Under the Non-Communicable Diseases (NCDs) and Cancer theme that is led by Prof Moffat Joha Nyirenda, a study on Management of Chronic Conditions in Africa (MOCCA) has revealed that integrating care for diabetes, hypertension and HIV is a feasible strategy for the management of these conditions; and it reduces both health service and household costs substantially.
Integrated care was defined as a ‘one-stop’ chronic care clinic, where patients with either one or more of the three conditions receive care at same triage point, sharing same waiting area, reviewed by the same clinician and given single return appointment if they have more than one condition. The study was carried out between 2018 and 2021 in ten primary health care facilities in Uganda and Tanzania including 8 Public health facilities and two Non-Government Organisations. In Uganda the facilities included; Wakiso Health center (HC) IV, Ndejje HC IV, Kiswa HC III, Kisugu HC III and TASO Mulago.
Most patients approached agreed to join the study whether they had a single chronic condition or had multiple conditions. Overall, 2,273 patients were enrolled and followed for 6 - 11 months. The proportions alive and retained in care at study end was above 79% for all conditions.
After the study ended, health care facility staff have continued implementing integrated care as they had witnessed its benefits and were convinced that the evidence from this MOCCA pilot study was sufficient to start the integration, pending further evidence from the larger study. The benefits mentioned included; improved screening for NCDs among patients living with HIV, reduced number of patient visits especially those with multiple conditions. Health workers are also more confident in handling patients with more than one chronic condition and at the same time improved monitoring of patients and records management.
Following the study dissemination, MRC/UVRI and LSHTM Uganda Research Unit has been also invited to several meetings to share their experience and findings on integrated care in Uganda. These have included meeting the parliamentarians of the NCD forum, Centers for Disease Control and Prevention (CDC) team together with implementing partners and ART subcommittee at the Ministry of Health among others.
Dr. Josephine Birungi and Dr. Ivan Namakoola were chosen to join the Ministry of Health Technical Working Group (TWG) that is developing Standard Operating Procedures (SOPs) for integrating NCD care into HIV clinics and training materials, Social behavior change and communication materials. The two are also involved in updating the national guidelines for HIV and Anti-Retroviral Therapy (ART) together with the national data collection like patient care card, the register and reporting tools.
Results from this study are published in the BMJ open Journal (Birungi et al..) and were a proof of concept that has been used to subsequently inform a large-scale cluster-randomised control trial INTE-AFRICA. The INTE-AFRICA study is being conducted at 17 primary health facilities in Uganda and 15 in Tanzania will soon be completed to provide evidence for the national scale up.
The AIDS Support Organisation (TASO)
Liverpool School of Tropical Medicine (LSTM)
National Institute for Medical Research – Muhimbili Centre (NIMR), Tanzania
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