%0 Journal Article
%T Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland
%A Miriam Rabkin
%A Zenebe Melaku
%A Kerry Bruce
%A Ahmed Reja
%A Alison Koler
%A Yonathan Tadesse
%A Harrison Njoroge Kamiru
%A Lindiwe Tsabedze Sibanyoni
%A Wafaa El-Sadr
%J Journal of Tropical Medicine
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/137460
%X The scale-up of HIV services in sub-Saharan Africa has catalyzed the development of highly effective chronic care systems. The strategies, systems, and tools developed to support life-long HIV care and treatment are locally owned contextually appropriate resources, many of which could be adapted to support continuity care for noncommunicable chronic diseases (NCD), such as diabetes mellitus (DM). We conducted two proof-of-concept studies to further the understanding of the status of NCD programs and the feasibility and effectiveness of adapting HIV program-related tools and systems for patients with DM. In Swaziland, a rapid assessment illustrated gaps in the approaches used to support DM services at 15 health facilities, despite the existence of chronic care systems at HIV clinics in the same hospitals, health centers, and clinics. In Ethiopia, a pilot study found similar gaps in DM services at baseline and illustrated the potential to rapidly improve the quality of care and treatment for DM by adapting HIV-specific policies, systems, and tools. 1. Introduction HIV/AIDS is the leading cause of death among adults in sub-Saharan Africa (SSA), but the burden of noncommunicable chronic diseases (NCD) is high and growing [1]. The regional prevalence of diabetes mellitus (DM), for example, is expected to double between 2010 and 2030, when 28 million people in SSA are projected to be living with DM [2]. In addition to DM-specific morbidity and mortality, diabetes contributes to the burden of other noncommunicable diseases (e.g., renal and cardiovascular disease) as well as communicable diseases (e.g., pneumonia and tuberculosis), further increasing its impact on public health [3]. In 2010, 6% of total mortality in SSA was attributable to DM [4]. Unfortunately, access to prevention, care, and treatment services for NCD like DM remains out of reach for most in SSA, and health systems in lower-income countries are rarely designed to provide the continuity services required to effectively identify patients at risk, engage them in care, and retain them for the course of what is usually life-long treatment. The International Diabetes Federation estimates that 78% of those with DM in SSA remain undiagnosed [5], a consequence of limited access to trained health workers and laboratory testing as well as limited awareness of DM and its risk factors. Although there have been several promising pilot studies of nurse-led DM management and other innovations [6¨C9], glycemic control tends to be suboptimal for those enrolled in care, even at specialized treatment centers [10,
%U http://www.hindawi.com/journals/jtm/2012/137460/