Department of Public Health, Aarhus University, Aarhus, Denmark.
Danish Non-communicable Diseases Alliance, Copenhagen, Denmark.
BMJ Open. 2021 Nov 16;11(11):e054629. doi: 10.1136/bmjopen-2021-054629.
INTRODUCTION: Antiretroviral therapy has reduced mortality and led to longer life expectancy in people living with HIV. These patients are now at an increased risk of non-communicable diseases (NCDs). Integration of care for HIV and NCDs has become a focus of research and policy. In this article, we aim to review patient perspectives on integration of healthcare for HIV, type 2 diabetes and hypertension. METHODS: The framework for scoping reviews developed by Arksey and O'Malley and updated by Peter was applied for this review. The databases PubMed, Web of Science and Cochrane library were searched. Broad search terms for HIV, NCDs (specifically type 2 diabetes and hypertension) and healthcare integration were used. As the review aimed to identify definitions of patient perspectives, they were not included as an independent term in the search strategy. References of included publications were searched for relevant articles. Titles and abstracts for these papers were screened by two independent reviewers. The full texts for all the publications appearing to meet the inclusion criteria were then read to make the final literature selection. RESULTS: Of 5502 studies initially identified, 13 articles were included in this review, of which 11 had a geographical origin in sub-Saharan Africa. Nine articles were primarily focused on HIV/diabetes healthcare integration while four articles were focused on HIV/hypertension integration. Patient's experiences with integrated care were reduced HIV-related stigma, reduced travel and treatment costs and a more holistic person-centred care. Prominent concerns were long waiting times at clinics and a lack of continuity of care in some clinics due to a lack of healthcare workers. Non-integrated care was perceived as time-consuming and more expensive. CONCLUSION: Patient perspectives and experiences on integrated care for HIV, diabetes and hypertension were mostly positive. Integrated services can save resources and allow for a more personalised approach to healthcare. There is a paucity of evidence and further longitudinal and interventional evidence from a more diverse range of healthcare systems are needed.
简介：抗逆转录病毒疗法降低了艾滋病毒感染者的死亡率，并延长了他们的预期寿命。这些患者现在面临着更高的非传染性疾病（NCD）风险。艾滋病毒与 NCD 护理的整合已成为研究和政策的重点。在本文中，我们旨在回顾患者对艾滋病毒、2 型糖尿病和高血压综合医疗的看法。
方法：我们采用了 Arksey 和 O'Malley 制定并经 Peter 更新的范围综述框架来进行本次综述。我们在 PubMed、Web of Science 和 Cochrane 图书馆中检索了数据库。广泛的艾滋病毒、非传染性疾病（特别是 2 型糖尿病和高血压）和医疗保健整合的搜索术语被用于检索。由于本次综述旨在确定患者观点的定义，因此它们并未作为独立术语包含在检索策略中。纳入出版物的参考文献也被用于检索相关文章。两位独立评审员对这些论文的标题和摘要进行了筛选。然后，阅读所有符合纳入标准的出版物的全文，以做出最终的文献选择。
结果：最初确定的 5502 项研究中，有 13 项研究被纳入本次综述，其中 11 项研究的地理起源在撒哈拉以南非洲。9 项研究主要关注艾滋病毒/糖尿病医疗保健的整合，而 4 项研究则关注艾滋病毒/高血压的整合。患者对综合护理的体验是减少与艾滋病毒相关的耻辱感、减少旅行和治疗费用以及更全面的以人为本的护理。突出的问题是诊所的候诊时间长，由于缺乏医护人员，一些诊所的护理连续性不足。非整合护理被认为既费时又昂贵。
结论：患者对艾滋病毒、糖尿病和高血压综合护理的看法和体验大多是积极的。综合服务可以节省资源，并允许对医疗保健采取更个性化的方法。证据不足，需要更多来自不同医疗保健系统的纵向和干预性证据。
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