TY - JOUR
T1 - Management of chronic conditions in resource limited settings
T2 - multi stakeholders' perception and experiences with receiving and providing integrated HIV, diabetes and hypertension services in Tanzania
AU - Shayo, Elizabeth H
AU - Murdoch, Jamie
AU - Kiwale, Zenais
AU - Bachmann, Max
AU - Bakari, Mtumwa
AU - Mbata, Doris
AU - Masauni, Salma
AU - Kivuyo, Sokoine
AU - Mfinanga, Sayoki
AU - Jaffar, Shabbar
AU - Van Hout, Marie-Claire
N1 - Funding Information:
We are grateful for funding support from the European Union. Support from the district and health facility management in the implementing the study are highly acknowledged. Atanasia Joseph and Albert Majura for assisting with data transcription. Much appreciations go our study participants at all levels for providing substantial information that generated findings presented in this paper.
Funding Information:
The INTE-AFRICA project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 825 698.
Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.
PY - 2023/10/19
Y1 - 2023/10/19
N2 - BACKGROUND: The rising prevalence of non-communicable diseases (NCDs) alongside the continuing high burden of HIV poses a serious challenge to middle- and low-income countries' healthcare systems. Pilot studies of integrated models of service delivery for HIV, hypertension and diabetes have demonstrated that they are feasible and acceptable among patients and care providers. This study assessed multi-stakeholders' perspectives of the delivery and receipt of integrated care in Tanzania.METHODS: A qualitative process evaluation was conducted in Dar es Salaam region of Tanzania where the integrated service delivery model was implemented from July to November 2021. In-depth interviews were held with seven key informants at the national, regional and district levels, eight healthcare providers, two researchers working at the integrated clinic and forty patients benefiting from integrated services at a large hospital. Three focus group discussions were held with community leaders and residents of the hospital's catchment area, and clinic level observations were conducted. Thematic analysis was conducted followed by the use of Bronfenbrenner's ecological model to identify factors pertinent to sustaining and scaling up of the integrated model.RESULTS: Participants of the study at all levels were aware of the increased prevalence of NCDs specifically for hypertension and diabetes and were concerned about the trend of increasing co-morbid conditions among people living with HIV (PLHIV). The integrated service delivery model was positively perceived by stakeholders because of its multiple benefits for both patients and the healthcare system. These include stigma and discrimination reduction, improved quality of care, efficient use of limited resources, cost and time saving, reduced duplication of services and fostering of early detection for undiagnosed conditions. The organisation of the clinic was critical in increased satisfaction. Several challenges were observed, which included costs for NCD services relative to free care for HIV and inconsistent availability of NCD medications.CONCLUSION: Stakeholders reported numerous benefits of the integrated service delivery model that are fundamental in improving the health of many Tanzanians living with NCDs and HIV. These benefits highlight the need for policy and decision-makers to sustain and expand the integrated service delivery model as a solution to many challenges facing the health system especially at the primary care level.
AB - BACKGROUND: The rising prevalence of non-communicable diseases (NCDs) alongside the continuing high burden of HIV poses a serious challenge to middle- and low-income countries' healthcare systems. Pilot studies of integrated models of service delivery for HIV, hypertension and diabetes have demonstrated that they are feasible and acceptable among patients and care providers. This study assessed multi-stakeholders' perspectives of the delivery and receipt of integrated care in Tanzania.METHODS: A qualitative process evaluation was conducted in Dar es Salaam region of Tanzania where the integrated service delivery model was implemented from July to November 2021. In-depth interviews were held with seven key informants at the national, regional and district levels, eight healthcare providers, two researchers working at the integrated clinic and forty patients benefiting from integrated services at a large hospital. Three focus group discussions were held with community leaders and residents of the hospital's catchment area, and clinic level observations were conducted. Thematic analysis was conducted followed by the use of Bronfenbrenner's ecological model to identify factors pertinent to sustaining and scaling up of the integrated model.RESULTS: Participants of the study at all levels were aware of the increased prevalence of NCDs specifically for hypertension and diabetes and were concerned about the trend of increasing co-morbid conditions among people living with HIV (PLHIV). The integrated service delivery model was positively perceived by stakeholders because of its multiple benefits for both patients and the healthcare system. These include stigma and discrimination reduction, improved quality of care, efficient use of limited resources, cost and time saving, reduced duplication of services and fostering of early detection for undiagnosed conditions. The organisation of the clinic was critical in increased satisfaction. Several challenges were observed, which included costs for NCD services relative to free care for HIV and inconsistent availability of NCD medications.CONCLUSION: Stakeholders reported numerous benefits of the integrated service delivery model that are fundamental in improving the health of many Tanzanians living with NCDs and HIV. These benefits highlight the need for policy and decision-makers to sustain and expand the integrated service delivery model as a solution to many challenges facing the health system especially at the primary care level.
KW - Humans
KW - Tanzania/epidemiology
KW - Noncommunicable Diseases/epidemiology
KW - HIV Infections/therapy
KW - Hypertension/epidemiology
KW - Diabetes Mellitus/epidemiology
KW - Perception
KW - Chronic Disease
UR - http://www.scopus.com/inward/record.url?scp=85174465050&partnerID=8YFLogxK
U2 - 10.1186/s12913-023-10123-4
DO - 10.1186/s12913-023-10123-4
M3 - Article
C2 - 37858150
SN - 1472-6963
VL - 23
SP - 1120
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 1120
ER -
