Global Health Research Group on Prevention & Management of Non-Communicable Diseases and HIV infection in Africa
In Africa, the burden of non-communicable diseases has risen sharply alongside a continuing high burden of infectious diseases.
Deaths attributed to NCDs are expected to overtake deaths from infectious causes within the next 10-20 years.
The control of NCDs, therefore, represents one of the biggest health challenges of our time
Raised blood pressure is the leading cause of deaths worldwide and raised blood glucose is the 3rd leading cause of death. Diabetes and hypertension need lifelong treatment. If they are not treated, then people with these conditions will go on to develop serious medical conditions, such as cardiovascular disease, kidney disease, blindness, and foot ulcers that do not heal.
In Africa, the age at which these conditions occur is younger than in high-income countries and so the consequences of poor control of these conditions is grave, causing deaths and poor health in many people of prime working age. Treating these conditions and their complications incurs high costs for the health service, and for patients both from the costs of accessing care and from income lost from the inability to work.
Diabetes and hypertension are probably the most easily treatable and preventable of all of the non-communicable diseases. These are our focus.
HIV has been transformed from a deadly infectious disease to a chronic condition through HIV treatment programmes. Today in Africa, over 60% of all people estimated to be living with HIV-infection are in care and many will have a near normal lifespan.
Unlike for HIV, the coverage of services for NCDs remains low across Africa. In particular, drug supplies for conditions such as hypertension and diabetes are limited on the continent, and there is a lack of trained health care workers to manage patients with these conditions. It is estimated that only 5% of persons with diabetes are in regular care and the number is probably similar for hypertension.
What we will do
Preliminary findings from our pilot studies suggest support for integration of services from both health care providers and patients but this needs confirmation in a larger study with follow-up over a longer-term.
We are taking a broad approach to understanding integration. We are using epidemiological methods and clinical trials to quantify the clinical effects of integration and social science methods to explore how patients and healthcare workers perceive and experience integrated care. We will also provide evidence on the costs and cost-effectiveness of the integrated interventions; and how vertical HIV programmes can best adapt to serving additional co-morbidities. It has been argued that integrating NCDs into HIV screening and treatment may reduce HIV stigma (a persistent barrier to improving HIV public health outcomes) – we will study this further.
Integration cuts across all points of health care. Other areas to be explored during the integration studies include clinical and counselling services, referral systems, records and data management, health worker training and support, clinic re-organisation including managing the waiting areas and drugs supply management.
There is much that we don’t understand about chronic diseases in Africa. Data on how these conditions present and develop over time is limited. This lack of information limits the development of appropriate identification, prevention and treatment strategies for Africa. We will be looking to develop long term cohorts of persons with chronic disease to broaden our understanding of these conditions and provide policy-relevant data.
Increasing coverage of services for diabetes and hypertension will be challenging for African health authorities. We have an opportunity to learn from and use the platforms developed for HIV-infection. However, we don’t know about the effects (beneficial or harmful) of integrating services for NCDs and HIV-infection. For this reason, rigorous research is needed first before embarking on a re-organisation of health care delivery on the continent.
Using our experience and rigorous research we are confident that, as a partnership, we can provide evidence of what will work to meet the global challenge that NCDs present.
Current research projects
This research was commissioned by the National Institute for Health Research (NIHR) using UK aid from the UK Government. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
The INTE-AFRICA project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 825698.