BACKGROUND: Non-communicable diseases (NCD) are a growing cause of morbidity and mortality among persons with or without HIV in sub-Saharan Africa. Diabetes and hypertension alone are estimated to cause about 2 million deaths annually. This dual burden requires that health care delivery systems are re-organized to address the needs of patients with chronic conditions for better outcomes. In partnership with public health services, we conducted a large cluster-randomised trial; INTE-Africa and compared blood pressure control among patients between the two arms; integrated management and standard care.
METHODS: The study was part of a large cluster-randomised control trial. High volume primary care facilities were randomized. Study participants were selected systematically. In the integrated care clinic (intervention arm), participants with either HIV, diabetes or hypertension or combinations of these were managed in a single common clinic by the same clinical teams, had joint triage and waiting areas, and shared laboratory, counselling and pharmacy services. Standard care was organized in separate clinics. Participants were followed up for 12 months.
RESULTS: A total 32 facilities were randomised. 16 to integrated care and 16 to standard care. We enrolled 7030 participants in the study, of whom 5150 (73.3%) were female. Of these 3081 (43.8%) had hypertension (either as a single or multiple condition) and had been in care for at least six months. At end of the study, 2440/3081 (79.2%) participants’ blood pressure measurement was recorded, 1190 (48.8%) were in the integrated care arm and 1250 (51.2%) in the standard of care. In our study, 586/1190 (49.2%) participants in integrated care compared to 480/1259 (38.4%) participants in the standard of care arm had blood pressure controlled at the end of the study. There was a difference in blood pressure control among patients with hypertension only, 379/692(54.8%) in the integrated care arm compared with 288/689(41.8%) in the standard of care arm of although not statistically significant (p-value of 0.05). Among patients with diabetes and hypertension there was a statistically significant difference between the two arms (p=0.01).
CONCLUSIONS: There was some improvement in blood pressure control among patients in integrated care arm compared to those in the standard of care arm.