title: HIV, tuberculosis, and noncommunicable diseases: what is known about the costs, effects, and cost-effectiveness of integrated care?
abstract: Unprecedented investments in health systems in low- and middle-income countries (LMICs) have resulted in more than 8 million individuals on antiretroviral therapy. Such individuals experience dramatically increased survival but are increasingly at risk of developing common noncommunicable 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 health care interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as 1 example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as 2 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 in LMICs will help to prioritize specific health care services by contributing to an understanding of the affordability and implementation of an integrated approach.
authors.affiliation: *Harvard Medical School, Boston, MA; †Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; ‡Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA; §Division of General Medicine, Massachusetts General Hospital, Boston, MA; ‖Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa; ¶International Center for AIDS Care and Treatment Programs (ICAP), Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY; #Center for AIDS Research (CFAR), Harvard University, Boston, MA; **Department of Epidemiology, Boston University, Boston, MA; and ††Department of Health Policy and Management, Harvard School of Public Health, Boston, MA.
authors.forename: Emily P
authors.initials: EP
authors.lastname: Hyle
authors.forename: Kogieleum
authors.initials: K
authors.lastname: Naidoo
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Su
authors.forename: Wafaa M
authors.initials: WM
authors.lastname: El-Sadr
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000379:methods*; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*