Yale University

Leveraging HIV care for human rights-based chronic disease management Highly Ranked

Health care access

We will transform how primary health care is delivered in Africa by adapting the multi-sectoral, stakeholder-engaged, evidence-based, human-rights-focused model that revolutionized HIV care and outcomes.

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

In Sub-Saharan African (SSA), the collision of communicable and non-communicable diseases requires us to ‘think and work together’ to benefit communities buffeted not only by HIV, tuberculosis, or malaria, for example, but also cancer, cardiovascular disease, hypertension, diabetes, and depression. Between 10-20 million people in SSA have hypertension; if 70% were treated, 4.5 million deaths could be delayed (11.5% of global delayed deaths). Morbidity and mortality can be prevented or treated with known low-cost, high-impact interventions. Integrated service delivery is key for reducing health disparities. Uganda, Nigeria, and South Africa have well-established HIV testing and treatment infrastructures, alongside up-to-date guidelines for NCD control. Using capacity-building and continuous quality improvement within a health and human rights framework, we will partner with Ministries and stakeholders to scale-up, monitor, and evaluate a multi-sectorial, integrated package of health promotion and primary care services (the IDEAL clinic), building upon HIV care and treatment clinic infrastructures.

Problem Statement

The World Health Organization (WHO) has issued primary care guidelines for the prevention, screening and treatment of NCDs, including addressing necessary components of facility infrastructure and health care provider training requirements in low resources settings. Implementation has lagged far behind WHO’s guidance, however, such that persons with NCDs in SSA typically do not receive needed prevention or care and/or a reasonable quality of care has not been reached. Women, ethnic and linguistic minorities, persons displaced and in conflict zones often receive especially inequitable services. Vertical funding streams allocate far more resources to HIV control than to NCDs; distorted investments make it especially difficult for national policy makers to coordinate care. A lack of clinic supplies, health care facility infrastructure, and human resources for health care contribute to poor health outcomes. We have found that system limitations can be overcome with rigorous management, leadership, and continuous quality improvement within a human rights, community-centered framework. Due to national and PEPFAR investments, HIV treatment and care services have been scaled up throughout SSA, with phenomenal success in reducing HIV incidence and mortality. Well-capacitated HIV clinics are assets that can be expanded to include NCDs, reducing HIV stigma and broadening the community and political constituencies that support community clinics. High quality care, with community education and stakeholder engagement, will drive utilization; supply chains, infrastructures, and human resources will be enhanced. When U.S. HIV support inevitably is reduced, broad-based clinics will endure, having been integrated fully into a quality-controlled management structure.

Solution Overview

We will leverage successful HIV Treatment and Care Facilities towards South Africa’s IDEAL clinic model[1] to offer NCD services. We will monitor progress through the continuum of care: persons screened, linked to care, and treated with successful outcomes. Process indicators include training outcomes and WHO’s Service Availability and Readiness Assessment for clinics. Workforce and patient experience will be assessed through provider knowledge and practice enhancement and a patient ‘dignity and equality’ experience score card. Disease-specific outcomes include blood pressure, glucose, depression symptoms, cancer screening, and uptake of family planning. We will assess whether expanding HIV services towards integrated care reduces HIV patient stigma and increases service acceptability, as well as improving participatory process, concern resolutions, and compliance with human rights and non-discrimination standards. Developing this framework and selecting the sites is Phase 1 (4 months). During the first 4 years of 100&Change (Phase 2), we will focus on representative regions chosen by in-country partners, scaling-up catchment areas to reach approximately 10 million people, 2.5-10% of the populations of Nigeria, South Africa, and Uganda. In Phase 3, we focus on within- and between-country scale-up of IDEAL clinic expansions found by the project to be cost-effective. Rates of cardiovascular disease in SSA have increased 81% since 1990; 80% of persons with diabetes now live in low- and middle-income countries (LMICs). Because of the magnitude of the NCD epidemic and the poor quality and availability of prevention, screening, and treatment in SSA, we expect significant improvements and impact, a model for the world.

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Project Funders

  • Ministry of Health, Nigeria 2003 - Ongoing
  • Ministry of Health, South Africa 2003 - Ongoing
  • Ministry of Health, Uganda 2003 - Ongoing

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