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Integrated Diagnosis in Africa’s Low- and Middle-Income Countries: What Is It, What Works, and for Whom? A Realist Synthesis Cover

Integrated Diagnosis in Africa’s Low- and Middle-Income Countries: What Is It, What Works, and for Whom? A Realist Synthesis

Open Access
|Sep 2024

References

  1. Goodwin N. Understanding Integrated Care. Int J Integr Care. 2016; 16(4): 6. DOI: 10.5334/ijic.2530
  2. Frisch NC. What’s in a Definition? Holistic Nursing, Integrative Health Care, and Integrative Nursing. Journal of Holistic Nursing. 2019; 37. DOI: 10.1177/0898010119860685
  3. WHO. WHO global strategy on people-centred and integrated health services; 2015.
  4. Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, et al. The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet. 2021; 398(10315): 19972050. DOI: 10.1016/S0140-6736(21)00673-5
  5. Sweeney S, Obure C, Maier C, Greener R, Dehne K, Vassall A. Costs and efficiency of integrating HIV/AIDS services with other health services: a systematic review of evidence and experience. Global Health and Development; 2011. DOI: 10.1136/sextrans-2011-050199
  6. Unitaid. Multi-Disease diagnostic landscape for integrated management of HIV, HCV, TB and other coinfections; 2018.
  7. Haldane V, Legido-Quigley H, Chuah FLH, Sigfrid L, Murphy G, Ong SE, et al. Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review. AIDS Care. 2017; 30(1): 10315. DOI: 10.1080/09540121.2017.1344350
  8. Trankle SA, Usherwood T, Abbott P, Roberts M, Crampton M, Girgis CM, et al. Integrating health care in Australia: a qualitative evaluation. BMC Health Serv Res. 2019; 19(1): 954. DOI: 10.1186/s12913-019-4780-z
  9. Dudley L, Garner P. Strategies for integrating primary health services in low- and middle-income countries at the point of delivery. Cochrane Database Syst Rev. 2011(7): CD003318. DOI: 10.1002/14651858.CD003318.pub3
  10. Sentes K, Kipp W. Global Burden of Disease: Huge Inequities in the Health Status in Developing and Developed Countries. Brief report; 2003. DOI: 10.1016/S0840-4704(10)60229-3
  11. Umubyeyi Nyaruhirira A, Scholten JN, Gidado M, Suarez PG. Coronavirus Disease 2019 Diagnosis in Low- and Middle-Income Countries: The Big New Bully Disrupting TB and HIV Diagnostic Services. J Mol Diagn. 2022; 24(4): 28993. DOI: 10.1016/j.jmoldx.2021.12.008
  12. Hopkins KL, Hlongwane KE, Otwombe K, Dietrich J, Cheyip M, Olivier J, et al. The substantial burden of non-communicable diseases and HIV-comorbidity amongst adults: Screening results from an integrated HIV testing services clinic for adults in Soweto, South Africa. EClinicalMedicine. 2021; 38: 101015. DOI: 10.1016/j.eclinm.2021.101015
  13. George S, McGrath N, Oni T. The association between a detectable HIV viral load and non-communicable diseases comorbidity in HIV positive adults on antiretroviral therapy in Western Cape, South Africa. BMC Infect Dis. 2019; 19(1): 348. DOI: 10.1186/s12879-019-3956-9
  14. Haregu TN, Setswe G, Elliott J, Oldenburg B. Integration of HIV/AIDS and noncommunicable diseases in developing countries: rationale, policies and models. International Journal of Healthcare. 2015; 1(1). DOI: 10.5430/ijh.v1n1p21
  15. Organisation WH. Framework on integrated, people-centred health services; 2016.
  16. Hafiz O, Yin X, Sun S, Yang J, Liu H. Examining the Use and Application of the WHO Integrated People-Centred Health Services Framework in Research Globally – a Systematic Scoping Review. Int J Integr Care. 2024; 24(2): 9. DOI: 10.5334/ijic.7754
  17. WHO, ASLM. Molecular Diagnostics Integration Global Meeting Report, 10–12 July, Geneva, Switzerland; 2019. https://www.who.int/publications/i/item/9789240002135.
  18. WHO. WHO policy on collaborative TB/HIV activities: Guidelines for national programmes and other stakeholders; 2012.
  19. UCN/NCD/ISD W. Implementation Guidance to INTEGRATE Noncommunicable Disease Services into Other Programmatic Areas and Health Systems: Draft; 2021.
