HIV Tuberculosis and Non-Communicable Diseases: What is known about the costs effects and cost-effectiveness of integrated care?

摘要

Unprecedented investments in health systems low- and middle-income countries (LMICs) have resulted in more than eight million individuals on antiretroviral therapy (ART). Such individuals experience dramatically increased survival, but are increasingly at risk of developing common non-communicable diseases (NCDs). Integrating clinical care for HIV, other infectious diseases, and NCDs could make health services more effective and provide greater value. Cost-effectiveness analysis is a method to evaluate the clinical benefits and costs associated with different healthcare interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as one example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as two examples of NCDs for which integrating care with HIV services could offer excellent value. Direct evidence of the benefits of integrated services generally remains scarce; however, data suggest that improved effectiveness and reduced costs may be attained by integrating additional services with existing HIV clinical care. Further investigation into clinical outcomes and costs of care for NCDs among people living with HIV (PLHIV) in LMICs will help to prioritize specific healthcare services by contributing to an understanding of the affordability and implementation of an integrated approach.