Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD–HIV model
Objectives Non-communicable diseases (NCDs) account for one-third of disability-adjusted life years in Malawi, and access to care is exceptionally limited. Integrated services with HIV are widely recommended, but few examples exist globally. We report descriptive outcomes from an Integrated Chronic...
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| Format: | Article |
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BMJ Publishing Group
2020-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/10/e036836.full |
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| author | Gene Bukhman Luckson Dullie Emily B Wroe Elizabeth L Dunbar Noel Kalanga Lawrence Nazimera Natalie F Price Adarsh Shah Bright Mailosi Grant Gonani Enoch P L Ndarama George C Talama Lila Kerr Emilia Connolly Chiyembekezo Kachimanga |
| author_facet | Gene Bukhman Luckson Dullie Emily B Wroe Elizabeth L Dunbar Noel Kalanga Lawrence Nazimera Natalie F Price Adarsh Shah Bright Mailosi Grant Gonani Enoch P L Ndarama George C Talama Lila Kerr Emilia Connolly Chiyembekezo Kachimanga |
| author_sort | Gene Bukhman |
| collection | DOAJ |
| description | Objectives Non-communicable diseases (NCDs) account for one-third of disability-adjusted life years in Malawi, and access to care is exceptionally limited. Integrated services with HIV are widely recommended, but few examples exist globally. We report descriptive outcomes from an Integrated Chronic Care Clinic (IC3).Design This is a retrospective cohort study.Setting The study includes an HIV–NCD clinic across 14 primary care facilities in the rural district of Neno, Malawi.Participants All new patients, including 6233 HIV–NCD diagnoses, enrolled between January 2015 and December 2017 were included. This included 3334 patients with HIV (59.7% women) and 2990 patients with NCD (67.3% women), 10% overall under age 15 years.Interventions Patients were seen at their nearest health centre, with a hospital team visiting routinely to reinforce staffing. Data were collected on paper forms and entered into an electronic medical record.Primary and secondary outcome measures Routine clinical measurements are reported at 1-year post-enrolment for patients with more than one visit. One-year retention is reported by diagnosis.Results NCD diagnoses were 1693 hypertension, 668 asthma, 486 epilepsy, 149 diabetes and 109 severe mental illness. By December 2018, 8.3% of patients with NCD over 15 years were also on HIV treatment. One-year retention was 85% for HIV and 72% for NCDs, with default in 8.4% and 25.5% and deaths in 4.0% and 1.4%, respectively. Clinical outcomes showed statistically significant improvement for hypertension, diabetes, asthma and epilepsy. Of the 1807 (80%) of patients with HIV with viral load results, 85% had undetectable viral load.Conclusions The IC3 model, built on an HIV platform, facilitated rapid decentralisation and access to NCD services in rural Malawi. Clinical outcomes and retention in care are favourable, suggesting that integration of chronic disease care at the primary care level poses a way forward for the large dual burden of HIV and chronic NCDs. |
| format | Article |
| id | doaj-art-d9b3444650204bcfa01657161da0ce06 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d9b3444650204bcfa01657161da0ce062024-11-16T10:20:13ZengBMJ Publishing GroupBMJ Open2044-60552020-10-01101010.1136/bmjopen-2020-036836Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD–HIV modelGene Bukhman0Luckson Dullie1Emily B Wroe2Elizabeth L Dunbar3Noel Kalanga4Lawrence Nazimera5Natalie F Price6Adarsh Shah7Bright Mailosi8Grant Gonani9Enoch P L Ndarama10George C Talama11Lila Kerr12Emilia Connolly13Chiyembekezo Kachimanga144 Partners In Health, Boston, Massachusetts, USAPartners In Health, Neno, MalawiPartners In Health, Boston, Massachusetts, USAPartners In Health, Neno, MalawiDepartment of Health Systems and Policy, College of Medicine, Blantyre, MalawiMinistry of Health, Neno, MalawiPartners In Health, Boston, Massachusetts, USAPartners In Health, Boston, Massachusetts, USA2 Partners In Health, Neno, MalawiMinistry of Health, Neno District Health Office, Ministry of Health, Neno, MalawiMinistry of Health, Neno, MalawiPartners In Health, Neno, MalawiPartners In Health, Neno, MalawiPartners In Health, Neno, Malawi2 Partners In Health, Neno, MalawiObjectives Non-communicable diseases (NCDs) account for one-third of disability-adjusted life years in Malawi, and access to care is exceptionally limited. Integrated services with HIV are widely recommended, but few examples exist globally. We report descriptive outcomes from an Integrated Chronic Care Clinic (IC3).Design This is a retrospective cohort study.Setting The study includes an HIV–NCD clinic across 14 primary care facilities in the rural district of Neno, Malawi.Participants All new patients, including 6233 HIV–NCD diagnoses, enrolled between January 2015 and December 2017 were included. This included 3334 patients with HIV (59.7% women) and 2990 patients with NCD (67.3% women), 10% overall under age 15 years.Interventions Patients were seen at their nearest health centre, with a hospital team visiting routinely to reinforce staffing. Data were collected on paper forms and entered into an electronic medical record.Primary and secondary outcome measures Routine clinical measurements are reported at 1-year post-enrolment for patients with more than one visit. One-year retention is reported by diagnosis.Results NCD diagnoses were 1693 hypertension, 668 asthma, 486 epilepsy, 149 diabetes and 109 severe mental illness. By December 2018, 8.3% of patients with NCD over 15 years were also on HIV treatment. One-year retention was 85% for HIV and 72% for NCDs, with default in 8.4% and 25.5% and deaths in 4.0% and 1.4%, respectively. Clinical outcomes showed statistically significant improvement for hypertension, diabetes, asthma and epilepsy. Of the 1807 (80%) of patients with HIV with viral load results, 85% had undetectable viral load.Conclusions The IC3 model, built on an HIV platform, facilitated rapid decentralisation and access to NCD services in rural Malawi. Clinical outcomes and retention in care are favourable, suggesting that integration of chronic disease care at the primary care level poses a way forward for the large dual burden of HIV and chronic NCDs.https://bmjopen.bmj.com/content/10/10/e036836.full |
| spellingShingle | Gene Bukhman Luckson Dullie Emily B Wroe Elizabeth L Dunbar Noel Kalanga Lawrence Nazimera Natalie F Price Adarsh Shah Bright Mailosi Grant Gonani Enoch P L Ndarama George C Talama Lila Kerr Emilia Connolly Chiyembekezo Kachimanga Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD–HIV model BMJ Open |
| title | Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD–HIV model |
| title_full | Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD–HIV model |
| title_fullStr | Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD–HIV model |
| title_full_unstemmed | Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD–HIV model |
| title_short | Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD–HIV model |
| title_sort | expanding access to non communicable disease care in rural malawi outcomes from a retrospective cohort in an integrated ncd hiv model |
| url | https://bmjopen.bmj.com/content/10/10/e036836.full |
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