  20. WHO. Strengthening diagnostics capacity, Seventy-sixth World Health Assembly. In: WHA76.5, editor. 2023.
  21. Church K, Wringe A, Lewin S, Ploubidis GB, Fakudze P, Integra I, et al. Exploring the Feasibility of Service Integration in a Low-Income Setting: A Mixed Methods Investigation into Different Models of Reproductive Health and HIV Care in Swaziland. PloS One. 2015; 10(5). DOI: 10.1371/journal.pone.0126144
  22. Jagosh J. Realist Synthesis for Public Health: Building an Ontologically Deep Understanding of How Programs Work, For Whom, and In Which Contexts. Annu Rev Public Health. 2019; 40: 36172. DOI: 10.1146/annurev-publhealth-031816-044451
  23. Pawson R, Greenhalg, Harvey G, Walshe, K. Realist review – a new method of systematic review designed for complex policy interventions. Journal of Health Services Research & Policy. 2005; 10: 2134. DOI: 10.1258/1355819054308530
  24. Rycroft-Malone J, McCormack B, Hutchinson A, DeCorby K, Bucknall T, Kent B, et al. Realist synthesis: illustrating the method for implementation research. Implementation Science. 2012; 7. DOI: 10.1186/1748-5908-7-33
  25. Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson, R. RAMESES publication standards: realist syntheses. BMC Medicine; 2013. DOI: 10.1186/1741-7015-11-21
  26. Briggs CJ, Capdegelle P, Garner P. Strategies for integrating primary health services in middle- and low-income countries: effects on performance, costs and patient outcomes. Cochrane Database Syst Rev. 2001(4): CD003318. DOI: 10.1002/14651858.CD003318
  27. Adeyemi O, Lyons M, Njim T, Okebe J, Birungi J, Nana K, et al. Integration of non-communicable disease and HIV/AIDS management: a review of healthcare policies and plans in East Africa. BMJ Glob Health. 2021; 6(5). DOI: 10.1136/bmjgh-2020-004669
  28. Youssef A, Chaudhary Z, Wiljer D, Mylopoulos M. Mapping Evidence of Patients’ Experiences in Integrated Care: A Scoping Review. General Hospital Psychiatry. 2019; 61. DOI: 10.1016/j.genhosppsych.2019.08.004
  29. Legido-Quigley H, Montgomery CM, Khan P, Atun R, Fakoya A, Getahun H, et al. Integrating tuberculosis and HIV services in low- and middle-income countries: a systematic review. Tropical Medicine and International Health. 2013; 18(2): 199211. DOI: 10.1111/tmi.12029
  30. Gera T, Shah D, Garner P, Richardson M, Sachdev HS. Integrated management of childhood illness (IMCI) strategy for children under five. Cochrane Database Syst Rev. 2016(6): CD010123. DOI: 10.1002/14651858.CD010123.pub2
  31. McCombe G, Lim J, Hout MCV, Lazarus JV, Bachmann M, Jaffar S, et al. Integrating Care for Diabetes and Hypertension with HIV Care in Sub-Saharan Africa: A Scoping Review. Int J Integr Care. 2022; 22(1): 6. DOI: 10.5334/ijic.5839
  32. Duffy M, Ojikutu B, Andrian S, Sohng E, Minior T, Hirschhorn L. Non-communicable diseases and HIV care and treatment: models of integrated service delivery. Tropical Medicine and International Health. 2017; 22: 92637. DOI: 10.1111/tmi.12901
  33. Kane J, Landess M, Carroll C, Nolen A, Sodhi S. A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa. BMC Family Practice. 2017; 18(46). DOI: 10.1186/s12875-017-0613-5
  34. van Olmen J, Schellevis F, Van Damme W, Kegels G, Rasschaert F. Management ofChronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care. Journal ofTropical Medicine; 2012. DOI: 10.1155/2012/349312
  35. Hope R, Kendall T, Langer T, Barningausen T. Health Systems Integration of Sexual and Reproductive Health and HIV Services in Sub-Saharan Africa: A Scoping Study. J Acquir Immune Defic Syndr. 2014; 67. DOI: 10.1097/QAI.0000000000000381
  36. Jongh T, I G-U, Allen EZ, NJ, Atun R. Barriers and enablers to integrating maternal and child health services to antenatal care in low and middle income countries. BJOG An International Journal of Obstetrics and Gynaecology; 2016. DOI: 10.1111/1471-0528.13898
  37. Kikuchu K, Ayer R, Okawa S, Nishikitani M, Yokota F, Jimba M, et al. Interventions integrating non-communicable disease prevention and reproductive, maternal, newborn, and child health: A systematic review. BioScience Trends. 2018; 12(2): 11625. DOI: 10.5582/bst.2018.01070
