National Institute for Medical Research, Dar-Es-Salaam, Tanzania.
Kings College London, London, England, UK.
BMC Health Serv Res. 2023 Oct 19;23(1):1120. doi: 10.1186/s12913-023-10123-4.
The rising prevalence of non-communicable diseases (NCDs) alongside the continuing high burden of HIV poses a serious challenge to middle- and low-income countries' healthcare systems. Pilot studies of integrated models of service delivery for HIV, hypertension and diabetes have demonstrated that they are feasible and acceptable among patients and care providers. This study assessed multi-stakeholders' perspectives of the delivery and receipt of integrated care in Tanzania.
A qualitative process evaluation was conducted in Dar es Salaam region of Tanzania where the integrated service delivery model was implemented from July to November 2021. In-depth interviews were held with seven key informants at the national, regional and district levels, eight healthcare providers, two researchers working at the integrated clinic and forty patients benefiting from integrated services at a large hospital. Three focus group discussions were held with community leaders and residents of the hospital's catchment area, and clinic level observations were conducted. Thematic analysis was conducted followed by the use of Bronfenbrenner's ecological model to identify factors pertinent to sustaining and scaling up of the integrated model.
Participants of the study at all levels were aware of the increased prevalence of NCDs specifically for hypertension and diabetes and were concerned about the trend of increasing co-morbid conditions among people living with HIV (PLHIV). The integrated service delivery model was positively perceived by stakeholders because of its multiple benefits for both patients and the healthcare system. These include stigma and discrimination reduction, improved quality of care, efficient use of limited resources, cost and time saving, reduced duplication of services and fostering of early detection for undiagnosed conditions. The organisation of the clinic was critical in increased satisfaction. Several challenges were observed, which included costs for NCD services relative to free care for HIV and inconsistent availability of NCD medications.
Stakeholders reported numerous benefits of the integrated service delivery model that are fundamental in improving the health of many Tanzanians living with NCDs and HIV. These benefits highlight the need for policy and decision-makers to sustain and expand the integrated service delivery model as a solution to many challenges facing the health system especially at the primary care level.
随着非传染性疾病（NCDs）的发病率不断上升，以及艾滋病毒的负担持续居高不下，中低收入国家的医疗保健系统面临着严峻挑战。针对艾滋病毒、高血压和糖尿病的综合服务提供模式的试点研究表明，这些模式在患者和医护人员中是可行且可接受的。本研究评估了坦桑尼亚多方利益攸关者对综合护理提供和接受的看法。
在坦桑尼亚达累斯萨拉姆地区开展了一项定性过程评估，该地区于 2021 年 7 月至 11 月实施了综合服务提供模式。在国家、地区和地区各级与 7 名利益攸关方进行了深入访谈，与 8 名医疗保健提供者、在综合诊所工作的 2 名研究人员以及在一家大医院接受综合服务的 40 名患者进行了访谈。与医院服务范围内的社区领导和居民举行了 3 次焦点小组讨论，并对诊所层面进行了观察。进行了主题分析，并使用 Bronfenbrenner 生态模型来确定与维持和扩大综合模式相关的因素。
各级研究参与者都意识到 NCD 特别是高血压和糖尿病的发病率增加，并对艾滋病毒感染者（PLHIV）中合并病症增多的趋势感到担忧。由于该综合服务提供模式对患者和医疗保健系统都有多重益处，因此利益攸关方对此模式持积极态度。这些益处包括减少污名化和歧视、提高护理质量、高效利用有限资源、节省成本和时间、减少服务重复和促进对未确诊疾病的早期发现。诊所的组织对提高满意度至关重要。观察到了一些挑战，包括 NCD 服务的成本相对于艾滋病毒的免费护理较高，以及 NCD 药物的供应不一致。
利益攸关方报告了综合服务提供模式的许多益处，这些益处对于改善许多患有 NCD 和艾滋病毒的坦桑尼亚人的健康状况至关重要。这些益处强调了政策制定者和决策者维持和扩大综合服务提供模式的必要性，这是解决卫生系统面临的许多挑战的一个办法，特别是在初级保健层面。
