University College Dublin, Dublin, Ireland.
Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
BMC Health Serv Res. 2021 Nov 15;21(1):1235. doi: 10.1186/s12913-021-07073-0.
BACKGROUND: Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. The aim of this study was to identify key components, outcomes, and best practice in integrated service provision for the prevention, identification and treatment of HIV, hypertension and diabetes. METHODS: An international, multi stakeholder e-Delphi consensus study was conducted over two successive rounds. In Round 1, 24 participants were asked to score 27 statements, under the headings 'Service Provision' and 'Benefits of Integration', by importance. In Round 2, the 16 participants who completed Round 1 were shown the distribution of scores from other participants along with the score that they attributed to an outcome and were asked to reflect on the score they gave, based on the scores of the other participants and then to rescore if they wished to. Nine participants completed Round 2. RESULTS: Based on the Round 1 ranking, 19 of the 27 outcomes met the 70% threshold for consensus. Four additional outcomes suggested by participants in Round 1 were added to Round 2, and upon review by participants, 22 of the 31 outcomes met the consensus threshold. The five items participants scored from 7 to 9 in both rounds as essential for effective integrated healthcare delivery of health services for chronic conditions were improved data collection and surveillance of NCDs among people living with HIV to inform integrated NCD/HIV programme management, strengthened drug procurement systems, availability of equipment and access to relevant blood tests, health education for all chronic conditions, and enhanced continuity of care for patients with multimorbidity. CONCLUSIONS: This study highlights the outcomes which may form key components of future complex interventions to define a model of integrated healthcare delivery for diabetes, hypertension and HIV in sub-Saharan Africa.
背景：尽管艾滋病毒在撒哈拉以南非洲（SSA）的成年人中仍然高发，但糖尿病和高血压等非传染性疾病（NCD）的负担正在迅速增加。迫切需要扩大 SSA 医疗保健系统的能力，以提供 NCD 服务并扩大现有的慢性护理管理途径。本研究的目的是确定预防、识别和治疗艾滋病毒、高血压和糖尿病的综合服务提供的关键组成部分、结果和最佳实践。
方法：进行了一项国际、多利益相关者电子德尔菲共识研究，分为两轮进行。在第一轮中，24 名参与者被要求根据重要性对“服务提供”和“整合效益”标题下的 27 项陈述进行评分。在第二轮中，完成第一轮的 16 名参与者展示了其他参与者的分数分布以及他们赋予某个结果的分数，并被要求根据其他参与者的分数来反思他们给出的分数，然后根据他们的意愿重新评分。有 9 名参与者完成了第二轮。
结果：根据第一轮排名，27 项结果中有 19 项达到了 70%的共识阈值。在第一轮中由参与者提出的另外 4 项结果被添加到第二轮中，经过参与者审查，31 项结果中有 22 项达到了共识阈值。在两轮中，参与者都将 5 项评分从 7 到 9 的项目评为有效综合医疗保健服务提供慢性病健康服务的重要组成部分，包括改善艾滋病毒感染者的 NCD 数据收集和监测以告知综合 NCD/HIV 项目管理、加强药物采购系统、提供设备和获得相关血液检查、对所有慢性病进行健康教育以及增强患有多种疾病的患者的护理连续性。
结论：本研究强调了可能成为未来综合干预措施关键组成部分的结果，以确定撒哈拉以南非洲地区糖尿病、高血压和艾滋病毒综合医疗保健服务的提供模式。
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