Person‐centred, integrated non‐communicable disease and HIV decentralized drug distribution in Eswatini and South Africa: outcomes and challenges
Introduction Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person‐centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa...
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| Published in | Journal of the International AIDS Society Vol. 26; no. S1; pp. e26113 - n/a |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Switzerland
John Wiley & Sons, Inc
01.07.2023
John Wiley and Sons Inc Wiley |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Introduction
Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person‐centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here.
Discussion
Launched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre‐exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person‐centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility‐based settings. South Africa's CCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community‐based pickup points, facility “fast lanes” and adherence clubs with public sector health facilities and private sector medication collection units. There are no out‐of‐pocket payments for medications or testing commodities. Wait‐times for medication refills are lower at CCMDD sites than facility‐based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications.
Conclusions
Eswatini and South Africa demonstrate person‐centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends. |
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| AbstractList | Abstract Introduction Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person‐centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here. Discussion Launched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre‐exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person‐centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility‐based settings. South Africa's CCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community‐based pickup points, facility “fast lanes” and adherence clubs with public sector health facilities and private sector medication collection units. There are no out‐of‐pocket payments for medications or testing commodities. Wait‐times for medication refills are lower at CCMDD sites than facility‐based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications. Conclusions Eswatini and South Africa demonstrate person‐centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends. Non-communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person-centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here. Launched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre-exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person-centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility-based settings. South Africa's CCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community-based pickup points, facility "fast lanes" and adherence clubs with public sector health facilities and private sector medication collection units. There are no out-of-pocket payments for medications or testing commodities. Wait-times for medication refills are lower at CCMDD sites than facility-based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications. Eswatini and South Africa demonstrate person-centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends. INTRODUCTIONNon-communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person-centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here. DISCUSSIONLaunched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre-exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person-centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility-based settings. South Africa's CCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community-based pickup points, facility "fast lanes" and adherence clubs with public sector health facilities and private sector medication collection units. There are no out-of-pocket payments for medications or testing commodities. Wait-times for medication refills are lower at CCMDD sites than facility-based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications. CONCLUSIONSEswatini and South Africa demonstrate person-centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends. Introduction: Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person‐centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here. Discussion: Launched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre‐exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person‐centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility‐based settings. South Africa's CCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community‐based pickup points, facility “fast lanes” and adherence clubs with public sector health facilities and private sector medication collection units. There are no out‐of‐pocket payments for medications or testing commodities. Wait‐times for medication refills are lower at CCMDD sites than facility‐based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications. Conclusions: Eswatini and South Africa demonstrate person‐centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends. Abstract Introduction Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person‐centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here. Discussion Launched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre‐exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person‐centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility‐based