IPCHS. Integrated People-Centred Health Services

Contents

Contents tagged: hiv

April 27, 2016 Africa Publication

People-centred health systems, a bottom-up approach: where theory meets empery

BACKGROUND AND METHODS:

Health systems are complex and constantly adapt to changing demands. These complex-adaptive characteristics are rarely considered in the current bureaucratic top-down approaches to health system reforms aimed to constrain demand and expenditure growth. The economic focus fails to address the needs of patients, providers and communities, and ultimately results in declining effectiveness and efficiency of the health care system as well as the health of the wider community. A needs-focused complex-adaptive health system can be represented by the 'healthcare vortex' model; how to build a needs-focused complex-adaptive health system is illustrated by Eastern Deanery AIDS Relief Program approaches in the poor neighbourhoods of Nairobi, Kenya.

FINDINGS AND CONCLUSIONS:

A small group of nurses and community health workers focused on the care of terminally ill HIV/AIDS patients. This work identified additional problems: tuberculosis (TB) was underdiagnosed and undertreated, a local TB-technician was trained to run a local ...

July 12, 2017 Global Publication

Interventions and approaches to integrating HIV and mental health services: a systematic review

The main key messages of this article are:

  • Available literature on interventions integrating HIV and mental health services reveal that there is much diversity in the approaches adopted in combining treatment modalities; ranging from integration within a single facility, to multi-facility integration, and integrated care coordinated by non-physician case managers.

  • Existing evidence, although limited, suggest that integrating HIV and mental health services may be linked to improved patient and service delivery outcomes in diverse settings.

  • There is a need for higher quality and robustly designed studies to evaluate and compare integration models at different levels of service delivery in terms of long-term impact on patient outcomes and cost-effectiveness, particularly in low- and middle-income countries with high HIV and AIDS burden.

July 25, 2017 Africa Publication

Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa

mHealth has been proposed to address inefficiencies in the current South African healthcare system, including home-based HIV testing and counseling (HTC) programs. Yet wide-scale adoption of mHealth has not occurred. Even as infrastructure barriers decrease, a need to better understand perceived adoption barriers by skateholders remains. 

Nov. 26, 2019 Africa News

Release of USAID ASSIST publications on promoting IPCHS in Mali and South Africa

The Integrated Health Services (formerly Service Delivery and Safety) department has collaborated with the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project to contribute to the development of integrated and people-centred health services (IPCHS) in different contexts and settings, including South Africa and Mali.

In Mali, work to improve the adoption of people-centred approaches in clinical consultations by health providers during pregnancy and delivery has been undertaken in collaboration with the Ministry of Health. In South Africa, collaboration has focused on HIV, and specifically, on how to promote patient-centredness in HIV services.


Reports describing both collaborations have been recently released.

Access the South Africa report here >>

Access the Mali report here >>

Jan. 13, 2020 Europe Publication

Tuberculosis, HIV, and viral hepatitis diagnostics in eastern Europe and central Asia: high time for integrated and people-centred services

The international medical journal, The Lancet, has published an article demonstrating the benefits of integrated and people-centred services in responding to the rise of HIV, tuberculosis (TB) and viral hepatitis in eastern European and central Asian countries of the WHO European Region.

 

July 3, 2020 Africa Publication

Context matters: a qualitative study of the practicalities and dilemmas of delivering integrated chronic care within primary and secondary care settings in a rural Malawian district

With the increasing double burden of communicable and non-communicable diseases (NCDs) in sub-Saharan Africa, health systems require new approaches to organise and deliver services for patients requiring long-term care. There is increasing recognition of the need to integrate health services, with evidence supporting integration of HIV and NCD services through the reorganisation of health system inputs, across system levels. This study investigates current practices of delivering and implementing integrated care for chronically-ill patients in rural Malawi, focusing on the primary level.

Sept. 30, 2020 Africa Publication

Opportunities and challenges to integrating mental health into HIV programs in a lowand middle-income country: insights from the Nigeria implementation science Alliance

In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes. This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria.

Nov. 7, 2020 Africa Publication

Community-based antiretroviral therapy versus standard clinic-based services for HIV in South Africa and Uganda (DO ART): a randomised trial

Maintaining high levels of adherence to antiretroviral therapy (ART) is a challenge across settings and populations. Understanding the relative importance of different barriers to adherence will help inform the targeting of different interventions and future research priorities.

Community-based delivery of antiretroviral therapy (ART) for HIV, including ART initiation, clinical and laboratory monitoring, and refills, could reduce barriers to treatment and improve viral suppression, reducing the gap in access to care for individuals who have detectable HIV viral load, including men who are less likely than women to be virally suppressed. The aim to test the effect of community-based ART delivery on viral suppression among people living with HIV not on ART.

