Opportunities and Challenges for HIV/AIDS and Non-Communicable Diseases Integration: A Systematic Review of Different Models of Integrated Care

Abstract

It is evident that HIV and Non-Communicable diseases (NCD) programs often intersect. However, HIV services are stand alone and decentralized making it attractive to patients in peripheral facilities, and retaining them in care. In contrast, NCD care is provided using a centralised model, with the majority of care provided by hospitals. Patients have limited access and commonly present late with symptoms of complications. Therefore, HIV/NCD integration would strengthen the health systems capacity to address the full range of needs for HIV patients, at both the population and individual level. This systematic review explores the pertinent opportunities and challenges for HIV/NCD integration in comparison to different models of integrated care. Twenty studies with some conducted in America, Africa and Asia that heavily relied on primary data and implied that HIV/NCD integration increases the utilization of healthcare services and improve health outcomes were examined. Three studies reported increased utilization and improved outcomes through a population-based model of integrated care, however, reported challenges with linkage to care, loss to follow up and low levels of male involvement. Seventeen studies reported on individual models of integrated care which translated into impressive health outcomes including efficiency gains in staffing, increased coverage, improved medication adherence, and high rates of retention in care. One study reported on a case management approach that was found to be more effective when supporting integrated services for depressed HIV patients. The review findings show that intense efforts are needed to improve male involvement, invest in point of care technologies, reduce the return visit rates and provide streamlined care to reduce the loss to follow up for individual-based models of integrated care. There is diversity in integration models combining HIV and NCD services, and they have the potential in yielding positive patient and service delivery outcomes when implemented within appropriate contexts.