  38. WHO. Integrated Health Services – What and Why ?; 2008.
  39. Mwanahamuntu MH, Sahasrabuddhe VV, Pfaendler KS, Mudenda V, Hicks ML, Vermund SH, et al. Implementation of ‘see-and-treat’ cervical cancer prevention services linked to HIV care in Zambia. AIDS. 2009; 23(6): N15. DOI: 10.1097/QAD.0b013e3283236e11
  40. Parham GP, Mwanahamuntu MH, Sahasrabuddhe VV, Westfall AO, King KE, Chibwesha C, et al. Implementation of cervical cancer prevention services for HIV-infected women in Zambia: measuring program effectiveness. HIV Ther. 2010; 4(6): 70322. DOI: 10.2217/hiv.10.52
  41. Church K, Warren CE, Birdthistle I, Ploubidis GB, Tomlin K, Zhou W, et al. Impact of Integrated Services on HIV Testing: A Nonrandomized Trial among Kenyan Family Planning Clients. Stud Fam Plann. 2017; 48(2): 20118. DOI: 10.1111/sifp.12022
  42. Gengiah S, Barker PM, Yende-Zuma N, Mbatha M, Naidoo S, Taylor M, et al. A cluster-randomized controlled trial to improve the quality of integrated HIV-tuberculosis services in primary healthcareclinics in South Africa. J Int AIDS Soc. 2021; 24(9): e25803. DOI: 10.1002/jia2.25803
  43. Bygrave H, Golob L, Wilkinson L, Roberts T, Grimsrud A. Let’s talk chronic disease: can differentiated service delivery address the syndemics of HIV, hypertension and diabetes? Curr Opin HIV AIDS. 2020; 15(4): 25660. DOI: 10.1097/COH.0000000000000629
  44. Ramogola-Masire D, de Klerk R, Monare B, Ratshaa B, Friedman HM, Zetola NM. Cervical cancer prevention in HIV-infected women using the “see and treat” approach in Botswana. J Acquir Immune Defic Syndr. 2012; 59(3): 30813. DOI: 10.1097/QAI.0b013e3182426227
  45. Maina W. Integrating noncommunicable disease prevention into maternal and child health programs: Can it be done and what will it take? International Journal of Gynecology and Obstetrics. 2011; 115. DOI: 10.1016/S0020-7292(11)60010-6
  46. Wroe EB, Kalanga N, Dunbar EL, Nazimera L, Price NF, Shah A, et al. Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD-HIV model. BMJ Open. 2020; 10(10): e036836. DOI: 10.1136/bmjopen-2020-036836
  47. UNAIDS. Chronic care of HIV and noncommunicable diseases: How to leverage the HIV experience; 2011.
  48. Raben D, Hoekstra M, Combs L, Sullivan A, Lazarus JV, Lambert J, et al. A call to action toward integrated testing and earlier care for viral hepatitis, HIV, STIs and TB. HIV Medicine. 2020; 21: 4038. DOI: 10.1111/hiv.12844
  49. Smith PJ, Davey DJ, Green H, Cornell M, Bekker LG. Reaching underserved South Africans with integrated chronic disease screening and mobile HIV counselling and testing: A retrospective, longitudinal study conducted in Cape Town. PLoS One. 2021; 16(5): e0249600. DOI: 10.1371/journal.pone.0249600
  50. Doherty T, Chopra M, Tomlinson M, Oliphant N, Nsibande D, Mason J. Moving from vertical to integrated child health programmes: experiences from a multi-country assessment of the Child Health Days approach in Africa. Tropical Medicine and International Health. 2010; 15: 296305. DOI: 10.1111/j.1365-3156.2009.02454.x
  51. Conference AotXIA. Track E Implementation Science, Health Systems and Economics. Journal of the International AIDS Society. 2012; 15(Suppl 3). DOI: 10.7448/IAS.15.5.18443
