Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
BMJ Glob Health. 2021 May;6(5). doi: 10.1136/bmjgh-2020-004669.
Low-income and middle-income countries are struggling to manage growing numbers of patients with chronic non-communicable diseases (NCDs), while services for patients with HIV infection are well established. There have been calls for integration of HIV and NCD services to increase efficiency and improve coverage of NCD care, although evidence of effectiveness remains unclear. In this review, we assess the extent to which National HIV and NCD policies in East Africa reflect the calls for HIV-NCD service integration.
Between April 2018 and December 2020, we searched for policies, strategies and guidelines associated with HIV and NCDs programmes in Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. Documents were searched manually for plans for integration of HIV and NCD services. Data were analysed qualitatively using document analysis.
Thirty-one documents were screened, and 13 contained action plans for HIV and NCDs service integration. Integrated delivery of HIV and NCD care is recommended in high level health policies and treatment guidelines in four countries in the East African region; Kenya, Rwanda, Tanzania and Uganda, mostly relating to integrating NCD care into HIV programmes. The increasing burden of NCDs, as well as a move towards person-centred differentiated delivery of services for people living with HIV, is a factor in the recent adoption of integrated HIV and NCD service delivery plans. Both South Sudan and Burundi report a focus on building their healthcare infrastructure and improving coverage and quality of healthcare provision, with no reported plans for HIV and NCD care integration.
Despite the limited evidence of effectiveness, some East African countries have already taken steps towards HIV and NCD service integration. Close monitoring and evaluation of the integrated HIV and NCD programmes is necessary to provide insight into the associated benefits and risks, and to inform future service developments.
中低收入国家正在努力应对慢性非传染性疾病（NCD）患者人数的不断增加，而艾滋病毒感染者的服务已得到很好的建立。有人呼吁将艾滋病毒和非传染性疾病服务相结合，以提高效率并改善非传染性疾病护理的覆盖面，尽管其有效性的证据仍不清楚。在本次审查中，我们评估了东非国家的艾滋病毒和非传染性疾病国家政策在多大程度上反映了对艾滋病毒-非传染性疾病服务整合的呼吁。
在 2018 年 4 月至 2020 年 12 月期间，我们搜索了布隆迪、肯尼亚、卢旺达、南苏丹、坦桑尼亚和乌干达与艾滋病毒和非传染性疾病方案相关的政策、战略和指南。手动搜索文件以查找艾滋病毒和非传染性疾病服务整合计划。使用文件分析对数据进行了定性分析。
共筛选出 31 份文件，其中 13 份文件包含艾滋病毒和非传染性疾病服务整合行动计划。在东非地区的四个国家（肯尼亚、卢旺达、坦桑尼亚和乌干达）的高级别卫生政策和治疗指南中，建议综合提供艾滋病毒和非传染性疾病护理；主要涉及将非传染性疾病护理纳入艾滋病毒方案。非传染性疾病负担的增加，以及向艾滋病毒感染者提供以人为主导的差异化服务的转变，是最近采用艾滋病毒和非传染性疾病综合服务提供计划的一个因素。南苏丹和布隆迪都报告说，重点是建立他们的医疗保健基础设施，提高医疗保健的覆盖面和质量，而没有报告艾滋病毒和非传染性疾病护理整合的计划。
尽管有效性的证据有限，但一些东非国家已经朝着艾滋病毒和非传染性疾病服务整合迈出了一步。需要密切监测和评估综合艾滋病毒和非传染性疾病方案，以深入了解相关的利弊，并为未来的服务发展提供信息。
