World AIDS Day has taken place every year on December 1st since its inception in 1988. On this international day dedicated to raising funds and awareness for the HIV/AIDS pandemic, supporting those who have personally been affected by the illness, and remembering those who have died because of it, there is also cause for hope. Successful implementation of health services for HIV/AIDs in sub-Saharan Africa has offered a valuable framework and opportunity for confronting other health challenges in the region through the integration of multiple services and leveraging of existing ones.
For the last ten years, African health services have encountered an equal or higher burden of chronic conditions, such as diabetes and hypertension, compared to previous years in which they primarily faced acute infections, such as tuberculosis (TB), malaria, and the opportunistic infections/conditions due to HIV infection. These chronic conditions, like HIV-infection, require regular and lifelong treatment, necessitating that those affected have accessible and affordable access to healthcare.
Diabetes and hypertension lead to serious clinical complications including heart attacks, stroke and kidney disease and like HIV/AIDS, require lifelong treatment and management. Previously, health services in Africa had to maintain their focus and resources on infectious diseases. Thus, they are relatively ill-equipped to provide adequate health services for the diagnosis and management of these noncommunicable diseases (NCDs) – only 10-20% of people living with diabetes or hypertension are estimated to be in regular care. Additionally, NCD funding from abroad is limited in comparison to funding for HIV treatment and care, despite NCDs causing 60% of global disability-adjusted life-years (DALYs) and HIV causing 3%.
Successful implementation of health services for HIV/AIDs in sub-Saharan Africa has offered a valuable framework and opportunity for confronting other health challenges in the region through the integration of multiple services and leveraging of existing ones.
Identifying efficient cost-effective approaches to increase access to health services for the management of diabetes and hypertension for populations in Africa, therefore, represents one of the greatest public health challenges of our time. The INTE-AFRICA (Integrating and Decentralising HIV, diabetes and hypertension services in Africa) project is the first of its kind and aims to test the efficacy of integrating diabetes and hypertension services alone, or together with HIV-infection services, in two sub-Saharan African countries: Tanzania and Uganda. The severe absence of clinically skilled healthcare staff across Africa combined with stand-alone services are among the biggest factors behind the very low coverage of diabetes and hypertension services and the reason why integration with HIV services could make care more efficient, resulting in better outcomes for patients. The results from this large trial are expected to be relevant and applicable to other conditions and other sub-Saharan African countries.
In addition to contributing to the evidence on efficacy and cost-effectiveness of such a large-scale intervention as this one, INTE-AFRICA will provide services and care for people with diabetes or hypertension who may not have known they were affected, or who were not previously able to access care.
As health researchers, we are part of the community that must seek to address greater to access to care for chronic diseases such as diabetes and hypertension. The INTE-AFRICA project strives to evaluate integrated prevention and management of HIV-infection, diabetes and hypertension in Uganda and Tanzania, and to use the findings to support the greater integration and implementation of diabetes and hypertension services in sub-Saharan Africa and around the world.
INTE-AFRICA is coordinated by the Liverpool School of Tropical Medicine (LSTM, UK), in collaboration with the National Institute for Medical Research NIMR, (Tanzania), the MRC & LSHTM Uganda Research Unit (Uganda), and The Aids Support Organisation (TASO Uganda), the 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).