Healthcare integration | Infrastructure and study setting | Sociodemographic characteristics of patients (no of patient–participants, gender, age, diseases, housing, employment rate, income) | Conceptualisation of patient perspectives | |
Matima et al21 | The Innovative Care for Chronic Conditions38 model adapted through the Integrated Chronic Disease Management (ICDM)32 framework was used to conceptualise healthcare integration. | Separate clinics for HIV and T2D (a clinic providing care for HIV and TB, and a PHC clinic providing care for all other diseases, including T2D). |
| Shippee’s Cumulative Complexity Model39-workload of demands related to chronic disease management (‘patient workload’), and a patient’s capacity to meet this workload (‘patient capacity’), which is determined by factors such as their physical or mental functioning, socioeconomic resources, social support, level of literacy and attitudes or beliefs. |
Rawat et al14 | Healthcare integration was conceptualised as integration of HIV care in PHC clinics. | Some PHC clinics had integrated care for HIV, but not all. The study was conducted 2–3 years after implementation of HIV into PHC clinics. The study included only PHC clinics where HIV was integrated. |
| How patients experienced quality of care (QoC) and satisfaction with staff after integration of HIV care into PHC clinics. |
Venables et al22 | Integration of HIV, DM and hypertensive patients in Medication Adherence Clubs (MACs). | HIV/TB services in PHC since 2003, and integrated NCD management from 2009. MACs provide a medication refill system for HIV, DM and HT patients who meet defined clinical eligibility criteria. |
| How patients experienced integrated NCD-HIV MACs, the challenges they faced and their perceptions about models of care for chronic conditions. |
Lebina et al23 | The ICDM model32 was used to conceptualise healthcare integration by implementing the model at PHC facilities. | HIV and T2D integrated into PHC clinics. DKK and WR were the pilot sites for the ICDM model32,40 implementation. 16 PHC clinics were included in the study (8 in the WR and 8 in the DKK health districts). |
| The healthcare workers perceptions of patient perspectives regarding moderating factors of implementation fidelity of the ICDM model.32 |
Bosire24 | The ICDM model32 and WHO’s definition:: “the organisation, management and coordination of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money.”41 | A large tertiary hospital in Soweto. Comprehensive HIV care provided at PHC clinics, and comprehensive diabetes care only provided at the tertiary hospital. |
| How patients experienced getting access to healthcare for comorbid HIV and T2D, and how they experienced self-management of their concurrent chronic illnesses at home. |
Ameh et al25 | The ICDM model32 and WHO’s definition of integrated chronic care was used to conceptualise healthcare integration.41 | At the time of the study, the ICDM model32 was being implemented in 17 out of the 39 PHC clinics in the sub-district. 7 of the 17 facilities implementing the ICDM model32 in Agincourt Health and Demographic Surveillance System. |
| Avedis Donabedian’s structure, process, and outcome theoretical framework42 was used to conceptualise Patient perspectives regarding the QoC in the ICDM model32 implemented in PHC facilities and regarding the patient-provider interactions in these integrated PHC facilities. |
Knight et al26 | The ICDM model32 and Chronic Care Clubs43 (a counterpart to MACs) were used to understand healthcare integration. | Langa: PHC provided care for HIV and the Vanguard Community Health Centre provided similar services as the Langa Clinic and additionally chronic care services (incl. T2D). Khayelitsha: provides the same services as Vanguard CHC, including care for HIV and T2D. Different staff members provide care for HIV and NCDs (incl.T2D) in different sections. |
| Older PLWH’s experiences in accessing healthcare and treatment for comorbidities including HIV and T2D were conceptualised in the context of the syndemics model.44 The syndemics model assesses the interaction of two or more concurrent diseases in a biopsychosocial context to consider reasoning for behaviour and outcomes.44 |
Moise et al27 | The concept of healthcare integration were based on three common models: (1) integrating services for NCD into centres initially providing HIV care; (2) integrating care for HIV into centres initially providing NCD services; and (3) synchronised integration of both HIV and NCD care and services.11 45 | Study conducted in Chiang Mai, a province of 1.6 million people with 25 hospitals (1 general, 1 university and 23 community), with 266 health centres. At the time of the study, T2D and HIV clinics were operated independently in Thailand. |
| The syndemics framework44 was used to explore patients’ knowledge and perceptions of health status and management of care for comorbidity of T2D and HIV. |
Mkumba et al28 | The concept of integrated healthcare was described as a consolidated care, where all HIV and non-HIV care was provided by a single provider.46 | Duke Adult Infectious Diseases Clinic. This clinic provided care for approx. 1900 PLWH. In 2017, 48% of HIV clinic patients received chronic NCD care outside of the clinic. |
| The conceptualisation of patient perspectives was assessed by the HIV patient’s preference for provider models for their concurrent NCDs (including T2D) and how NCD care delivery could be improved according to them. |
Moucheraud et al29 | ‘Integrated care’ if patients reported that they refilled antihypertensive medications and ART during the same clinic visit. Any antihypertensive medication refill outside of Partners in Hope, or at Partners in Hope but not at the same time as an ART visit, was classified as a non-integrated client. | Partners in Hope Medical Centre, an urban, (President’s Emergency Plan for AIDS Relief)-USAID–supported HIV-treatment site in Malawi. Partners in Hope has both an outpatient clinic that operates on a fee-for-service model and an HIV clinic that provides free care. |
| Assessment of behaviours related to care-seeking and prescription refills. |
Peer et al10 | ICDM Model. This model incorporates a diagonal approach that integrates the vertical HIV programme with the horizontal general healthcare system. | 17 public healthcare facilities in Cape Town, South Africa and the surrounding rural municipalities. All clinics treated more than 300 HIV infected patients monthly. |
| The study used the ‘framework for understanding diabetes care within the context of comorbid chronic conditions’ as described by Piette and Ker (2006). Two themes were investigated: (1) Experiences of comorbid HIV and HT diagnoses and (2) Experiences with the primary healthcare system. |
Muddu et al30 | HIV and NCD care were colocated. HIV-infected patients received HIV and NCD-focused care simultaneously during their visit. HIV-uninfected persons received treatment for hHT and/or diabetes. | Three high volume HIV clinics (average 3600 PLHIV) in Eastern Uganda. |
| The Consolidated Framework for Implementation Research (CFIR) was used to explore barriers to and facilitators of HTN/HIV. CFIR’s five major domains include intervention characteristics, outer setting, inner setting, characteristics of individuals, and implementation process. |
Manavalan et al31 | HT care is managed separately from HIV care by a medical doctor or clinical officer in a different department. | Conducted at the Moshi urban district of northern Tanzania at two HIV clinics located in government-funded primary health centres with approximately 2300 adults (1700 women and 600 men) with HIV |
| Perspectives and experiences of PLWH and HT were assessed The in-depth interview guide was developed by an interdisciplinary team of physicians, nurses and social scientists from Tanzania and the USA with expertise in HT or HIV. |
ART, antiretroviral therapy; CHC, Community Health Center; DKK, Dr. Kenneth Kaunda; DM, diabetes mellitus; FGDs, focus group discussions; HT, hypertension; N/A, not available; NCDs, non-communicable diseases; PHC, Primary Health Care; PLWH, people living with HIV; TB, Tuberculosis; T2D, type 2 diabetes; USAID,United States Agency for International Development; WR, West Rand.