Integrated Management of Chronic Conditions: A one-stop clinic for HIV, Diabetes and Hypertension in Africa

Stakeholders attend the stakeholders' meeting to discuss preliminary results from the MOCCA study.

Stakeholders comprising policy makers, health care providers, researchers, and civil society discussed the preliminary findings and lessons learned from a pilot research project on integrating care for HIV and Non-Communicable Diseases (NCDs) in Africa.

Funded by the UK National Institute for Health Research (NIHR), the pilot research project; MOCCA (Management of Chronic Conditions in Africa) is coordinated by the MRC/UVRI & LSHTM Uganda Research Unit in partnership with Liverpool School of Tropical Medicine (UK), The AIDS Support Organization (TASO), National Institute for Medical Research (NMIR), Tanzania and the Ministries of Health (MoH) in Uganda and Tanzania. The study is being conducted in ten health facilities (five in Uganda and five in Tanzania). In Uganda, the study sites include four public health facilities; Kiswa and Kisugu health center III, Wakiso and Ndejje health centre IV and one not-for profit clinic (TASO) in Kampala and Wakiso districts.

Africa is undergoing a rapid health care transition. Non-Communicable (non-infectious) Diseases have risen rapidly in Africa and their control represents one of the biggest health challenges of our time. The chronic conditions of gravest concern are high blood pressure and high blood glucose, which together are responsible are 20% of all mortality globally. Unlike in high-income countries, in Africa, these conditions affect young-middle-aged adults across all socioeconomic classes. According to the survey by Prof Guwatude and others, about 20% of adults in Uganda have hypertension, and 5% of adults have diabetes. Of the adults diagnosed with diabetes, as little as 5% are thought to be in regular care.

Presenting the study progress and preliminary findings, Prof Moffat Nyirenda, Head of the NCD Theme (one of the Co-Principal Investigators) together with Dr Ivan Namakoola and Dr Josephine Birungi of MRC/UVRI & LSHTM Uganda Research Unit shared important lessons learned. They reported that a total of 1300 adults with either one, two or all three conditions of HIV, Diabetes and Hypertension have been enrolled over a six months’ period. Similar to previous research, preliminary findings from this pilot study indicate that hypertension and diabetes treatment services are poorly resourced, have problems with drug supply and inadequate adherence counseling support. They noted that it is important to clearly define the integrated chronic care package to the health care workers before implementation. “Integration of chronic care of HIV/NCDs cuts across all points of health care including health education, counseling, clinical review and dispensing as well as training of health care workers in use of various clinical care guidelines. Other areas to be considered during integration include records/data management, clinic re-organization including managing the waiting areas as well as drugs availability” reported Dr. Birungi.

Speaking at the meeting in Kampala, Dr Gerald Mutungi, the Program Manager for NCDs at the Ministry of Health drew attention to the increased mortality resulting from NCDs. “People who have both HIV and NCDs are more likely to die from NCDs than HIV related illnesses. We therefore need to curb the rising numbers of people getting NCDs”, he said.

Dr Joshua Musinguzi, the Assistant Commissioner and Head of the AIDS Control Programme (ACP) at the Ministry of Health applauded the research team and emphasized the importance of using existing systems and infrastructure to improve healthcare. “Using the existing HIV platforms to manage NCDs will improve the treatment outcomes as HIV is well resourced and has strong established care systems.” He added, “Solid experience has been acquired over the years in managing HIV as a chronic disease, and many of these practices could be applied for the effective management of diabetes and hypertension.”

He ended his remarks with a pledge to support the integration of chronic health care (HIV/NCDs) in Uganda’s healthcare system and emphasized the urgent need for more evidence to support policy change.

Next steps

MOCCA research project has informed a larger four-year European Commission-funded project called INTE-AFRICA that will study the scale up of integration and decentralisation of HIV, diabetes and hypertension care in over 80 health facilities in Uganda and Tanzania.

INTE-AFRICA is a collaborative research project between multiple partners including the Liverpool School of Tropical Medicine (LSTM), the MRC/UVRI & LSHTM Uganda Research Unit, and The AIDS Support Organisation (TASO Uganda), the National Institute for Medical Research (NIMR), Tanzania; and crucially the two Ministries of Health in Uganda (represented by Dr Gerald Mutungi and Dr. Joshua Musinguzi) and in Tanzania (represented by Dr Janneth Mghamba and Dr Sarah Maongezi). The collaboration also includes partners at various district levels, health managers and senior hospital managers.

In Europe, other partners include Barcelona Institute for Global Health (ISGlobal, Spain), the University of Bergen (Norway), the University College Dublin (Ireland), the University of East Anglia (UK) and the Liverpool John Moores University (UK).

As explained by Prof. Shabbar Jaffar of LSTM, “Building on the findings of the MOCCA study, INTE-AFRICA presents an opportunity for this international partnership to carry out further research that establishes the feasibility, acceptability, effectiveness and cost-effectiveness of integrating and decentralizing HIV, diabetes, and hypertension services in sub-Saharan Africa."

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