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Van Hout, Marie Claire, Zalwango, Flavia, Akugizibwe, Mathias, Chaka, Moreen Namulundu, Birungi, Josephine, Okebe, Joseph, Jaffar, Shabbar, Bachmann, Max 
ORCID: https://orcid.org/0000-0003-1770-3506 and Murdoch, Jamie
(2023)
Implementing integrated care clinics for HIV-infection, diabetes and hypertension in Uganda (INTE-AFRICA): Process evaluation of a cluster randomised controlled trial.
BMC Health Services Research, 23.
ISSN 1472-6963
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Abstract
Background: Sub-Saharan Africa is experiencing a dual burden of chronic human immunodeficiency virus and non-communicable diseases. A pragmatic parallel arm cluster randomised trial (INTE-AFRICA) scaled up ‘one-stop’ integrated care clinics for HIV-infection, diabetes and hypertension at selected facilities in Uganda. These clinics operated integrated health education and concurrent management of HIV, hypertension and diabetes. A process evaluation (PE) aimed to explore the experiences, attitudes and practices of a wide variety of stakeholders during implementation and to develop an understanding of the impact of broader structural and contextual factors on the process of service integration. Methods: The PE was conducted in one integrated care clinic, and consisted of 48 in-depth interviews with stakeholders (patients, healthcare providers, policy-makers, international organisation, and clinical researchers); three focus group discussions with community leaders and members (n = 15); and 8 h of clinic-based observation. An inductive analytical approach collected and analysed the data using the Empirical Phenomenological Psychological five-step method. Bronfenbrenner’s ecological framework was subsequently used to conceptualise integrated care across multiple contextual levels (macro, meso, micro). Results: Four main themes emerged; Implementing the integrated care model within healthcare facilities enhances detection of NCDs and comprehensive co-morbid care; Challenges of NCD drug supply chains; HIV stigma reduction over time, and Health education talks as a mechanism for change. Positive aspects of integrated care centred on the avoidance of duplication of care processes; increased capacity for screening, diagnosis and treatment of previously undiagnosed comorbid conditions; and broadening of skills of health workers to manage multiple conditions. Patients were motivated to continue receiving integrated care, despite frequent NCD drug stock-outs; and development of peer initiatives to purchase NCD drugs. Initial concerns about potential disruption of HIV care were overcome, leading to staff motivation to continue delivering integrated care. Conclusions: Implementing integrated care has the potential to sustainably reduce duplication of services, improve retention in care and treatment adherence for co/multi-morbid patients, encourage knowledge-sharing between patients and providers, and reduce HIV stigma. Trial registration number: ISRCTN43896688.
| Item Type: | Article |
|---|---|
| Additional Information: | Funding information: The INTE-AFRICA project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 825 698. |
| Uncontrolled Keywords: | diabetes,hiv,hypertension,integrated care,non-communicable disease,uganda,health policy,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2719 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Centres > Population Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 12 Oct 2023 00:43 |
| Last Modified: | 19 Oct 2023 03:40 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/93267 |
| DOI: | 10.1186/s12913-023-09534-0 |
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