title: Delivery of health care for cardiovascular and metabolic diseases among people living with HIV/AIDS in African countries: a systematic review protocol.
abstract: BACKGROUND
  People living with HIV (PLHIV) in African countries are living longer due to the rollout of antiretroviral drug therapy programs, but they are at increasing risk of non-communicable diseases (NCDs). However, there remain many gaps in detecting and treating NCDs in African health systems, and little is known about how NCDs are being managed among PLHIV. Developing integrated chronic care models that effectively prevent and treat NCDs among PLHIV requires an understanding of the current patterns of care delivery and the major barriers and facilitators to health care. We present a systematic review protocol to synthesize studies of healthcare delivery for an important subset of NCDs, cardiovascular and metabolic diseases (CMDs), among African PLHIV.
  
  
  METHODS
  We plan to search electronic databases and reference lists of relevant studies published in African settings from January 2003 to the present. Studies will be considered if they address one or both of our major objectives and focus on health care for one or more of six interrelated CMDs (ischemic heart disease, stroke, heart failure, hypertension, diabetes, and hyperlipidemia) in PLHIV. Our first objective will be to estimate proportions of CMD patients along the "cascade of care"-i.e., screened, diagnosed, aware of the diagnosis, initiated on treatment, adherent to treatment, and with controlled disease. Our second objective will be to identify unique barriers and facilitators to health care faced by PLHIV in African countries. For studies deemed eligible for inclusion, we will assess study quality and risk of bias using previously published criteria. We will extract study data using standardized instruments. We will meta-analyze quantitative data at each level of the cascade of care for each CMD (first objective). We will use meta-synthesis techniques to understand and integrate qualitative data on health-related behaviors (second objective).
  
  
  CONCLUSIONS
  CMDs and other NCDs are becoming major health concerns for African PLHIV. The results of our review will inform the development of research into chronic care models that integrate care for HIV/AIDS and CMDs among PLHIV. Our findings will be highly relevant to health policymakers, administrators, and practitioners in African settings.
  
  
  BACKGROUND
  PROSPERO CRD42015029375.
authors.affiliation: Department of Medicine, University of Washington, 325 9th Ave, Box 359780, Seattle, WA, 98104, USA. davidaw@uw.edu.|Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa. davidaw@uw.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Watkins
authors.affiliation: Department of Medicine, University of Washington, 325 9th Ave, Box 359780, Seattle, WA, 98104, USA.
authors.forename: Nathaniel L
authors.initials: NL
authors.lastname: Tulloch
authors.affiliation: Department of Medicine, University of Washington, 325 9th Ave, Box 359780, Seattle, WA, 98104, USA.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Anderson
authors.affiliation: Department of Medicine, University of Washington, 325 9th Ave, Box 359780, Seattle, WA, 98104, USA.|Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Barnhart
authors.affiliation: Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Krisela
authors.initials: K
authors.lastname: Steyn
authors.affiliation: Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Levitt
mesh_terms: D000349:Africa; D002318:Cardiovascular Diseases / Q000150:complications / Q000628:therapy*; D003695:Delivery of Health Care; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008659:Metabolic Diseases / Q000150:complications / Q000628:therapy*; D012107:Research Design; D000078202:Systematic Reviews as Topic
keywords: Access to health care; Africa; Cardiovascular disease; Delivery of health care; Diabetes; Diagnosis; HIV/AIDS; Medication adherence; Non-communicable diseases; Screening