Effectiveness of an Integrated Approach to HIV and Hypertension Care in Rural South Africa: Controlled Interrupted Time-Series Analysis

Soter Ameh, Kerstin Klipstein-Grobusch, Eustasius Musenge, Kathleen Kahn, Stephen Tollman, Francesc Xavier Gómez-Olivé, Soter Ameh, Kerstin Klipstein-Grobusch, Eustasius Musenge, Kathleen Kahn, Stephen Tollman, Francesc Xavier Gómez-Olivé

Abstract

Background: South Africa faces a dual burden of HIV/AIDS and noncommunicable diseases. In 2011, a pilot integrated chronic disease management (ICDM) model was introduced by the National Health Department into selected primary health care (PHC) facilities. The objective of this study was to assess the effectiveness of the ICDM model in controlling patients' CD4 counts (>350 cells/mm) and blood pressure [BP (<140/90 mm Hg)] in PHC facilities in the Bushbuckridge municipality, South Africa.

Methods: A controlled interrupted time-series study was conducted using the data from patients' clinical records collected multiple times before and after the ICDM model was initiated in PHC facilities in Bushbuckridge. Patients ≥18 years were recruited by proportionate sampling from the pilot (n = 435) and comparing (n = 443) PHC facilities from 2011 to 2013. Health outcomes for patients were retrieved from facility records for 30 months. We performed controlled segmented regression to model the monthly averages of individuals' propensity scores using autoregressive moving average model at 5% significance level.

Results: The pilot facilities had 6% greater likelihood of controlling patients' CD4 counts than the comparison facilities (coefficient = 0.057; 95% confidence interval: 0.056 to 0.058; P < 0.001). Compared with the comparison facilities, the pilot facilities had 1.0% greater likelihood of controlling patients' BP (coefficient = 0.010; 95% confidence interval: 0.003 to 0.016; P = 0.002).

Conclusions: Application of the model had a small effect in controlling patients' CD4 counts and BP, but showed no overall clinical benefit for the patients; hence, the need to more extensively leverage the HIV program for hypertension treatment.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Monthly probabilities of having a CD4 count >350 cells/mm3 after propensity score matching in the ICDM pilot and comparison facilities in the Bushbuckridge municipality, 2011–2013.
FIGURE 2.
FIGURE 2.
Monthly probabilities of having a BP