  52. Havlir DV, Balzer LB, Charlebois ED, Clark TD, Kwarisiima D, Ayieko J, et al. HIV Testing and Treatment with the Use of a Community Health Approach in Rural Africa. N Engl J Med. 2019; 381(3): 21929. DOI: 10.1056/NEJMoa1809866
  53. Young N, Achieng F, Desai M, Phillips-Howard P, Hill J, Aol G, et al. Integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at antenatal facilities in western Kenya: a qualitative study exploring end-users’ perspectives of appropriateness, acceptability and feasibility. BMC Health Serv Res. 2019; 19(1): 74. DOI: 10.1186/s12913-018-3844-9
  54. Bryce J, Victora CG, Habicht JP, Black RE, Scherpbier RW. Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness. Oxford University Press in association with The London School of Hygiene and Tropical Medicine; 2005. DOI: 10.1093/heapol/czi055
  55. Kjærgaard J, Anastasaki M, Østergaard MS, Isaeva E, Akylbekov A, Nguyen NQ, et al. Diagnosis and treatment of acute respiratory illness in children under five in primary care in low-, middle-, and high-income countries: A descriptive FRESH AIR study. PLoS ONE. 2019; 14(11). DOI: 10.1371/journal.pone.0221389
  56. Shayo EH, Kivuyo S, Seeley J, Bukenya D, Karoli P, Mfinanga SG, et al. The acceptability of integrated healthcare services for HIV and non-communicable diseases: experiences from patients and healthcare workers in Tanzania. BMC Health Serv Res. 2022; 22(1): 655. DOI: 10.1186/s12913-022-08065-4
  57. Mulupi S, Ayakaka I, Tolhurst R, Kozak N, Shayo E, Abdalla E, et al. Perspectives of healthcare workers, national and regional policy stakeholders on the management of chronic lung disease in five sub-saharan African countries: tale of a vicious cycle of neglect. Preprint; 2022.
  58. Sweeny S, Obure C, Terris-Prestholt F, Darsamo V, Michaels-Igbokwe C, Muketo E, et al. The impact of HIV/SRH service integration on workload: analysis from the Integra Initiative in two African settings. Human Resources for Health. 2014; 12. DOI: 10.1186/1478-4491-12-42
  59. Bryce J, Victora CG, Habicht JP, Vaughan JP, Black RE. The multi-country evaluation of the integrated management of childhood illness strategy: lessons for the evaluation of public health interventions. Am J Public Health. 2004; 94(3): 40615. DOI: 10.2105/AJPH.94.3.406
  60. Wang M, Boeke CE, Rioja MR, Maparo T, Banda C, Chavula C, et al. Feasibility and impact of near-point-of-care integrated tuberculosis/HIV testing in Malawi and Zimbabwe. AIDS. 2021; 35(15): 25317. DOI: 10.1097/QAD.0000000000003031
  61. Ndlovu Z, Fajardo E, Mbofana E, Maparo T, Garone D, Metcalf C, et al. Multidisease testing for HIV and TB using the GeneXpert platform: A feasibility study in rural Zimbabwe. PLoS One. 2018; 13(3): e0193577. DOI: 10.1371/journal.pone.0193577
  62. Organisation WH. Considerations for Adoption and Use of Multidisease testing devices in Integrated Laboratory networks; 2017.
  63. Manosuthi W, Wiboonchutikul S, Sungkanuparph S. Integrated therapy for HIV and tuberculosis. AIDS Res Ther. 2016; 13: 22. DOI: 10.1186/s12981-016-0106-y
  64. Phetlhu D, Bimerew M, Marie-Modeste R, Naidoo M, Igumbor J. Nurses’ Knowledge ofTuberculosis, HIV, and Integrated HIV/TB Care Policies in Rural Western Cape, South Africa. Journal of the Association of Nurses in Aids Care. 2018; 29. DOI: 10.1016/j.jana.2018.05.008