settings. South Africa's CCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community‐based pickup points, facility “fast lanes” and adherence clubs with public sector health facilities and private sector medication collection units. There are no out‐of‐pocket payments for medications or testing commodities. Wait‐times for medication refills are lower at CCMDD sites than facility‐based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications. Conclusions Eswatini and South Africa demonstrate person‐centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends. Introduction Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person‐centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here. Discussion Launched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre‐exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person‐centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility‐based settings. South Africa's CCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community‐based pickup points, facility “fast lanes” and adherence clubs with public sector health facilities and private sector medication collection units. There are no out‐of‐pocket payments for medications or testing commodities. Wait‐times for medication refills are lower at CCMDD sites than facility‐based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications. Conclusions Eswatini and South Africa demonstrate person‐centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends. Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person‐centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here. Launched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre‐exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person‐centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility‐based settings. South Africa's CCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community‐based pickup points, facility “fast lanes” and adherence clubs with public sector health facilities and private sector medication collection units. There are no out‐of‐pocket payments for medications or testing commodities. Wait‐times for medication refills are lower at CCMDD sites than facility‐based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications. Eswatini and South Africa demonstrate person‐centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends. |
| Audience | Academic |
| Author | Minior, Thomas Kisyeri, Nicholas Munsamy, Maggie Bateganya, Moses Nishimoto, Lirica Ford, Nathan Kambale, Herve Osi, Kufor Goldstein, Deborah |
| AuthorAffiliation | 2 Global HIV Hepatitis and Sexually Transmitted Infections Programmes World Health Organization Geneva Switzerland 7 Resolve to Save Lives Abuja Nigeria 1 Office of HIV/AIDS USAID Washington DC USA 3 Eswatini National AIDS Program Mbabane Eswatini 6 FHI 360 Durham North Carolina USA 8 ICAP Columbia University Mailman School of Public Health New York New York USA 5 National Department of Health Pretoria South Africa 4 ICAP Columbia University Mbabane Eswatini |
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| Author_xml | – sequence: 1 givenname: Deborah orcidid: 0000-0003-1858-3905 surname: Goldstein fullname: Goldstein, Deborah email: degoldstein@usaid.gov organization: USAID – sequence: 2 givenname: Nathan surname: Ford fullname: Ford, Nathan organization: World Health Organization – sequence: 3 givenname: Nicholas surname: Kisyeri fullname: Kisyeri, Nicholas organization: Columbia University – sequence: 4 givenname: Maggie surname: Munsamy fullname: Munsamy, Maggie organization: National Department of Health – sequence: 5 givenname: Lirica surname: Nishimoto fullname: Nishimoto, Lirica organization: FHI 360 – sequence: 6 givenname: Kufor surname: Osi fullname: Osi, Kufor organization: Resolve to Save Lives – sequence: 7 givenname: Herve surname: Kambale fullname: Kambale, Herve organization: Columbia University Mailman School of Public Health – sequence: 8 givenname: Thomas surname: Minior fullname: Minior, Thomas organization: USAID – sequence: 9 givenname: Moses orcidid: 0000-0001-9442-7854 surname: Bateganya fullname: Bateganya, Moses organization: FHI 360 |
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| Copyright | 2023 The Authors. published by John Wiley & Sons Ltd on behalf of the International AIDS Society. 2023 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. COPYRIGHT 2023 John Wiley & Sons, Inc. 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| References | 2020;; 10 2022; 75 2021;; 11 2022; 2 2021;; 21 2022;; 22 2022 2018;; 32 2020 2019;; 7 2021;; 18 e_1_2_8_17_1 Eswatini Ministry of Health (e_1_2_8_14_1) 2020 e_1_2_8_18_1 e_1_2_8_19_1 Bassett IV (e_1_2_8_20_1) e_1_2_8_13_1 e_1_2_8_3_1 e_1_2_8_2_1 e_1_2_8_5_1 e_1_2_8_4_1 e_1_2_8_7_1 e_1_2_8_6_1 e_1_2_8_9_1 e_1_2_8_8_1 e_1_2_8_10_1 Meeting Targets and Maintaining Epidemic Control (EpiC) and FHI 360 (e_1_2_8_15_1) 2022 e_1_2_8_21_1 e_1_2_8_11_1 e_1_2_8_12_1 Kisyeri N (e_1_2_8_16_1) |
