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  • Wiley  (2)
  • Menzies, Nicolas A  (2)
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  • Wiley  (2)
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  • 1
    Online Resource
    Online Resource
    Cost‐effectiveness analysis of integrating screening and treatment of selected non‐communicable diseases into HIV/AIDS treatment in Uganda
    Wiley ; 2020
    In:  Journal of the International AIDS Society Vol. 23, No. S1 ( 2020-06)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 23, No. S1 ( 2020-06)
    Abstract: Despite growing enthusiasm for integrating treatment of non‐communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub‐Saharan Africa, there is little evidence on the potential health and financial consequences of such integration. We aim to study the cost‐effectiveness of basic NCD‐HIV integration in a Ugandan setting. Methods We developed an epidemiologic‐cost model to analyze, from the provider perspective, the cost‐effectiveness of integrating hypertension, diabetes mellitus (DM) and high cholesterol screening and treatment for people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Uganda. We utilized cardiovascular disease (CVD) risk estimations drawing from the previously established Globorisk model and systematic reviews; HIV and NCD risk factor prevalence from the World Health Organization’s STEPwise approach to Surveillance survey and global databases; and cost data from national drug price lists, expert consultation and the literature. Averted CVD cases and corresponding disability‐adjusted life years were estimated over 10 subsequent years along with incremental cost‐effectiveness of the integration. Results Integrating services for hypertension, DM, and high cholesterol among ART patients in Uganda was associated with a mean decrease of the 10‐year risk of a CVD event: from 8.2 to 6.6% in older PLWH women (absolute risk reduction of 1.6%), and from 10.7 to 9.5% in older PLWH men (absolute risk reduction of 1.2%), respectively. Integration would yield estimated net costs between $1,400 and $3,250 per disability‐adjusted life year averted among older ART patients. Conclusions Providing services for hypertension, DM and high cholesterol for Ugandan ART patients would reduce the overall CVD risk among these patients; it would amount to about 2.4% of national HIV/AIDS expenditure, and would present a cost‐effectiveness comparable to other standalone interventions to address NCDs in low‐ and middle‐income country settings.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.v23.s1
    DOI: 10.1002/jia2.25507
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2467110-1
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Integrating care for non‐communicable diseases into routine HIV services: key considerations for policy design in sub‐Saharan Africa
    Wiley ; 2020
    In:  Journal of the International AIDS Society Vol. 23, No. S1 ( 2020-06)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 23, No. S1 ( 2020-06)
    Abstract: There is great interest for integrating care for non‐communicable diseases (NCDs) into routine HIV services in sub‐Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the general population. We summarize opportunities and challenges related to leveraging HIV treatment platforms to address NCDs among PLHIV. We emphasize key considerations that can guide integrated care in SSA and point to possible interventions for implementation. Discussion Integrating care offers an opportunity for effective delivery of NCD services to PLHIV, but may be viewed to unfairly ignore the larger number of NCD cases in the general population. Integration can also help maintain the substantial health and economic benefits that have been achieved by the global HIV/AIDS response. Implementing interventions for integrated care will require assessing the prevalence of common NCDs among PLHIV, which can be achieved via increased screening during routine HIV care. Successful integration will also necessitate earmarking funds for NCD interventions in national budgets. Conclusions An expanded agenda for addressing HIV‐NCD comorbidities in SSA may require adding selected NCDs to conditions that are routinely monitored in PLHIV. Attention should be given to mitigating potential tradeoffs in the quality of HIV services that may result from the extra responsibilities borne by HIV health workers. Integrated care will more likely be effective in the context of concurrent health system reforms that address NCDs in the general population, and with synergies with other HIV investments that have been used to strengthen health systems.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.v23.s1
    DOI: 10.1002/jia2.25508
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2467110-1
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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