Pre-post study | Primary health care facilities (n = 42) |
| Joshi et al., 2014 [57] | Task Shifting for Non-Communicable Disease Management in Low and Middle Income Countries – A Systematic Review | Low and middle income countries e.g. Ethiopia, Kenya, Tanzania, Zimbabwe | Systematic review | RCTs (n = 7) and observational studies (n = 15) Hypertension, diabetes, CVD, mental health, neurological conditions, COPD, cancer |
| Govindasamy et al, 2013 [58] | Linkage to HIV, TB and Non-Communicable Disease Care from a Mobile Testing Unit in Cape Town, South Africa | Cape Town, South Africa | Observational cohort study | Clients (n = 9806) screened at mobile testing unit HIV, TB, diabetes, hypertension, |
| Chamie et al, 2012 [59] | Leveraging rapid community-based HIV testing campaigns for noncommunicable diseases in rural Uganda | Uganda | Feasibility study Controlled before-after design | Residents (n = 6300) of the rural Ugandan parish HIV, malaria, TB, hypertension, diabetes Community members (n = 4343) |
| Rabkin et al., 2012 [18] | Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland | Swaziland, Ethiopia | 2 feasibility/proof-of-concept studies | Patients (n = 100 in Swaziland and n = 260 in Ethiopia) with DM whose charts were randomly reviewed HIV, diabetes mellitus |
| Van Olmen et al., 2012 [60] | Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care | SSA | Literature review | Patients with DM and HIV/AIDS Diabetes mellitus type 2 and HIV/AIDS. |
| Levitt et al., 2011 [61] | Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings—insights from South Africa | South Africa | Narrative review | HIV, NCDs |
| Lekoubou et al., 2010 [62] | Hypertension, Diabetes Mellitus and Task Shifting in Their Management in Sub-Saharan Africa | SSA South Africa, Cameroon | Narrative literature review | Articles (n = 5) Hypertension, diabetes |
| Maher et al., 2010 [63] | Health transition in Africa: practical policy proposals for primary care | SSA | Narrative review | Patients with co-morbid communicable diseases and NCDs Communicable (CDs) and non-communicable diseases (NCDs) |
[i] * PLHIV – People living with HIV.
* LMIC – Low-and-middle income countries.