A new healthcare paradigm: Integrating noncommunicable diseases in the HIV response
Thursday, 7 September 2023 (Geneva, Switzerland) -- Integrating noncommunicable disease (NCD) health services for people living with HIV delivers significant returns on investment and better health outcomes for patients, according to the new report Spending Wisely: Exploring the economic and societal benefits of integrating HIV/AIDS and NCDs service delivery launched today ahead of the Global Week for Action on NCDs by the NCD Alliance and RTI International.
People living with HIV are living longer thanks to access to antiretroviral therapy (ART), and it is a cruel irony of the success of the HIV response in many parts of the world that people living with the virus are now faced with a higher prevalence of NCDs than adults without HIV. In some countries, more than half of people living with HIV are also living with NCDs, not only because they are living into old age but also because their status puts them at an increased risk of some NCDs.
The Spending Wisely report identifies studies describing 28 HIV-NCD programs in 16 countries in Africa and Asia. It shows that integrated programmes can deliver wider health impact than standalone care delivery. Via clinical, functional, and organisational support, integrated programmes can improve NCD outcomes while sustaining or improving HIV outcomes. Furthermore, these programs are more efficient for patients and health systems. People living with NCDs gain significant economic benefits from synchronised care visits, with care offered closer to their homes. For health systems, the additional cost of integrating care for NCDs is marginal compared to the health outcomes that the programs generate.
“The reality on the ground in regions such as Sub-Saharan Africa is that for a person living with HIV having access to treatment and care for other chronic conditions like diabetes or hypertension is just as important as receiving antiretroviral drugs,” said Monika Arora, President of the NCD Alliance. “This report makes the economic and societal case for how we might begin to reconfigure national and sub-national responses to infectious diseases such as HIV that more accurately reflect emerging disease burdens in low- and middle-income countries, which is something that will also be vital for achieving 2030 Sustainable Development Goals (SDG) health and development targets.”
There are four main co-morbidities to HIV in low- and middle-income countries (LIMCs): cardiovascular disease (CVD), depression, diabetes, and cancer. Globally, as many as one in four people living with HIV are estimated to have moderate to severe depression, one in five have one or more modifiable risk factor for developing cardiovascular disease, and cervical cancer prevalence amongst women living with HIV is six times higher than for women without HIV.
The report describes the results of a systematic literature review to identify HIV-NCD service delivery integration models in LIMCs, and to assess their costs, impact, and cost-effectiveness. It found evidence on the types of models deployed to integrate service delivery, the impact of HIV-NCD programs on a range of clinical and nonclinical outcomes, and the costs of implementation from patient and/or healthcare system perspectives. Highlights of the report include:
- 79 per cent of programmes reported favourable and significant outcomes on at least half of the outcomes that they measured.
- 11 of 13 programs assessing both NCD and HIV related outcomes reported improvements to - or maintenance of - HIV outcomes and positive NCD outcomes.
- Programmes targeting depression were highly successful, achieving favourable results in 10 out of 13 measured outcomes.
The NCD Alliance commissioned RTI International to develop the report with support from Viatris. The report concludes with a series of recommendations to governments, donors, and researchers to generate continued momentum for integrated service delivery to fulfill its role as a key contributor to achieving Universal Health Coverage (UHC) and SDG goals worldwide.
Over 20 per cent of the world’s eight billion people live with at least one NCD such as cancer, diabetes or heart disease. Each year NCDs cause 41 million deaths and drive millions of households into poverty. It has been projected that by 2030, NCD deaths could reach 52 million per year, adding a significant burden to communities and health systems. This number is being driven upward by a growing population and by ever-increasing exposure to risk factors like unhealthy diets, tobacco, alcohol, and air pollution.
Publication of the report comes just one week ahead of the Global Week for Action on NCDs which begins on 14 September and brings together civil society organisations and individuals around the world in calling on governments to ensure that everyone has access to quality healthcare, regardless of their ability to pay, where they live or who they are. This must include care for NCDs.
A virtual event co-hosted by the World Health Organization, the World Diabetes Foundation and the NCD Alliance: “Towards achieving Universal Health Coverage: Multistakeholder Gathering on Tackling Noncommunicable Diseases” will explore the cross-cutting actions to strengthen the prevention and control of NCDs and mental health issues. This webinar will be held at the start of the Global Week for Action—14 September, from 13.00-15.00 CEST and will feature the launch of the “WHO Global Mapping Report on Multisectoral Actions to Strengthen the Prevention and Control of NCDs and Mental Health”. It will be simultaneously translated into Spanish and French.
This year’s Global Week for Action on NCDs coincides with the United Nations High-Level Meeting (HLM) on UHC on 21 September, which offers the opportunity for governments to agree on specific actions to achieve UHC by 2030, a commitment previously made by all world leaders. At least half of the world’s population does not currently have full coverage of essential health services. Most of these people live in LMICs.
NCD Alliance Media Relations
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About the NCD Alliance
The NCD Alliance (NCDA) is a registered non-governmental organisation (NGO) based in Geneva, Switzerland, dedicated to supporting a world free from preventable suffering, disability and death caused by noncommunicable diseases (NCDs). Founded in 2009, NCDA brings together a unique network of over 400 members in more than 60 countries into a respected, united and credible global civil society movement. The movement is unified by the cross-cutting nature of common risk factors including unhealthy diets, alcohol, tobacco, air pollution and physical inactivity, and the system solutions for chronic NCDs such as cancer, cardiovascular disease, chronic lung disease, diabetes, mental health and neurological disorders.
About RTI International
RTI International is a global research institute and leading international development organization. RTI’s core mission is to improve the human condition. We combine our capabilities with those of partners to co-create smart, shared solutions for a more prosperous, equitable, and resilient world. Since its founding in 2016, RTI’s Center for Global Noncommunicable Diseases (NCDs) has worked with multi-sectoral clients to co-produce solutions tailored to national, local, and organizational circumstances, with emphasis on the needs of low- and middle- income countries where NCD prevalence and impacts are growing most rapidly. We build evidence and capacity to address modifiable risk factors that contribute to increasing NCD prevalence, and to assist health systems to develop effective and feasible ways to diagnose, treat, and manage NCDs among their populations.