Offering integrated care for HIV/AIDS, diabetes and hypertension within chronic disease clinics in Cambodia

• Published in: Bulletin of the World Health Organization Vol. 85; no. 11; pp. 880 - 885
• Main Authors: JANSSENS, B, VAN DAMME, W, RALEIGH, B, GUPTA, J, KHEM, S, SOY TY, K, VUN, M. C, FORD, N, ZACHARIAH, R
• Format: Journal Article
• Language: English
• Published: Genève Organisation mondiale de la santé 01.11.2007; World Health Organization; The World Health Organization
• Subjects: Acquired immune deficiency syndrome; AIDS; Ambulatory Care Facilities - organization & administration; Biological and medical sciences; Cambodia; Cambodia - epidemiology; Care and treatment; Chronic Disease - therapy; Chronic illnesses; Clinics; Developing countries; Diabetes; Diabetes Mellitus, Type 2 - therapy; Disease; HIV; HIV Infections - mortality; HIV Infections - therapy; Hospitals; Human immunodeficiency virus; Human viral diseases; Humans; Hypertension; Hypertension - therapy; Infectious diseases; Integrated delivery systems; Laboratories; LDCs; Lessons from the Field; Medical referrals; Medical sciences; Meningitis; Mental health care; Miscellaneous; Patients; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Stigma; Treatment Outcome; Tuberculosis; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Cambodia; Asia; Endocrinopathy; Human; Hypertension; Immunopathology; Chronic disease; Managed care; Diabetes mellitus; Cardiovascular disease; AIDS; Immune deficiency; Infection; Chronic; Association; Viral disease; Tropical medicine; Public health
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.06.036574

In Cambodia, care for people with HIV/AIDS (prevalence 1.9%) is expanding, but care for people with type II diabetes (prevalence 5-10%), arterial hypertension and other treatable chronic diseases remains very limited. We describe the experience and outcomes of offering integrated care for HIV/AIDS, diabetes and hypertension within the setting of chronic disease clinics. Chronic disease clinics were set up in the provincial referral hospitals of Siem Reap and Takeo, 2 provincial capitals in Cambodia. At 24 months of care, 87.7% of all HIV/AIDS patients were alive and in active follow-up. For diabetes patients, this proportion was 71%. Of the HIV/AIDS patients, 9.3% had died and 3% were lost to follow-up, while for diabetes this included 3 (0.1%) deaths and 28.9% lost to follow-up. Of all diabetes patients who stayed more than 3 months in the cohort, 90% were still in follow-up at 24 months. Over the first three years, the chronic disease clinics have demonstrated the feasibility of integrating care for HIV/AIDS with non-communicable chronic diseases in Cambodia. Adherence support strategies proved to be complementary, resulting in good outcomes. Services were well accepted by patients, and this has had a positive effect on HIV/AIDS-related stigma. This experience shows how care for HIV/AIDS patients can act as an impetus to tackle other common chronic diseases.