Lighthouse Trust, Kamuzu Central Hospital campus, Lilongwe, Malawi.
Department of Public Health, Faculty of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
AIDS. 2018 Jul 1;32 Suppl 1:S21-S32. doi: 10.1097/QAD.0000000000001885.
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.
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.
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.
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.
撒哈拉以南非洲（SSA）的国家认识到艾滋病毒和非传染性疾病（NCDs）双重负担的日益加重。本文探讨了四个 SSA 国家（马拉维、肯尼亚、南非和斯威士兰）中艾滋病毒/非传染性疾病综合防治政策和方案的可用性、实施过程、机遇和挑战。
我们使用文件审查和专家意见，于 2017 年 1 月至 4 月对与艾滋病毒/非传染性疾病护理综合管理相关的现行政策和方案进行了横断面分析。审查重点是相关政策文件的可用性和内容以及实施国家艾滋病毒/非传染性疾病综合管理政策的进程。
四个案例研究国家都至少有一个政策文件，其中包括艾滋病毒/非传染性疾病护理综合管理的某些方面。除了南非分阶段在全国范围内实施全面综合慢性疾病模式外，其他三个国家（马拉维、肯尼亚和斯威士兰）要么是试点实施，要么是全国范围内单一疾病对非传染性疾病和艾滋病毒的综合管理。艾滋病毒/非传染性疾病综合管理政策的机遇包括：存在承认整合必要性的总体卫生政策文件，以及决策者、研究人员和执行者的协调行动。确定的挑战包括：成本效益的证据差距、整合对关键艾滋病毒和非传染性疾病结果的影响以及为持续实施综合艾滋病毒/非传染性疾病护理战略提供资金的机制。
马拉维、肯尼亚、南非和斯威士兰的政策制定者已经考虑将非传染性疾病和艾滋病毒护理相结合，但缺乏强有力的证据阻碍了艾滋病毒/非传染性疾病综合管理的大规模实施。对于 SSA 各国卫生部和中低收入国家来说，利用现有机会并倡导以证据为基础的艾滋病毒/非传染性疾病综合管理战略至关重要。
