Integrating and decentralising diabetes and hypertension services in Africa

We will integrate and scale up services for diabetes and hypertension in clinics in Tanzania and Uganda, either as standalone or integrated with HIV-infection. This builds on pilot studies that the partners are conducting, funded by UK NIHR, on the prevention and management of HIV, diabetes and hypertension in Africa. The aim of INTE-AFRICA is to assess the effectiveness and feasibility of large-scale scale up. Research evidence needed by African health services to scale-up and sustain the screening and management of diabetes and hypertension in different settings will be generated. The objectives include: to re-organise primary health care services so that diabetes and hypertension can be diagnosed and treated in dedicated chronic care clinics in two large regions, one in Tanzania and in Uganda; to decentralise care from health facilities to the community in order to reduce patient load at clinics and reduce reliance on (scarce) clinical staff; to evaluate these approaches in terms of acceptability (by patients and the community), numbers of patients treated and retained in care, patient clinical outcomes (blood pressure control, blood glucose control), costs of delivering integrated care for the health service and cost-effectiveness (compared to current standard care); to use the data generated to contribute evidence to the development of clinical guidelines; to develop the sustainable partnerships needed between researchers, government policy makers, public-private partnerships on an ethos of openness and equality so as to facilitate the expansion of the scale-up nationally. The majority of individuals with either hypertension or diabetes are identified after they develop complications, which leads to their poor outcomes, and to catastrophic costs to both the health service and the patient. Scaling up services for would prevent clinical complications in patients and could result in immense cost savings for patients and the health service.