The Acceptability of Integrated Healthcare Services for HIV and Non-Communicable Diseases: Experiences from Patients and Healthcare Workers in Tanzania

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Abstract Background: In sub-Saharan Africa, the prevalence of non-communicable diseases (NCDs) has risen sharply alongside a continuing high burden of communicable diseases. An integrated approach to HIV and NCD care offers the potential to strengthen disease control programmes. We used qualitative methods to explore patient and care provider experiences and perspectives on the acceptability of integrated care for HIV-infection, diabetes, and hypertension in Tanzania. Methods: A cross-sectional study was conducted in selected health facilities in Dar-es-Salaam and Coastal regions which had started to provide integrated care and management for HIV, diabetes, and hypertension (i.e., from a single clinic for patients with one or more of these conditions). In-depth interviews were conducted with care providers and patients at three time points: at enrolment (i.e., just prior to the patient receiving integrated care), at mid-line and at study end 8-10 months later. A minimum of 12 care providers and 16 patients were sampled for each time point. Observation was also carried out in the respective clinics at pre- and mid-line phase. The Theoretical Framework of Acceptability (TFA) underpinned the structure and interpretation of the findings using five constructs: Affective attitude, Self-efficacy, Perceived effectiveness, Ethicality, and Intervention coherence.Results: Patients and care providers revealed a positive attitude towards the integrated care delivery model at the mid-line and at study end time points. High acceptability was related to increased exposure to service integration in terms of satisfaction with the clinic setup, seating arrangements and medical care services provided. Satisfaction also centred on the patients’ freedom to move from one service point to another, and to discuss the services and their own health status amongst themselves. Adherence to medication and scheduling of clinic appointments appeared central to the patient-provider relationship as an aspect in the provision of quality services. Stakeholders reported benefits of integration which included multi-condition health education, patient time and cost saving, and the care team ability to detect undiagnosed disease conditions due to enhanced opportunity and ability to screen patients. Conclusion: The study reveals a continued high level of acceptability of the integrated care model among both patients and care providers. Further studies on integrated care are warranted in different settings to generate greater scientific evidence to inform health and health systems policy and practice.

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