Offering More: The Integration of HIV, Diabetes and Hypertension Services in sub-Saharan Africa through INTE-AFRICA

World Diabetes Day 2020

[Prof Sayoki Mfinanga is the Director and Chief Research Scientist for NIMR Muhimbili Centre in Tanzania, Honorary Professor of Global Health at Liverpool School of Tropical Medicine, Honorary Lecturer at Muhimbili University of Health and Allied Sciences in Dar es Salaam, and Adjunct Professor at Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania]

For the last decade, African health services have encountered an increased burden of chronic conditions, such as diabetes and hypertension, that is equal to or higher than that of acute infections, such as tuberculosis (TB), malaria, and the consequences associated with HIV infection. These chronic conditions require regular and lifelong treatment and therefore it is necessary that those affected have access to affordable healthcare.

Diabetes and hypertension lead to serious clinical complications including heart attack, stroke and kidney disease. They pose a serious challenge to health systems in Africa, which historically have focused on infectious diseases and are therefore ill-equipped to provide proper health services for the diagnosis and management of these chronic conditions – less than 5% of those affected by diabetes or hypertension are in regular care.

World Diabetes Day (WDD) has been marked on this day (14 November) every year since its creation by the International Diabetes Foundation (IDF) and the World Health Organization in 1991 in response to the growing health threat posed by diabetes. The purpose of the WDD campaign is to promote advocacy and concerted actions to confront diabetes on a global level. Thus, on this day, we recognise the continued challenge of diabetes management and prevention in sub-Saharan Africa.

INTE-AFRICA aims to evaluate the effectiveness of integrating services for diabetes, hypertension, and HIV-infection in Tanzania and Uganda

The INTE-AFRICA (Integrating and Decentralising HIV, diabetes and hypertension services in Africa) project is a novel approach to this challenge. It aims to evaluate the effectiveness of integrating services for diabetes, hypertension, and HIV-infection in Tanzania and Uganda. Having identified a model for integrated care, we are currently conducting a large-scale pragmatic trial to evaluate the integrated model versus vertical care. We are a multidisciplinary team, including health researchers, Ministries of Health, community representatives and patients working closely to offer quality, integrated, and simplified diabetes and hypertension care across Tanzania and Uganda. The results from this trial are expected to be relevant and applicable to other conditions and other sub-Saharan African countries.

The Global Alliance for Chronic Diseases (GACD), which recognises diabetes as one of its priority diseases, has just recently held its annual scientific meeting (10-13 November 2020) where INTE-AFRICA was showcased, highlighting its contribution to the evidence on effectiveness of integrated services for these three chronic conditions. INTE-AFRICA will provide services and care for people with diabetes and/or hypertension who may not have known they were affected, or who were not able to access care previously. We hope that INTE-AFRICA’s presentation in this large network reached key researchers and policy-makers around the globe to impact policy on a wider scale.

The INTE-AFRICA Consortium

INTE-AFRICA is coordinated by the Liverpool School of Tropical Medicine (LSTM, UK), in close collaboration with the National Institute for Medical Research (NIMR), Shree Hindu Mandal Hospital and the Ministry of Health in Tanzania, the MRC & LSTMH Uganda Research Unit, The Aids Support Organisation (TASO) and the Ministry of Health in Uganda, the Barcelona Institute for Global Health (ISGlobal, Spain), the University of Bergen (Norway), the University College Dublin (Ireland), the University of East Anglia (UK), and the Liverpool John Moores University (UK).

• To learn more about the challenges of non-communicable diseases in Africa, presented by the Liverpool School of Tropical Medicine.
• Recent updates regarding the INTE-AFRICA project.