Integration of HIV and non-communicable diseases services among rural primary health care facilities in Mkuranga district council

Abstract

ABSTRACT Background: People living with HIV (PLHIV) have a greater chance of suffering from non communicable diseases (NCDs) such as diabetes mellitus (DM), cervical cancer and cardiovascular diseases, in part because of the longer life expectancy brought on by anti-retro viral treatment (ART). With HIV and NCDs intersecting, integrative approaches to manage chronic diseases are considered critical especially in low resource environments where the complexity of multi-morbid illnesses presents concerns for health systems. In Tanzania, despite efforts to integrate HIV and NCD services since 2014, challenges persist in the rural Primary health care facilities and anecdotal evidence suggests suboptimal implementation of these integrative services within these facilities. Objective: To explore factors affecting integration of HIV-NCD services among rural Primary health care facilities in Mkuranga district council. Methodology: A phenomenological qualitative research design was used to conduct in depth interviews across health care providers working at CTC and members from hospital management teams, where they were purposively selected across 3 rural primary health care (PHC) facilities that operated care and treatment clinics within Mkuranga district council. The collected data was transcribed, translated into English and then analyzed using thematic analysis. Results: In this study, three themes emerged which explained the factors that affect integration of HIV and NCD services at the care and treatment clinics. The findings revealed that limited availability of resources characterized by insufficient staffing at CTC, presence of financial constrain, limited availability of medical supplies and inadequate infrastructure at CTC have negatively affected the delivery of integrated HIV-NCD services. However, the findings further showed that the presence of enabling policies and guidelines in relation to integrated services and the awareness on non-communicable diseases among providers created a conducive working environment for the delivery of integrated HIV-NCD services. In addition, the findings reported a few perceived benefits of integration including increased job satisfaction to the vi provider and improved quality of care to the patients and some perceived disadvantages of integration such as overloading the health care providers with work and causing delay while providing care. Lastly, this study revealed a few perceived strategies to improve integrated services which include among others increased number of staff and ensuring ongoing training to staff working at the CTC. Conclusion and recommendation: Integration benefits both patients and providers with presence of enabling policies and guidelines identified as critical in facilitating integrated HIV NCD care. However, lack of trained staff, limited financing, and substandard buildings was observed to hinder the delivery of integrated care at CTC. Presence of cultural beliefs and ignorance among community members regarding NCDs was also described to affect the provision of integrated services. As a recommendation, health facility management in collaboration with implementing partners should make targeted investment in areas such as capacity building, infrastructure development within the CTC so as to enhance service delivery and ensure successful integration of HIV and NCD services.