After three years of implementation and follow-up, the INTE AFRICA trial has come to an end. During this cluster-randomized trial which took place between 2019 and 2022, the effectiveness of integrated care services for people living with HIV infection, diabetes, and hypertension was compared to stand alone/vertical care for these conditions. The trial was completed in June 2022, with 7030 participants having been enrolled and followed for 12 months. The primary endpoints were retention in care for those living with diabetes and / or hypertension as well as viral load suppression in people living with HIV.
Stakeholders gather to review the results of the INTE-AFRICA trial in Uganda, September 2022.
Main results
Importantly, retention in care was much higher than previously reported in other clinical studies and retention in care was equally high in both integrated and standard care arms. Levels of viral load suppression were also high in both arms and within the nationally recommended standards. These findings suggest that integrating services did not adversely affect the care being offered for these health conditions. Through a continued process evaluation of the project’s role out, results indicate that duplication of care processes for people with multiple conditions were avoided and the skillset of health workers was broadened to include management of multiple conditions, rather than focusing on one condition alone. The initial results of the economic evaluation showed that integrated care may lead to substantial cost-savings in similar health centers and might be cost-effective, for both providers and for the households of people living with these conditions. The RESPOND-AFRICA research team has hosted meetings in Tanzania and Uganda to share the results with relevant stakeholders.
“Retention in care was much higher than previously reported in the literature and was equally high in both integrated and standard care arms.”
Dissemination of results in Uganda
On 12-15 September 2022, the RESPOND-AFRICA team hosted meetings with stakeholders in Uganda to share the results of the INTE-AFRICA trial. The meeting was attended by Dr. Gerald Mutungi, the Assistant Commissioner for non-communicable diseases (NCDs) of the Ministry of Health of Uganda, members of the RESPOND-AFRICA national steering committee, regional health managers, health facility managers and staff of the facilities where the trial was conducted. The trial results were well received and attendees noted that integrating services did not adversely affect patient retention in clinical care, and health managers pledged to continue promoting integrated care in their facilities.
Stakeholders gather in Tanzania to discuss the results of the INTE-AFRICA trial, November 2022.
Dissemination of results in Tanzania
On 17-18 November 2022, the results of the INTE-AFRICA study were shared with policy-makers in Tanzania. In attendance were the Permanent Secretary, Directors of the Preventive and Curative Services Department of the Ministry of Health and District Health Managers from the Ministry of Health Tanzania. Other attendees were members from the NCD services and HIV program in Uganda and national steering committee members. The results were well received and a short overview of the meeting was posted in local media.
“Given the success of the INTE-AFRICA trial, both Tanzania and Uganda have made a commitment to scale up integrated care in their countries”
Next steps
Both countries have made a commitment to scale up integrated care. To accelerate this, they have agreed to set up a joint taskforce to chart a plan for implementation. They have requested continued support from the researchers with materials to develop guidelines and training manuals as well as further analyses of the economic data.