Integrated chronic disease model in South Africa

Project title
Chronic disease care in primary health care facilities in a rural South African setting

Research question
What is the quality of care in the ICDM model? Is the ICDM model effective in improving patients’ health outcomes?

Rationale
Non-communicable diseases (NCDs) are currently the leading cause of death globally, with nearly three-quarter of these deaths occurring in Low- and Middle-Income Countries (LMICs) which have age-adjusted mortality rates nearly twice that of high-income countries. The increasing burden of NCDs is occurring against the backdrop of the persisting HIV/AIDS epidemic.
Many LMICs are experiencing an increasing dual burden of HIV and NCDs in their epidemiological transition. This has been attributed to the commonalities that are related to their causation; progression; and prevention and control. The premature ageing effect of the HIV and increased roll-out of antiretroviral treatment fuel the emergence of non-HIV-related chronic conditions similar to the rest of the population (e.g. hypertension), while opportunistic illnesses associated with HIV infections (e.g. HIV-associated lymphoma and cervical cancer) are NCDs in their own right. Furthermore, HIV and some NCDs have minimal or no symptoms at the early stages of onset; thus, requiring a model of care different from acute care model.
Similar to many LMICs, South Africa is experiencing a dual burden of HIV and NCDs which has been described as diseases on a collision course. In a response, the National Department of Health in South Africa initiated the ICDM model as a pilot programme in selected primary health care (PHC) facilities in the provinces of Gauteng, North West and Mpumalanga. The ICDM model is a component of the PHC reengineering strategy to strengthen the public healthcare system. The model adopts a diagonal approach in leveraging the innovations of the vertical HIV programme for scaling up or supporting services for NCDs.

Following the initiation of the pilot of the ICDM model, there is a dearth of published data to better understand the effectiveness of the model in improving the quality of integrated chronic care and health outcomes of chronic disease patients. My doctoral research on the effectiveness of leveraging successful HIV programme innovations to support or scale-up services for NCDs through evaluating South Africa’s ICDM model will contribute to the global debate on the benefits of integrated chronic disease care.

Research output
Soter Ameh, F. Xavier Gómez-Olivé, Kathleen Kahn, Stephen M. Tollman and Kerstin Klipstein-Grobusch. Predictors of health care use by adults 50 years and over in a rural South African setting.  Glob Health Action 2014.

Supervisors
Prof. Kerstin Klipstein-Grobusch; Prof. Stephen Tollman and Dr. Francesc Xavier Gómez-Olivé