McCombe Geoff, Lim Jayleigh, Hout Marie Claire Van, Lazarus Jeffrey V, Bachmann Max, Jaffar Shabbar, Garrib Anupam, Ramaiya Kaushik, Sewankambo Nelson K, Mfinanga Sayoki, Cullen Walter
University College Dublin, Dublin, IE.
Liverpool John Moores University, Liverpool, UK.
Int J Integr Care. 2022 Jan 31;22(1):6. doi: 10.5334/ijic.5839. eCollection 2022 Jan-Mar.
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. A scoping review mapped extant policy and evidence based literature on the feasibility of integrating NCD care with HIV in the region.
A scoping review methodology was utilised to conduct a systematic search of peer-reviewed and grey literature published in English language and with no date limitation. A systematic search was conducted on PubMed, Embase, CINAHL, and the Cochrane library. The initial search identified 231 records considered for inclusion in this review. Twelve duplicate records were removed. The remaining 219 records were screened by title and abstract of which 165 records were excluded and 54 records were selected for full-text review. A further 16 records were excluded due to a lack of relevance or the unavailability of the full text article. Finally, 38 were charted and analysed thematically.
Thirty-eight studies were included. These comprised a range of different models to integrate NCD and HIV care in the region, reflecting differences in health system environments, and disease epidemiology. The studies provide a variety of evidence that integration of HIV and NCD care can be feasible and can improve clinical effectiveness and identify barriers and facilitators to integration and task shifting. The review confirms that integrated HIV and NCD care services is by-and-large feasible, being both clinically effective and cost-effective.
The review may inform the understanding of how best to develop an integrated model of care service by reducing barriers to uptake, linkage and retention in HIV, diabetes and hypertension treatment in SSA countries.
尽管撒哈拉以南非洲地区（SSA）成年人中的艾滋病毒感染率仍然很高，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医疗系统提供非传染性疾病服务的能力，并扩大现有的慢性病管理途径。一项范围综述梳理了该地区将非传染性疾病护理与艾滋病毒护理相结合的可行性的现有政策和循证文献。
采用范围综述方法，对以英文发表且无日期限制的同行评审文献和灰色文献进行系统检索。在PubMed、Embase、CINAHL和Cochrane图书馆进行了系统检索。初步检索确定了231条记录供本综述纳入考虑。去除了12条重复记录。对其余219条记录进行标题和摘要筛选，排除165条记录，选择54条记录进行全文审查。由于缺乏相关性或无法获取全文，又排除了16条记录。最后，对38条记录进行了图表绘制和主题分析。
纳入了38项研究。这些研究包括一系列在该地区整合非传染性疾病和艾滋病毒护理的不同模式，反映了卫生系统环境和疾病流行病学的差异。这些研究提供了各种证据，表明艾滋病毒和非传染性疾病护理的整合是可行的，可以提高临床效果，并确定整合和任务转移的障碍及促进因素。该综述证实，艾滋病毒和非传染性疾病综合护理服务总体上是可行的，具有临床有效性和成本效益。
该综述可能有助于理解如何通过减少SSA国家在艾滋病毒、糖尿病和高血压治疗中的接受、联系和留存障碍，来最好地开发综合护理服务模式。