References

    1. WHO (2002). Innovative Care for Chronic Conditions: Building Blocks for Action. Geneva, Switzerland: World Health Organization; 2014. Available at: . Accessed July 20, 2014.
    1. UNAIDS (2011). Chronic Care of HIV and Non-communicable Diseases: How to Leverage the HIV Experience. Geneva, Switzerland: Joint United Nations Program on HIV/AIDS; 2014. Available at: . Accessed July 8, 2014.
    1. Kitahata MM, Tegger MK, Wagner EH, et al. Comprehensive health care for people infected with HIV in developing countries. BMJ. 2002;325:954–957.
    1. WHO (2014). Global Status Report on Noncommunicable Diseases. Geneva, Switzerland: World Health Organization; 2015. Available at: . Accessed July 10, 2015.
    1. WHO (2013). Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013–2020). Geneva, Switzerland: World Health Organization; 2015. Available at: . Accessed July 6, 2015.
    1. WHO (2008). 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases. Geneva, Switzerland: World Health Organization; 2015. Available at: . Accessed May 20, 2015.
    1. WHO (2014). Noncommunicable Diseases Country Profiles. Geneva, Switzerland: World Health Organization; 2015. Available at: . Accessed February 8, 2015.
    1. Statistics South Africa (2014). Mid-year population estimates. 2015. Available at: . Accessed February 2, 2015.
    1. Tollman SM, Kahn K, Sartorius B, et al. Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study. Lancet. 2008;372:893–901.
    1. Kawonga M, Fonn S, Blaauw D. Administrative integration of vertical HIV monitoring and evaluation into health systems: a case study from South Africa. Glob Health Action. 2013;6:19252.
    1. Daniels A, Biesma R, Otten J, et al. Ambivalence of primary health care professionals towards the South African guidelines for hypertension and diabetes. S Afr Med J. 2000;90:1206–1211.
    1. Steyn K, Levitt NS, Patel M, et al. Hypertension and diabetes: poor care for patients at community health centres. S Afr Med J. 2008;98:618–622.
    1. Bousquet J, Anto JM, Sterk PJ, et al. Systems medicine and integrated care to combat chronic noncommunicable diseases. Genome Med. 2011;3:43.
    1. Beaglehole R, Epping-Jordan J, Patel V, et al. Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care. Lancet. 2008;372:940–949.
    1. Alwan A, Maclean DR. A review of non-communicable disease in low- and middle-income countries. Int Health. 2009;1:3–9.
    1. Janssens B, Van Damme W, Raleigh B, et al. Offering integrated care for HIV/AIDS, diabetes and hypertension within chronic disease clinics in Cambodia. Bull World Health Organ. 2007;85:880–885.
    1. Schwartz JI, Dunkle A, Akiteng AR, et al. Towards reframing health service delivery in Uganda: the Uganda initiative for integrated management of non-communicable diseases. Glob Health Action. 2015;8:26537.
    1. Rabkin M, Melaku Z, Bruce K, et al. Strengthening health systems for chronic care: leveraging HIV programs to support diabetes services in Ethiopia and Swaziland. J Trop Med. 2012;2012:137460.
    1. Edwards JK, Bygrave H, Van den Bergh R, et al. HIV with non-communicable diseases in primary care in Kibera, Nairobi, Kenya: characteristics and outcomes 2010-2013. Trans R Soc Trop Med Hyg. 2015;109:440–446.
    1. National Department of Health, Republic of South Africa. Integrated Chronic Disease Management Manual, 2014. 2015. Available at: . Accessed April 23, 2015.
    1. Mahomed OH, Asmall S, Freeman M. An integrated chronic disease management model: a diagonal approach to health system strengthening in South Africa. J Health Care Poor Underserved. 2014;25:1723–1729.
    1. Mahomed OH, Asmall S. Development and implementation of an integrated chronic disease model in South Africa: lessons in the management of change through improving the quality of clinical practice. Int J Integr Care. 2015;15:e038. URN: NBN:NL: UI:10-1-117155.
    1. Kahn K, Collinson MA, Gómez-Olivé FX, et al. Profile: agincourt health and socio-demographic surveillance system. Int J Epidemiol. 2012;41:988–1001.
    1. Wagner AK, Soumerai SB, Zhang F. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27:299–309.
    1. Department of Health, Republic of South Africa. Primary Care 101: symptom-based integrated approach to the adult in primary care. 2014. Available at: . Accessed November 13, 2016.
    1. Thorogood M, Connor M, Tollman S, et al. A cross-sectional study of vascular risk factors in a rural South Africa population: data from the Southern African Stroke Prevention Initiative (SASPI). BMC Public Health. 2007;7:326.
    1. Thorogood M, Connor MD, Hundt GL, et al. Understanding and managing hypertension in an African sub-district: a multidisciplinary approach. Scand J Public Health Suppl. 2007;69:52–59.
    1. Thorogood M, Connor MD, Lewando-Hundt G, et al. Secondary prevention of stroke–results from the Southern Africa Stroke prevention initiative (SASPI) study. Bull World Health Organ. 2004;82:503–508.
    1. Diggle P, Heagerty P, Liang K, et al. Analysis of Longitudinal Data. Oxford, United Kingdom: Oxford University Press; 2002.
    1. Penfold RB, Zhang F. Use of interrupted time series analysis in evaluating health care quality improvements. Acad Pediatr. 2013;13:S38–S44.
    1. Leuven E, Sianesi B. PSMATCH2: stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing. 2015. Available at: . Accessed October 22, 2014.
    1. Ameh S, Klipstein-Grobusch K, D'ambruoso L, et al. Quality of integrated chronic disease care in rural South Africa: user and provider perspectives. Health Policy Plan. 2016. 10.1093/heapol/czw118.
    1. WHO (2013). Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva, Switzerland: World Health Organization; 2014. Available at: . Accessed August 22, 2015.
    1. Cozzi Lepri A, Phillips AN, d'Arminio Monforte A, et al. When to start highly active antiretroviral therapy in chronically HIV-infected patients: evidence from the ICONA study. AIDS. 2001;15:983–990.
    1. Gottlieb GS, Sow PS, Hawes SE, et al. Equal plasma viral loads predict a similar rate of CD4+ T cell decline in human immunodeficiency virus (HIV) type 1- and HIV-2-infected individuals from Senegal, West Africa. J Infect Dis. 2002;185:905–914.
    1. Lloyd-Sherlock P, Beard J, Minicuci N, et al. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control. Int J Epidemiol. 2014;43:116–128.
    1. Basu S, Millett C. Social epidemiology of hypertension in middle-income countries: determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study. Hypertension. 2013;62:18–26.
    1. Olubodun JO, Falase AO, Cole TO. Drug compliance in hypertensive Nigerians with and without heart failure. Int J Cardiol. 1990;27:229–234.
    1. Dzudie A, Kengne AP, Muna WF, et al. Prevalence, awareness, treatment and control of hypertension in a self-selected sub-Saharan African urban population: a cross-sectional study. BMJ Open. 2012;2.
    1. Mukora-Mutseyekwa FN, Chadambuka EM. Drug adherence behavior among hypertensive out-patients at a tertiary health institution in Manicaland province, Zimbabwe, 2011. Patient Prefer Adherence. 2013;7:65–70.
    1. Yaméogo NV, Kagambèga LJ, Millogo RC, et al. Factors associated with poor blood pressure control in hypertensive black Africans: cross-sectional study of 456 hypertensive patients from Burkina Faso. Annales de Cardiologie et d'Angéiologie. 2013;62:38–42.
    1. Ameh S, Gómez-Olivé FX, Kahn K, et al. Relationships between structure, process and outcome to assess quality of integrated chronic disease management in a rural South African setting: applying a structural equation model. BMC Health Serv Res. 2017;17:229.
    1. Mahomed OH, Asmall S, Voce A. Sustainability of the integrated chronic disease management model at primary care clinics in South Africa. Afr J Prim Health Care Fam Med. 2016;8:1248.
    1. WHO (2012). Health Policy and Systems Research: A Methodology Reader. Geneva, Switzerland: The WHO Document Production Series; 2012.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다