African patients suffering from chronic diseases such as diabetes and hypertension are facing neglect, according to scientists, with less than half of those who start treatment remaining in care one year later. Consequently, approximately two million premature deaths occur each year, yet the burden of chronic conditions and multi-morbidity is increasing in Africa.

In a new study in Tanzania and Uganda, scientists showed that integrated healthcare for chronic high-burden conditions in Sub-Saharan Africa is feasible and health services could deliver high-quality services for less cost than with the current approach of separate vertical care for each condition.

The team has come up with a blueprint highlighting the crucial need to reorganise Africa’s health systems to maximise limited resources.

The study, called INTE-Africa (Integrating and decentralising HIV, diabetes and hypertension services in Africa), is rooting for integrated chronic care in Africa, saying it has the potential to improve outcomes and save money.

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The platform hopes to draw lessons from HIV healthcare programmes.

Lower costs

The paper, published in The Lancet, last week, notes that the average monthly provider cost per participant was lower in the integrated care arm for participants with multiple conditions.

“Savings were driven by reduced staffing and overhead costs associated with reduced number of total visits required by patients with multiple morbidities,” it notes.

Presently, health care services for NDCs such as diabetes and hypertension are fragmented and the quality of care is inequitable when compared with services for HIV, said the scientists. The vast majority of people living with HIV are in regular care and virally suppressed, with mortality rates having fallen more than five-fold from a peak of two million deaths annually in the early 2000s, to less than 500,000 in 2022.

Katie Dain, CEO of the non-communicable conditions (NDCs) Alliance, said: “We need the same powerful and coordinated global response to tackle NCDs that we’ve seen for HIV. We know how to do this, and this time, we can build on existing infrastructure. Integrated care is a win-win opportunity.”

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The World Health Organisation recommended integration of diabetes and hypertension care with HIV services in 2021, but at the time there was limited data on outcomes. This study supports the recommendation.

“Our study provides clear evidence for policymakers to consider scale up of integrated care for HIV, diabetes and hypertension,” said Prof Tumaini Nagu, Chief Medical Officer of Tanzania.

With the high burden of non-communicable conditions (NDCs) now in Africa, and more and more people living with multiple chronic conditions, integrated management will be an essential and cost-effective approach for the continent,” said Professor Tumaini Nagu, Chief Medical Officer of Tanzania.

Director of the World Health Organisation Department of Global HIV, Hepatitis and STI Programmes, Dr Meg Doherty, noted “This has the potential to change policy and practice. It is the first study to test successfully the concept of a fully integrated one-stop clinic for people with HIV or NDCs, with excellent HIV and NDCs outcomes. It is exciting to see that by including hypertension and diabetes screening and care into the HIV clinic in these two countries, it did not affect HIV viral load suppression outcomes.”