HIV Intervention / Improving Health Systems response to Chronic Diseases in Africa

Lead Research Organisation: MRC/UVRI Uganda Research Unit on AIDS

Abstract

There is an increasing demand on primary health care services in Africa for the provision of chronic disease care, due to the dual burden of chronic non-communicable diseases (such as diabetes, hypertension and asthma) and HIV infection that today requires lifelong treatment. From a health services delivery point of view, the management of chronic HIV infection and the management of other chronic disease have many features in common.
In this research project we aim to contribute to the health systems’ response to chronic diseases, by providing data on the burden of treatable chronic diseases including HIV infection in 2 selected study populations in Uganda and Tanzania, and then then to design and evaluate a health system intervention to improve the management of chronic diseases in primary health care services.
The first phase of this study will consist of:
(i) a baseline review of policy and practices in regard to the long term HIV care and care of treatable chronic disease.
(ii) a population survey to be conducted in 2 communities in Uganda and Tanzania in order to document the burden of treatable chronic diseases and chronic HIV infection
(iii) a health facility survey from the same communities to assess the capacity of sampled health facilities to manage these conditions.
These surveys will be supplemented by social sciences and health economic studies and conducted in close collaboration with the national health services, with the overall aim being to find and institute simple service interventions that will improve the management of chronic diseases in primary health care centres such as dispensaries, peripheral health centres and outpatient departments of district hospitals.

In the 2nd phase of the study we will use the findings from the 1st phase to design and implement a simple and affordable package of health service interventions aimed at improving the management of chronic diseases in primary health care centres such as dispensaries, peripheral health centres and outpatient departments of district hospitals. Through a follow on study, the impact of this health service intervention on access to care for chronic diseases and the quality of care delivery will be evaluated.

Technical Summary

Traditionally, acute infectious diseases have been the main challenges for primary health systems in many sub-Saharan African countries. In the recent years however, primary care services in Africa have been facing an increasing burden of chronic diseases (CDs). Two factors that probably contribute to this trend are an increasing burden of chronic non-communicable diseases such as diabetes, hypertension and asthma as well as an increasing number of individuals on lifelong treatment for HIV infection.
Health services in sub Saharan Africa are in general ill equipped to manage these chronic conditions. Health workers at primary care facilities are often overburdened and usually lack the necessary tools, training and experience in chronic disease management and simple standardised treatment guidelines and protocols are not universally available.
At the same time there are few available systematic data to quantify the burden of CDs at population level since appropriate systems for documentation and reporting on CDs at health facility level as well as in the community are insufficiently developed. Existing data collection systems are not standardised and the data collected are often inadequate, making it difficult to plan appropriate responses and to evaluate their quality and effects. The result is a vicious circle in which the lack of necessary data, the lack of evidence-based policies and an inadequate response at primary care level reinforce each other, thus perpetuating a problem that will become worse over time unless it is actively addressed. Research is needed on the burden and risk factors for CDs to generate data that will guide policies on improved clinical care of patients with these diseases, direct preventive measures and make more effective use of resources.
This research project aims to contribute to the health systems’ response to chronic diseases, by providing data on the burden of treatable chronic diseases including HIV infection in 2 selected study populations and then designing and evaluating a health system intervention to improve the management of chronic diseases in primary health care services.
The study will be conducted in 2 selected populations in Uganda and Tanzania and is being planned and implemented in close collaboration with the Ministries of Health in the two countries.
Two districts in Uganda: Mpigi and Wakiso districts, and 3 districts in Tanzania: Geita, Kahama districts and Mwanza City have been selected for the study. The population survey is a stratified multi-stage sampling survey and will recruit 800 participants each from Uganda and Tanzania. The Health facility survey will include 24 health facilities representing different levels of the health services.
The 1st phase of the study will comprise: Collection of data required for health planning through: (i) a population survey to document burden of disease, (ii) a health facility survey to document current practices in the management of CDs, (iii) costing studies to estimate costs of providing or receiving care for chronic diseases, and (iv) social science studies to document community perceptions as well as health staff perceptions and attitudes.
The 2nd phase of the study will consist of design and phased implementation of an affordable intervention to improve the management of chronic diseases in primary health care centres such as dispensaries, peripheral health centres and outpatient departments of district hospitals; evaluation of the intervention and dissemination activities aiming to translate the findings and results into policy and programming.

Publications

10 25 50
 
Description Uganda Ministry of Health - HIV Clinical Care Commitee
Geographic Reach Africa 
Policy Influence Type Participation in a national consultation
Impact Development and revision of National antiretroviral therapy guidelines based on data from a research cohort in Uganda
 
Description London School of Hygiene and Tropical medicine 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Country United Kingdom 
Sector Academic/University 
PI Contribution Grant writing and Joint design and implementation of research project.
Collaborator Contribution Grant holders, joint design and implementation of research project
Impact None yet
Start Year 2010
 
Description Mwanza Intervention Trials Unit 
Organisation National Institute for Medical Research, Tanzania
Department Mwanza Intervention Trials Unit (MITU)
Country Tanzania, United Republic of 
Sector Public 
PI Contribution Joint design and implementation of study project
Collaborator Contribution Joint design and implementation of study project
Impact None yet, project ongoing
Start Year 2010
 
Description Uganda Ministry of Health NCD Department 
Organisation Ministry of Health, Uganda
Country Uganda 
Sector Public 
PI Contribution Helath Systems Research project. Obtained a research grant for health systems research project. Design, conduct and reporting of research project.
Collaborator Contribution Provision of National guidelines on management of NCDs. Consultation on training curriculum for health workers, required for study. Advice on alleging research objectives with national policy. Review and clearance of reports and publications.
Impact Training curriculum for health workers on management of NCDs in primary care cetera in Uganda
Start Year 2009
 
Description Stakeholder Feedback Workshops 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact 50 health workers and their supervisors from district health teams in 2 districts who participated in the health facility surveys and health system intervention within this project attended 4 workshops over the course of the year at which survey data were presented, system interventions and results of piloting these interventions in selected health faculties were presented and discussed; and improvements suggested. The intervention and evaluation are ongoing.
Year(s) Of Engagement Activity 2015
 
Description Uganda National Council of Science and Technology 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact National consultative meeting of research and medicines regulators to discuss ethical appropriateness of further trials on cotrimoxazole prophylaxis among HIV infected patients on antiretroviral therapy. We provided data on effect of Cotrimoxazole on haematologic parameters of untreated HIV infected adults.

A call was made for further studies evaluating continued prophylactic treatment with Cotrimoxazole for HIV infected patients on antiretroviral therapy
Year(s) Of Engagement Activity 2008