ArticleBMJ open2020
Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD-HIV model.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
46 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Integrated Care Models for HIV, Diabetes and Hypertension in Sub-Saharan Africa: A Systematic Review of Effectiveness, Implementation and Real-World Applicability.Journal of the International AIDS Society · 2026Pooled it
- Retention in care for type 2 diabetes management in Sub-Saharan Africa: A systematic review.Tropical medicine & international health : TM & IH · 2023Pooled it
- Cost analysis of integrating depression treatment into chronic care in Malawi: evidence from a cluster randomised controlled trial.BMJ open · 2025Trial
- Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western Kenya.BMJ global health · 2024Trial
- Depressive disorder at the household level: prevalence and correlates of depressive symptoms among household members.Global health action · 2023Trial
- Prevalence and correlates of internalized stigma among adults with HIV and major depressive disorder in rural Malawi.AIDS care · 2023Trial
- A household-based community health worker programme for non-communicable disease, malnutrition, tuberculosis, HIV and maternal health: a stepped-wedge cluster randomised controlled trial in Neno District, Malawi.BMJ global health · 2021Trial
- The Promise of Integration of HIV Into Primary Care: Challenges and Opportunities.Journal of the International AIDS Society · 2026Article
- Multimorbidity: a core priority for learning health systems amidst vertical disease programme cuts.Health research policy and systems · 2026Article
- Improving palliative care access in rural Malawi: insights from a mixed-methods exploration of structural and social determinants.BMC palliative care · 2026Article
- Exploring barriers and facilitators for non-communicable disease care for persons living with HIV in Peru through a socioecological framework: HIV physician and coordinator perspectives.PLOS global public health · 2026Article
- Disease control and its correlates among hypertensive, diabetic, and asthmatic patients enrolled in secondary-level Integrated Chronic Care Clinics in Neno District, rural Malawi.PLOS global public health · 2026Article
- Article
- Article
- Implementation strategies for integrating non-communicable disease care into primary healthcare settings in sub-Saharan Africa: A systematic review.PLOS global public health · 2026Article
- Pathway to developing paediatric non-communicable disease guidelines in Malawi: a scoping review.BMC health services research · 2025Article
- The potential impact of declining development assistance for health on population health in Malawi: A modelling study.PLoS medicine · 2025Article
- Article
- Multimorbidity and health system priorities in Zimbabwe: A participatory ethnographic study.PLOS global public health · 2025Article
- Advances in HIV Treatment and Vaccine Development: Emerging Therapies and Breakthrough Strategies for Long-Term Control.AIDS research and treatment · 2025Review
Corrections and comments
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Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesNon-communicable diseases (NCDs) account for one-third of disability-adjusted life years in Malawi, and access to care is exceptionally limited. Integrated services with HIV are widely recommended, but few examples exist globally. We report descriptive outcomes from an Integrated Chronic Care Clinic (IC3).
designThis is a retrospective cohort study.
settingThe study includes an HIV-NCD clinic across 14 primary care facilities in the rural district of Neno, Malawi.
participantsAll new patients, including 6233 HIV-NCD diagnoses, enrolled between January 2015 and December 2017 were included. This included 3334 patients with HIV (59.7% women) and 2990 patients with NCD (67.3% women), 10% overall under age 15 years.
interventionsPatients were seen at their nearest health centre, with a hospital team visiting routinely to reinforce staffing. Data were collected on paper forms and entered into an electronic medical record. PRIMARY AND SECONDARY OUTCOME MEASURES: Routine clinical measurements are reported at 1-year post-enrolment for patients with more than one visit. One-year retention is reported by diagnosis.
resultsNCD diagnoses were 1693 hypertension, 668 asthma, 486 epilepsy, 149 diabetes and 109 severe mental illness. By December 2018, 8.3% of patients with NCD over 15 years were also on HIV treatment. One-year retention was 85% for HIV and 72% for NCDs, with default in 8.4% and 25.5% and deaths in 4.0% and 1.4%, respectively. Clinical outcomes showed statistically significant improvement for hypertension, diabetes, asthma and epilepsy. Of the 1807 (80%) of patients with HIV with viral load results, 85% had undetectable viral load.
conclusionsThe IC3 model, built on an HIV platform, facilitated rapid decentralisation and access to NCD services in rural Malawi. Clinical outcomes and retention in care are favourable, suggesting that integration of chronic disease care at the primary care level poses a way forward for the large dual burden of HIV and chronic NCDs.
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