A new healthcare paradigm: Integrating noncommunicable diseases in the HIV response

Integrating noncommunicable disease (NCD) health services for people living with HIV delivers significant returns on investment and better health outcomes for patients, according to the new report Spending Wisely: Exploring the economic and societal benefits of integrating HIV/AIDS and NCDs service Delivery, launched today ahead of the Global Week for Action on NCDs by the NCD Alliance and RTI International.

It is a sad irony of the success of the HIV response in many parts of the world that people living with the virus are now faced with a higher prevalence of NCDs than adults without HIV. People living with HIV are living longer thanks to access to antiretroviral medication (ART). In certain nations, more than half of those with HIV also have non-communicable diseases (NCDs), partly because they live longer and partly because their condition puts them at higher risk for certain NCDs.

The Spending Wisely report identifies studies describing 28 HIV-NCD programs in 16 countries in Africa and Asia. It shows that integrated programs can deliver wider health impact than standalone care delivery. Via clinical, functional, and organizational support, integrated programs can improve NCD outcomes while sustaining or improving HIV outcomes. Furthermore, these programs are more efficient for patients and health systems. People living with NCDs gain significant economic benefits from synchronized care visits, with care offered closer to their homes. For health systems, the additional cost of integrating care for NCDs is marginal compared to the health outcomes that the programs generate.

“The reality on the ground in regions such as Sub-Saharan Africa is that for a person living with HIV having access to treatment and care for other chronic conditions like diabetes or hypertension is just as important as receiving antiretroviral drugs,” said Monika Arora, President of the NCD Alliance. “This report makes the economic and societal case for how we might begin to reconfigure national and sub-national responses to infectious diseases such as HIV that more accurately reflect emerging disease burdens in low- and middle-income countries, which is something that will also be vital for achieving 2030 Sustainable Development Goals (SDG) health and development targets.”

There are four main co-morbidities to HIV in low- and middle-income countries (LIMCs): cardiovascular disease (CVD), depression, diabetes, and cancer. Globally, as many as one in four people living with HIV are estimated to have moderate to severe depression, one in five have one or more modifiable risk factor for developing cardiovascular disease, and cervical cancer prevalence amongst women living with HIV is six times higher than for women without HIV.

The report describes the results of a systematic literature review to identify HIV-NCD service delivery integration models in LIMCs, and to assess their costs, impact, and cost-effectiveness. It found evidence on the types of models deployed to integrate service delivery, the impact of HIV-NCD programs on a range of clinical and nonclinical outcomes, and the costs of implementation from patient and/or healthcare system perspectives. Highlights of the report include:

  • 79% percent of programs reported favorable and significant outcomes on at least half of the outcomes that they measured.
  • 11 of 13 programs assessing both NCD and HIV-related outcomes reported improvements to -or maintenance of- HIV outcomes and positive NCD outcomes.
  • Programs targeting depression were highly successful, achieving favorable results in 10 out of 13 measured outcomes.

The NCD Alliance commissioned RTI International to develop the report with support from Viatris. The report concludes with a series of recommendations to governments, donors, and researchers to generate continued momentum for integrated service delivery to fulfill its role as a key contributor to achieving Universal Health Coverage (UHC) and SDG goals worldwide.

Over 20 per cent of the world’s eight billion people live with at least one NCD such as cancer, diabetes or heart disease. Each year NCDs cause 41 million deaths and drive millions of households into poverty. It has been projected that by 2030, NCD deaths could reach 52 million per year, adding a significant burden to communities and health systems. This number is being driven upward by a growing population and by ever-increasing exposure to risk factors like unhealthy diets, tobacco, alcohol, and air pollution.

Publication of the report comes just one week ahead of the Global Week for Action on NCDs which begins on 14 September and brings together civil society organisations and individuals around the world in calling on governments to ensure that everyone has access to quality healthcare, regardless of their ability to pay, where they live or who they are. This must include care for NCDs.

A virtual event co-hosted by the World Health Organization, the World Diabetes Foundation and the NCD Alliance: “Towards achieving Universal Health Coverage: Multistakeholder Gathering on Tackling Noncommunicable Diseases” will explore the cross-cutting actions to strengthen the prevention and control of NCDs and mental health issues. This webinar will be held at the start of the Global Week for Action—14 September, from 13.00-15.00 CEST and will feature the launch of the “WHO Global Mapping Report on Multisectoral Actions to Strengthen the Prevention and Control of NCDs and Mental Health”. It will be simultaneously translated into Spanish and French.

This year’s Global Week for Action on NCDs falls on the same day as the UN High-Level Meeting (HLM) on UHC, which gives governments the chance to decide on concrete steps to fulfill the commitment that all world leaders previously committed to achieve UHC by 2030. Currently, only a portion of the world’s population has access to all necessary health care. Most of them are residents of LMICs.

This article has been posted by a News Hour Correspondent. For queries, please contact through [email protected]
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