title: Preparedness of HIV care and treatment clinics for the management of concomitant non-communicable diseases: a cross-sectional survey.
abstract: BACKGROUND
  In Sub-Saharan Africa, epidemiological studies have reported an increasing burden of non-communicable diseases (NCD) among people living with HIV. NCD management can be feasibly integrated into HIV care; however, clinic readiness to provide NCD services in these settings should first be assessed and gaps in care identified.
  
  
  METHODS
  A cross-sectional survey conducted in July 2013 assessed the resources available for NCD care at 14 HIV clinics in Dar es Salaam, Tanzania. Survey items related to staff training, protocols, and resources for cardiovascular disease risk factor screening, management, and patient education.
  
  
  RESULTS
  43 % of clinics reported treating patients with hypertension; however, only 21 % had a protocol for NCD management. ECHO International Health standards for essential clinical equipment were used to measure clinic readiness; 36 % met the standard for blood pressure cuffs, 14 % for glucometers. Available laboratory tests for NCD included blood glucose (88 %), urine dipsticks (78 %), and lipid panel (57 %). 21 % had a healthcare worker with NCD training. All facilities provided some form of patient education, but only 14 % included diabetes, 57 % tobacco cessation, and 64 % weight management.
  
  
  CONCLUSIONS
  A number of gaps were identified in this sample of HIV clinics that currently limit the ability of Tanzanian healthcare workers to diagnose and manage NCD in the context of HIV care. Integrated NCD and HIV care may be successfully achieved in these settings with basic measures incorporated into existing infrastructures at minimal added expense, i.e., improving access to basic functioning equipment, introducing standardized treatment guidelines, and improving healthcare worker education.
authors.affiliation: Feinberg School of Medicine, Northwestern University, 420 E Superior Street, Chicago, IL, 60611, USA. Claudia-Leung@northwestern.edu.
authors.forename: Claudia
authors.identifier: http://orcid.org/0000-0003-3389-9115
authors.initials: C
authors.lastname: Leung
authors.affiliation: Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania.
authors.forename: Eric
authors.initials: E
authors.lastname: Aris
authors.affiliation: Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania.
authors.forename: Aisa
authors.initials: A
authors.lastname: Mhalu
authors.affiliation: Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania.
authors.forename: Hellen
authors.initials: H
authors.lastname: Siril
authors.affiliation: Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Christian
authors.affiliation: Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania.
authors.forename: Happiness
authors.initials: H
authors.lastname: Koda
authors.affiliation: Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania.
authors.forename: Talumba
authors.initials: T
authors.lastname: Samatta
authors.affiliation: Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania.
authors.forename: Martha Tsere
authors.initials: MT
authors.lastname: Maghimbi
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, 401 Park Drive 3East, Boston, MA, 02215, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
authors.affiliation: Management and Development for Health HIV/AIDS Care and Treatment Program, P.O. Box 79810. Plot #802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania.
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.affiliation: Feinberg School of Medicine, Northwestern University, 420 E Superior Street, Chicago, IL, 60611, USA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Hawkins
keywords: HIV; Health system strengthening; Integration; Non–communicable diseases; Tanzania