| References_xml | – volume: 2 issue: 2 year: 2022 article-title: Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: a qualitative methods study publication-title: PLOS Glob Public Health – volume: 32 start-page: S5 issue: 1 year: 2018; end-page: 20 article-title: Noncommunicable diseases among HIV‐infected persons in low‐income and middle‐income countries: a systematic review and meta‐analysis publication-title: AIDS – volume: 10 issue: 10 year: 2020; article-title: Strengthening integration of chronic care in Africa: protocol for the qualitative process evaluation of integrated HIV, diabetes and hypertension care in a cluster randomised controlled trial in Tanzania and Uganda publication-title: BMJ Open – volume: 10 year: 2020; article-title: Understanding how community antiretroviral delivery influences engagement in HIV care: a qualitative assessment of the Centralised Chronic Medication Dispensing and Distribution programme in South Africa publication-title: BMJ Open – volume: 32 start-page: 773 issue: 6 year: 2018; end-page: 82 article-title: The growing burden of noncommunicable disease among persons living with HIV in Zimbabwe publication-title: AIDS – volume: 18 issue: 9 year: 2021; article-title: Future directions for HIV service delivery research: research gaps identified through WHO guideline development publication-title: PLoS Med – volume: 32 start-page: S33 issue: 1 year: 2018; end-page: 42 article-title: Models of integration of HIV and noncommunicable disease care in sub‐Saharan Africa: lessons learned and evidence gaps publication-title: AIDS – year: 2022 – year: 2020 – volume: 7 start-page: e1375 year: 2019; end-page: 87 article-title: Burden of non‐communicable diseases in sub‐Saharan Africa, 1990–2017: results from the Global Burden of Disease Study 2017 publication-title: Lancet Glob Health – volume: 11 year: 2021; article-title: Effects of integrated models of care for diabetes and hypertension in low‐income and middle‐income countries: a systematic review and meta‐analysis publication-title: BMJ Open – volume: 22 start-page: 1 issue: 1 year: 2022; end-page: 22 article-title: Integrating care for diabetes and hypertension with HIV care in sub‐Saharan Africa: a scoping review publication-title: Int J Integr Care – volume: 75 start-page: 657 issue: 4 year: 2022 end-page: 664 article-title: . Predictors of all‐cause mortality among people with HIV in a prospective cohort study in East Africa and Nigeria publication-title: Clin Infect Dis – volume: 21 start-page: 463 year: 2021; article-title: Expansion of a national differentiated service delivery model to support people living with HIV and other chronic conditions in South Africa: a descriptive analysis publication-title: BMC Health Serv Res – ident: e_1_2_8_10_1 doi: 10.1371/journal.pmed.1003812 – ident: e_1_2_8_2_1 – ident: e_1_2_8_21_1 doi: 10.1136/bmjopen-2019-035412 – ident: e_1_2_8_8_1 doi: 10.1097/QAD.0000000000001887 – ident: e_1_2_8_12_1 doi: 10.1371/journal.pgph.0000084 – volume-title: Differentiated service delivery in Eswatini: adaptation, scale‐up and monitoring. Poster presented at AIDS ident: e_1_2_8_16_1 contributor: fullname: Kisyeri N – ident: e_1_2_8_6_1 – ident: e_1_2_8_19_1 – ident: e_1_2_8_11_1 doi: 10.1136/bmjopen-2020-043705 – volume-title: Does type of pickup‐point influence 12‐month virologic suppression in South Africa? ident: e_1_2_8_20_1 contributor: fullname: Bassett IV – volume-title: Leveraging the DDD infrastructure to provide integrated HIV/NCD care year: 2022 ident: e_1_2_8_15_1 contributor: fullname: Meeting Targets and Maintaining Epidemic Control (EpiC) and FHI 360 – ident: e_1_2_8_18_1 – ident: e_1_2_8_4_1 doi: 10.1093/cid/ciab995 – ident: e_1_2_8_7_1 doi: 10.1016/S2214-109X(19)30374-2 – volume-title: HIV annual performance report year: 2020 ident: e_1_2_8_14_1 contributor: fullname: Eswatini Ministry of Health – ident: e_1_2_8_9_1 doi: 10.5334/ijic.5839 – ident: e_1_2_8_17_1 doi: 10.1186/s12913-021-06450-z – ident: e_1_2_8_13_1 doi: 10.1136/bmjopen-2020-039237 – ident: e_1_2_8_5_1 doi: 10.1097/QAD.0000000000001888 – ident: e_1_2_8_3_1 doi: 10.1097/QAD.0000000000001754 |
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| Snippet | Introduction
Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There... Non-communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little... Abstract Introduction Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing... Introduction: Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There... Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little... IntroductionNon-communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There... INTRODUCTIONNon-communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There... Abstract Introduction Non‐communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing... |
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| SubjectTerms | Acquired immune deficiency syndrome AIDS Antiretroviral agents Antiviral agents Blood Glucose Blood Glucose Self-Monitoring Blood pressure Blood sugar monitoring Care and treatment Chronic diseases Chronic illnesses Commodities Communicable diseases Community COVID-19 decentralized drug distribution Diabetes Diabetes Mellitus Disease transmission Dispensing Drug stores Drug wholesalers Drugs Eswatini Evaluation Family planning Health facilities Highly active antiretroviral therapy HIV HIV (Viruses) HIV infection HIV Infections - drug therapy HIV Infections - prevention & control Human immunodeficiency virus Humans Hypertension Hypertension - drug therapy Hypoglycemic agents integration Low income groups Measurement Mortality Noncommunicable Diseases - drug therapy non‐communicable disease person‐centred care Pharmacy Private sector Prophylaxis Public health administration Public sector South Africa Subsidies Supply chains Tuberculosis |
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| Title | Person‐centred, integrated non‐communicable disease and HIV decentralized drug distribution in Eswatini and South Africa: outcomes and challenges |
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