Health Experts Call For Integrated HIV Care and Diabetes & Hypertension Clinics

By Prince Kurupati

Diabetes and hypertension have emerged as a hugely problematic pandemic on the African continent. The twin silent killer diseases indiscriminately affect different demographics, from the young to the old, different sexes, and people of different backgrounds, from the rich to the poor. The Integrated African Health Observatory (iAHO) together with the World Health Organization (WHO), in 2021, estimated the number of adults (20 – 79 years) living with diabetes globally to be 537 million. Of these, 24 million are in Africa.

While the statistics above are damning, what’s even more ominous are the projections that the prevalence of diabetes in Africa will increase by 129% hence translating to 55 million people living with diabetes by 2045. Several reports that have emerged since 2021 corroborate this. Further reinforcing this is the mere fact that more than half (54%) of people living with diabetes in the African region are undiagnosed.

Moreover, the sharp increase in the number of people living with diabetes in Africa from 2011 to 2021 suggests that if no strong mitigation measures are implemented, the trend will continue unabated. iAHO reports that between 2011 and 2021, the African region recorded a fivefold rise in Type 1 diabetes among children and teenagers below 19 years, with cases surging from four per 1000 children to nearly 20 per 1000.

Compounding matters even more is the huge economic burden that the prevalence of diabetes places on African governments. As of 2021, Africa had the second lowest diabetes-related expenditure (US $13 billion), accounting for 1% of global diabetes-related expenditure. In Africa, diabetes spending is healthcare associated with drugs, diagnosis, medical supplies, and consultation. The limited funding for fighting diabetes on the African continent makes it difficult to attain much success in combating the disease.

According to the National Health Institute (NIH), the pooled prevalence of hypertension in people diagnosed with diabetes is huge, as it’s pegged at 58.1%. This is largely necessitated by the fact that a longer duration of diabetes is one of the main causes of hypertension. In addition, other hypertension causative factors such as obesity (especially among females) and a sedentary lifestyle among urban dwellers are prevalent in Africa. Hypertension and diabetes comorbidity does increase healthcare expenditure hence making it a tall task for African countries to fight the silent killer diseases.

Owing to the massive expenditure required in fighting the twin silent killer diseases, a study done by La Trobe University revealed that across Africa, about two million premature deaths linked to diabetes and hypertension are recorded. Heartbroken by this and the continued prevalence of the silent killer diseases, public health researchers at La Trobe University juxtaposed the current diabetes and hypertension pandemic with the HIV/AIDS pandemic of the early 2000s. The rationale behind this was to copy disease management lessons from the HIV/AIDS pandemic that can be applied in the fight against diabetes and hypertension.

The study revealed significant patient benefits and cost savings when healthcare for people with diabetes and hypertension is delivered alongside HIV care in integrated clinics. La Trobe University public health experts said Africa, through various partnerships, has managed to put in place a robust HIV management model. This same model can be used in an integrated manner to fight other chronic conditions with great success as health professionals will leverage good practices developed in HIV care over the past 20 years to improve retention in care and use resources more efficiently.

Dr. Josephine Birungi, a graduate researcher in the public health domain at La Trobe University commented on the success of the HIV disease management model saying most people living with HIV in Africa are in regular care and virally suppressed, and HIV mortality rates have fallen five-fold since their peak of 2 million deaths annually in the early 2000s to less than 500,000 in 2022. In light of this success, Dr Birungi said the use of that same model in an integrated manner in dealing with other chronic conditions, such as diabetes and hypertension, will likely bring about the same results.

“The only difference is the medicine they take. We’re seeing diabetes and hypertension increasing across Africa, causing more deaths than HIV,” Dr Birungi said. Drawing lessons from Uganda and Tanzania, two countries that are already using the integrated model, Dr Birungi said, “Retention rates in the integrated care arm were close to 90%, which is a historic achievement in primary care across Africa. And, most importantly, integration did not compromise the rates of viral suppression among people living with HIV.”

The use of integrated clinics is also a cost-saving solution, according to Dr Birungi. Specifically commenting on the La Trobe University study, which used a sample of 7,028 adult patients, 3032 of whom had diabetes alone, hypertension alone, or both, and 3365 who had HIV alone, Dr Birungi said the average monthly provider cost per participant was lower in the integrated care arm for participants with multiple conditions. She said savings were largely driven by reduced staffing and overhead costs associated with a reduced number of total visits required by patients with multiple morbidities.

Commenting on the study done by La Trobe University and how its findings can be applied on a continental scale, Dr. Meg Doherty, the Director of the World Health Organization Department of Global HIV, Hepatitis and STI Programmes said, “This was a large ambitious and well-conducted study with the potential to change policy and practice. It is the first study to test successfully the concept of a fully integrated one-stop clinic for people with HIV or non-communicable conditions, with excellent HIV and NCD outcomes. It is exciting to see that by including hypertension and diabetes screening and care in the HIV clinic in these two countries (Uganda and Tanzania), there was no change in HIV viral load suppression outcomes.”

The La Trobe University study answers critical questions that were asked by Dr Godfrey Kisigo of Tanzania’s National Institute for Medical Research and Dr Robert Peck of Cornell Medical School. “What can be learned from the highly successful HIV programmes in Africa to address the growing problem of NCDs, and can we build on existing HIV infrastructure to address ACDs without compromising HIV programmes,” asked Dr Kisigo and Dr Peck. 

The La Trobe University study, which was funded by the European Union’s Horizon 2020 Research and Innovation program as part of the GACD Scale-Up Research Programme, has been heralded by health experts for providing a blueprint for re-organizing health system to meet demand and maximize the use of limited resources.