Integrated HIV, diabetes, and hypertension care in sub-Saharan Africa

Contrary to the claim of the INTE-AFRICA study by Sokoine Kivuyo and colleagues, a previous randomised population-level study (2013–17) directly evaluated a fully integrated HIV, hypertension, and diabetes care model for people living both with and without HIV in rural Uganda and Kenya. The SEARCH study randomly assigned 32 communities of approximately 10 000 people each to the intervention of either an integrated multidisease patient-centred care model for HIV, hypertension, and diabetes or standard of care. Hypertension, diabetes, and HIV treatment were provided using a fully integrated model for people with and without HIV in the same ministry of health clinics, featuring a nurse-driven triage system to tailor visits to patient needs, flexible clinic hours, and telephone access to clinicians; clinicians and staff were trained to create a welcoming environment. After 3 years, 47% of adults with prevalent hypertension in the intervention group had controlled hypertension, compared with 37% in the standard-of-care group (relative prevalence 1·26; 95% CI 1·15-1·39). All-cause mortality was reduced by 21% among people with hypertension in the intervention group versus the standard-of-care group. Integration of hypertension care in HIV clinics was estimated to increase costs by only 2–4% for people with and without HIV. Furthermore, the SEARCH intervention improved population-level viral suppression, achieving HIV viral suppression among 79% of all people living with HIV, exceeding the 71% viral suppression global estimate from the UNAIDS 2023 report 5 years later. The INTE-AFRICA study adds to the literature but is not the first to show the value of integration of HIV chronic care with other diseases such as hypertension and diabetes. We declare no competing interests.