Van Hout, MC, Akugizibwe, M, Shayo, EH, Namulundu, M, Kasujja, FX, Namakoola, I, Birungi, J, Okebe, J, Murdoch, J, Mfinanga, SG and Jaffar, S (2024) Decentralising chronic disease management in sub-Saharan Africa: a protocol for the qualitative process evaluation of community-based integrated management of HIV, diabetes and hypertension in Tanzania and Uganda. BMJ Open, 14. pp. 1-12. ISSN 2044-6055

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Abstract

Introduction: Sub Saharan Africa continues to experience a syndemic of human immunodeficiency virus (HIV) and non-communicable diseases (NCDs). Vertical (stand-alone) HIV programming has provided high-quality care in the region, with almost 80% of people living with HIV in regular care, and 90% virally suppressed. Whilst integrated health education and concurrent management of HIV, hypertension and diabetes is being scaled up in clinics, innovative, more efficient and cost-effective interventions which include decentralisation into the community are required to respond to increased burden of co-morbid HIV/NCD disease. Methods and analysis: This protocol describes procedures for a process evaluation running concurrently with a pragmatic cluster-randomized trial (INTE-COMM) in Tanzania and Uganda which will compare community-based integrated care (HIV, diabetes, hypertension) with standard facility-based integrated care. The INTE-COMM intervention will manage multiple conditions (HIV, hypertension, diabetes) in the community via health monitoring and adherence/lifestyle advice (medicine, diet, exercise) provided by community nurses and trained lay-workers, and the devolvement of NCD drug dispensing to community level. Based on Bronfenbrenner’s ecological systems theory, the process evaluation will use qualitative methods to investigate socio-structural factors shaping care delivery and outcomes in up to 10 standard care facilities and/or intervention community sites with linked healthcare facilities. Multi-stakeholder interviews (patients, community health workers/volunteers, healthcare providers, policymakers, clinical researchers, international and non-governmental organisations), focus group discussions (community leaders, members) and non-participant observations (community meetings, drug dispensing) will explore implementation from diverse perspectives at three timepoints in the trial implementation. Iterative sampling and analysis moving between data collection points and data analysis to test emerging theories will continue under saturation is reached. This process of analytic reflexivity and triangulation across methods and sources will provide findings to explain the main trial findings and offer clear directions for future efforts to sustain and scale up community-integrated care for HIV, diabetes and hypertension.

Item Type:	Article
Uncontrolled Keywords:	1103 Clinical Sciences; 1117 Public Health and Health Services; 1199 Other Medical and Health Sciences
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Public Health Institute
Publisher:	BMJ Publishing
SWORD Depositor:	A Symplectic
Date Deposited:	27 Feb 2024 14:55
Last Modified:	27 Mar 2024 14:30
DOI or ID number:	10.1136/bmjopen-2023-078044
URI:	https://researchonline.ljmu.ac.uk/id/eprint/22702

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