Differentiated Service Delivery for HIV and Non-Communicable Diseases

Non-communicable diseases (NCDs), such as cardiovascular disease, cancer, diabetes, and chronic respiratory disease, are the leading cause of death and disability around the world—and an increasing health threat for people living with HIV. As countries scale up differentiated service delivery (DSD), there is an opportunity to integrate screening for and management of NCDs into DSD models.

CQUIN supports member countries to explore and pilot approaches that enable recipients of care to receive both HIV and NCD services in an integrated fashion.

Case Study: Integrating Noncommunicable Disease Services into HIV Treatment Programs in Eswatini

Eswatini faces a dual epidemic of HIV and cardiovascular disease (CVD), and cardiovascular risk factors such as hypertension, high cholesterol, diabetes and tobacco use are prevalent among adults living with HIV. In 2016, ICAP and the Eswatini Ministry of Health partnered on the HEART study, which showed that 25 percent of adults aged > 40 years on antiretroviral therapy (ART) at a high-volume urban ART clinic had hypertension.

The MOH has since worked to integrate screening and management of hypertension and other non-communicable diseases (NCDs) into HIV treatment programs.  One example is the development of a new differentiated service delivery (DSD) model – a facility-based group model (“club”) for people with both HIV and NCDs.

Insights from Dr. Hervé Kambale, Differentiated Care Advisor, Eswatini National AIDS Programme

What is Eswatini’s approach to addressing NCDs in new DSD models?

HK: As Eswatini’s recipients of care are living longer, there are increasing numbers of people with NCD comorbidities. Recipients of care with NCDs have initially been considered ineligible for DSD because their needs typically require them to visit health facilities more frequently for medication refills. Therefore, Eswatini’s DSD program acknowledged the importance of creating a model specifically targeted at those with HIV and NCDs so these individuals could receive treatment together with their ARVs through a concurrent appointment spacing strategy.

Why should an NCD response be integrated within DSD programs? 

HK: It is important to integrate NCDs treatment into DSD to improve adherence and retention to both HIV and NCDs treatment. We need to limit health facility visits for recipients of care with controlled NCDs as there is no need for them to visit facilities on a monthly basis. In the future, Eswatini hopes to expand this appointment spacing model to more health facilities.

Herve Kambale speaking at CQUIN 3rd Annual Meeting

Catalytic Project: Blood Pressure Self-Monitoring for People on ART in Eswatini

Recognizing that the shift of people on ART to less-intensive community-based models might be a challenge for hypertension management, CQUIN supported a catalytic project to assess the feasibility of blood pressure self-monitoring for people with hypertension taking ART. Working with the Ministry of Health, CQUIN conducted a pilot study to assess the feasibility and acceptability of a blood pressure self-monitoring package that included use of a wrist-worn blood pressure monitor and ongoing contact with a study nurse via text message. Participants texted their blood pressure results to the nurse several times per week and nurses followed up with those reporting high blood pressure via phone. 

The study showed that the approach was both feasible and acceptable. In addition, all 26 study participants said the package improved their ART adherence, and those on blood pressure medication all said the package made them more likely to take their medication as directed.


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