An unblinded, home-randomized trial (DO ART) of community-based ART administration compare with the clinic in rural and peri-urban settings in KwaZulu-Natal, South Africa and Sheema District, Uganda.

Nov. 15, 2021 Africa Publication

Integrating diabetes, hypertension and HIV care in sub-Saharan Africa: a Delphi consensus study on international best practice

Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. This study highlights the outcomes which may form key components of future complex interventions to define a model of integrated healthcare delivery for diabetes, hypertension and HIV in sub-Saharan Africa.

Nov. 19, 2021 Africa Publication

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

ntiretroviral therapy has reduced mortality and led to longer life expectancy in people living with HIV. These patients are now at an increased risk of non-communicable diseases (NCDs). Integration of care for HIV and NCDs has become a focus of research and policy. In this article, we aim to review patient perspectives on integration of healthcare for HIV, type 2 diabetes and hypertension. Patient perspectives and experiences on integrated care for HIV, diabetes and hypertension were mostly positive. Integrated services can save resources and allow for a more personalised approach to healthcare. 

Nov. 26, 2021 Global Publication

Integrating Sexual and Reproductive Health Services Within HIV Services: WHO Guidance

The World Health Organization (WHO) recommends that sexual and reproductive health services, including contraception, may be integrated within HIV services. Integration is associated with increased offers and uptake of sexual and reproductive health services, including contraception, which is likely to result in improved downstream clinical outcomes. Integrating HIV and sexual and reproductive health services has been found to improve access, the quality of antenatal care and nurse productivity while reducing stigma and without compromising uptake of care. 

Feb. 2, 2022 Africa Publication

Integrating Care for Diabetes and Hypertension with HIV Care in Sub-Saharan Africa: A Scoping Review

 Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. A scoping review mapped extant policy and evidence based literature on the feasibility of integrating NCD care with HIV in the region.

Feb. 14, 2022 Africa Publication

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Abstract


Health policies in Africa are shifting towards integrated care services for chronic conditions, but in parts of Africa robust evidence on effectiveness is limited. We assessed the integration of vertical health services for HIV, diabetes and hypertension provided in a feasibility study within five health facilities in Uganda. From November 2018 to January 2020, we conducted a series of three in-depth interviews with 31, 29 and 24 service users attending the integrated clinics within Kampala and Wakiso districts. Ten healthcare workers were interviewed twice during the same period. Interviews were conducted in Luganda, translated into English, and analysed thematically using the concepts of availability, affordability and acceptability. All participants reported shortages of diabetes and hypertension drugs and diagnostic equipment prior to the establishment of the integrated clinics. These shortages were mostly addressed in the integrated clinics through a drugs buffer. Integration did not affect the already good provision of ...

March 14, 2022 Global Publication

The Effect of Integration of Family Planning Into HIV Services on Contraceptive Use Among Women Accessing HIV Services in Low and Middle-Income Countries: A Systematic Review

There is substantial unmet need for family planning (FP) among women living with HIV (WLHIV), leading to unintended pregnancies and may contribute indirectly to increasing the risk of transmission of HIV. This review aims to determine whether integration of FP into HIV testing and care results in increased use of contraception, a reduction in unmet need for FP, improved use of safer conception methods and a reduction in unintended pregnancies in low and middle-income countries. The primary outcome of the review was contraceptive uptake and secondary outcomes included unmet need for FP, safer conception and unintended pregnancy.

May 17, 2022 Africa Publication

The acceptability of integrated healthcare services for HIV and non-communicable diseases: experiences from patients and healthcare workers in Tanzania

In sub-Saharan Africa, the prevalence of non-communicable diseases (NCDs) has risen sharply amidst a high burden of communicable diseases. An integrated approach to HIV and NCD care offers the potential of strengthening disease control programmes. We used qualitative methods to explore patients’ and care-providers’ experiences and perspectives on the acceptability of integrated care for HIV-infection, diabetes mellitus (DM), and hypertension (HT) in Tanzania.

May 19, 2022 Africa Publication

Family Planning Experiences and Needs of Young Women Living With and Without HIV Accessing an Integrated HIV and SRH Intervention in Zimbabwe-An Exploratory Qualitative Study

People living with HIV have higher unmet family planning needs compared to those without HIV. This is heightened for young people. However, the provision of family planning for young people within HIV programmes is uncommon. We investigated family planning uptake, acceptability of, and engagement with a service offering integrated HIV and sexual and reproductive health services for youth in a community-based setting in Zimbabwe.

Recommendations for an HIV and family planning integrated service for young people living with HIV include: offering a range of services (including method-mix contraceptives) to choose from; supporting their agency to engage with the services which are most acceptable to them; and providing trained, supportive, knowledgeable, and non-judgmental health providers who can provide accurate information and counsel. We recommend youth-friendly, differentiated, person-centered care that recognize the multiple and intersecting needs of young people living with HIV.