What happens to NCD care when HIV-care is integrated into Primary Health Care Clinics? Read more to find out.
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Abstract:Background: Non-communicable diseases (NCDs), specifically diabetes and hypertension, are rising in high-HIV burdened countries like South Africa. How integrated HIV-care into primary health care (PHC) influences NCD care is unknown. We aimed to understand whether differences existed in NCD care (pre versus post-integration) and how changes may relate to HIV patient numbers. Setting: Public-sector PHC clinics in Free State, South Africa METHODS:: Using a quasi-experimental design, we analysed monthly administrative data on four indicators for diabetes and hypertension (clinic and population levels) during four years as HIV-integration was implemented in PHC. Data represented 131 PHC clinics (PHCCs) with a catchment population of 1.5 million. We utilised interrupted time series analysis at ±18 and ±30 months from HIV integration in each clinic to identify changes in trends post-integration compared to pre-integration. We utilised linear mixed effect models to study relationships between HIV and NCD indicators. Results: Patients receiving ART in the 131 PHC clinics studied increased from 1614 (April 2009) to 57, 958 (April 2013). Trends in new diabetes patients on treatment remained unchanged. However, population level new hypertensives on treatment decreased at ±30 months from integration by 6/100, 000 (SE=3,p<0.02) and was associated with the number of new HIV patients on treatment at the clinics. Conclusion: Our findings suggest that during the implementation of integrated HIV-care into PHCCs care for hypertensive patients could be compromised. Further research is needed to understand determinants NCD care in South Africa and other high HIV-burdened settings to ensure patient-centred PHC.
In primary care arizona they have a separate for HIV care and since they are leading primary clinic, they know what arrangement they will do to their patience.
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