  65. WHO. Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. World Health Organisation; 2010.
  66. Tapela N, Tshisimogo G, Shatera BP, Letsatsi V, Gaborone M, Madidimalo T, et al. Integrating noncommunicable disease services into primary health care, Botswana. Bull World Health Organ. 2019; 97: 14253. DOI: 10.2471/BLT.18.221424
  67. Torpey K, Iwelunmor J, Ezechi O, Obiezu-Umeh C, Gbajabiamila T, Musa AZ, et al. Capabilities, opportunities and motivations for integrating evidence-based strategy for hypertension control into HIV clinics in Southwest Nigeria. Plos One. 2019; 14(6). DOI: 10.1371/journal.pone.0217703
  68. Singer SJ, Kerrissey M, Friedberg M, Phillips R. A Comprehensive Theory of Integration. Medical Care Research and Review. 2018; 77(2): 196207. DOI: 10.1177/1077558718767000
  69. Kabatereine NB, Malecela M, Lado M, Zaramba S, Amiel O, Kolaczinski JH. How to (or not to) integrate vertical programmes for the control of major neglected tropical diseases in sub-Saharan Africa. PLoS Negl Trop Dis. 2010; 4(6): e755. DOI: 10.1371/journal.pntd.0000755
  70. de Jongh TE, Gurol-Urganci I, Allen E, Jiayue Zhu N, Atun R. Barriers and enablers to integrating maternal and child health services to antenatal care in low and middle income countries. BJOG. 2016; 123(4): 54957. DOI: 10.1111/1471-0528.13898
  71. Gwaza GP, Lamy M, Datta R, Dittrich S. Barriers to integrating diagnostic services for febrile illness to support surveillance and patient management in Asia-Pacific. Asia & the Pacific Policy Studies. 2022; 9(2): 196212. DOI: 10.1002/app5.353
  72. Corneli A, Jarrett N, Sabue M, Duvall S, Bahati E, Behets F, et al. Patient and provider perspectives on implementation models of HIV counseling and testing for patients with TB. International Journal of Tuberculosis and Lung diseases. 2008; 12(3): 57984.
  73. Zapata T, Forster N, Campuzano P, Kambapani R, Brahmbhatt H, Hidinua G, et al. How to Integrate HIV and Sexual and Reproductive Health Services in Namibia, the Epako Clinic Case Study. International Journal of Integrated Care. 2017; 17(4). DOI: 10.5334/ijic.2488
  74. Gwaza G, Leqheka M, Dittrich S, Mots’oane T, Kao K. Missed opportunities for integrated testing: An Evaluation of the implementation of TB and HIV EID Testing on the GeneXpert platform in Lesotho. African Journal for Laboratory Science; 2023. DOI: 10.5334/ijic.ICIC23406
  75. Chopra M, Binkin N, Mason E, Wolfheim C. Integrated management of childhood illness: what have we learned and how can it be improved? Global Child Health; 2012. DOI: 10.1136/archdischild-2011-301191
  76. Mitambo C, Khan S, Matanje-Mwagomba BL, Kachimanga C, Wroe E, Segula D, et al. Improving the screening and treatment of hypertension in people living with HIV: An evidence-based policy brief by Malawi’s Knowledge Translation Platform. Malawi Med J. 2017; 29(2): 2248. DOI: 10.4314/mmj.v29i2.27
  77. Youssef A, Wiljer D, Mylopoulos M, Maunder R, Sockalingam S. “Caring About Me”: a pilot framework to understand patient- centered care experience in integrated care – a qualitative study. BMJ Open. 2020; 10. DOI: 10.1136/bmjopen-2019-034970
  78. CHAI. Integrated Testing for TB and HIV using GenExpert Devices Expands Access to Near-Point-of-Care Testing Lessons Learned from Zimbabwe; August 2019.
  79. Hyle P, Naidoo K, Su A, El-Sadr M, Freedberg A. HIV, Tuberculosis, and Non-Communicable Diseases: What is known about the costs, effects, and cost-effectiveness of integrated care? J Acquir Immune Defic Syndr. 2014; 67(1): S87S95. DOI: 10.1097/QAI.0000000000000254
  80. Sweeny S, Obure C, Terris-Presholt F, Darsamo V, Michaels-Igbokwe C, Muketo E, et al. The impact of HIV/SRH service integration on workload: analysis from the Integra Initiative in two African settings. Human Resources for Health. 2014; 12(42). DOI: 10.1186/1478-4491-12-42
  81. Storeng K, Behague D. “Lives in the balance”: The politics of integration in the Partnership for Maternal, Newborn and Child Health. Health Policy and Planning. 2016; 31: 9921000. DOI: 10.1093/heapol/czw023
  82. Brodersen J, Schwartz L, Heneghan C, O’Sullivan J, Aronson J, Woloshin S. Overdiagnosis: what it is and what it isn’t. BMJ Evidence-Based Medicine. 2018; 23(1). DOI: 10.1136/ebmed-2017-110886
DOI: https://doi.org/10.5334/ijic.7788 | Journal eISSN: 1568-4156
Language: English
Submitted on: Nov 14, 2023
Accepted on: Sep 4, 2024
Published on: Sep 12, 2024
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2024 Gamuchirai Gwaza, Annette Plüddemann, Marcy McCall, Carl Heneghan, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.