Bukenya, D, Van Hout, MC, Shayo, E, Kitabye, I, Musenze, B, Kasidi, JR, Jaffar, S and Seeley, J (2022) Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study. PLOS Global Public Health. ISSN 2767-3375

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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 health care 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. Integrated clinics did not affect provision of anti-retroviral therapy. The cost of transport reduced because of fewer clinic visits after the establishment of the integrated clinic. Health care workers reported that the main cause of non-adherence among users with diabetes and hypertension was poverty. Participants with diabetes and hypertension reported they could not afford private clinical investigations and purchase of drugs prior to establishment of the integrated clinics. The strengthening of drug supply for non-communicable conditions in the integrated clinics was welcomed. Most participants observed that the integrated clinic reduced feelings of stigma for those living with HIV. Sharing the clinic afforded privacy about an individual’s condition, and users were comfortable with the waiting room sitting arrangement. We found that integrating non-communicable disease and HIV care had benefits for all users. Integrated care could be an effective model of care if service users have access to a reliable supply of basic medicines for both HIV and non-communicable disease conditions.

Item Type:	Article
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Public Health Institute
Publisher:	PLOS
Date Deposited:	09 Nov 2021 11:59
Last Modified:	14 Mar 2022 16:18
DOI or ID number:	10.1371/journal.pgph.0000084
URI:	https://researchonline.ljmu.ac.uk/id/eprint/15757

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