Evaluating the integration of health services for chronic diseases in Africa

INTERVENTION: Experimental arm: Integrated health service provision at health facilities providing primary care for HIV‐infection, diabetes and hypertension. Control arm: standard care – separate stand‐alone services for HIV‐infection, diabetes or hypertension. Integration will involve ‐ A single one‐stop clinic where patients with either HIV‐infection, diabetes or hypertension will be managed. Patients can have one or more of these conditions. ‐ They will be seen and managed by the same clinicians, nurses, counsellors and other staff ‐ There will be one pharmacy where dispensing is integrated ‐ Patient records will be the same – a similar card will be used for all patients ‐ Laboratory tests will be done by the same laboratory service Participants will be followed up from enrolment into the study for a period of 12 months. Randomisation of the health facilities will be stratified in each country by location, type of health facility (as defined by the clinical infrastructure available at the health facility) and by patient load at the health facility (i.e. the numbers of patients attending the facility on a monthly basis). Within each stratum, the researchers will randomise in a 1:1 ratio to either the experimental integration arm or the standard care arm using a computer‐generated randomisation list. CONDITION: HIV‐infection, diabetes, or hypertension or combinations of these conditions ; Infections and Infestations PRIMARY OUTCOME: ; 1. Retention in care for patients on diabetes and hypertension management measured using patient records at 12 months; 2. Plasma viral load suppression among persons HIV‐infected measured using lab test (suppression will be defined as plasma viral load < 1000 copies per ml.) at 12 months; SECONDARY OUTCOME: ; 1. Cost‐effectiveness measured using a decision analytical model at 12 months; 2. Biomedical indicators measured at baseline and 12 months; 2.1. Fasting blood glucose; 2.2. HbA1c; 2.3. Blood pressure (mmHg); 3. Clinic usage (aggregated data on day‐to‐day patient numbers, time spent at clinic by patients, and basic indicators of quality of service such as consultation times) measured over 12 months; INCLUSION CRITERIA: 1. Adults, 18 years and above 2. Confirmed HIV‐infection, diabetes, hypertension or any combination of these 3. Living within the catchment population of the health facility 4. Likely to remain in the catchment population for 6 months 5. Willing to provide written informed consent