Published in PLOS One on 2026-04-01, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Linda Sande, Mariet Benade, Timothy Tchereni, Aniset Kamanga, Vinolia Ntjikelane, Allison Morgan, Taurai Makwalu, Wyness Phiri, Priscilla Lumano-Mulenga, Prudence Haimbe, Hilda Shakwelele, Amy Huber, Sophie Pascoe, Mhairi Maskew, Nancy Scott, Sydney Rosen
Source: PLOS One • DOI 10.1371/journal.pone.0346029
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
A growing number of people living with HIV (PLHIV) also have non-communicable diseases (NCDs). Shifting to an integrated delivery model may facilitate care-seeking and improve outcomes for people with a dual burden of HIV and NCDs. We describe the current state of integration of hypertension and diabetes care into HIV treatment in Malawi, South Africa and Zambia.
We administered structured interviews to HIV treatment providers in 41 primary healthcare facilities to evaluate how NCD care is provided to PLHIV accessing antiretroviral therapy (ART). We defined integration as provision of NCD services within the HIV clinic. The potential degree of integration in HIV clinics ranged from not integrated at all (no NCD services) to fully integrated (all NCD services). We also surveyed a sample of ART clients about their access to integrated care.
The degree of integration varied across the facilities and countries. All facilities in South Africa reported being fully integrated for HIV care and hypertension and diabetes, and most providers in South Africa identified no barriers to integration. Integration was much less complete in Malawi and Zambia, with most facilities offering hypertension and diabetes screening/diagnosis and support but limited treatment or disease monitoring services. Frequently cited barriers to integration in Malawi and Zambia were limited staff knowledge of integrated care provision and facility space constraints. ART clients’ experience with integrated services mirrored provider responses. Over 90% of survey participants in South Africa reported HIV and non-HIV visit and medication collection alignment, compared to less than half in Malawi and Zambia.
The level of integration of hypertension and diabetes care with HIV treatment varies widely across facilities in Malawi, South Africa, and Zambia, despite each country having national guidelines that promote integration. Interventions to increase integration must consider differences among facilities at baseline.
Introduction
An increasing proportion of people living with HIV (PLHIV) require care for other chronic conditions, in addition to antiretroviral therapy (ART) for HIV. Globally, the population living with HIV is growing older and is thus at a higher risk for age-related non-communicable diseases (NCDs), as well as suffering the direct long-term consequences of HIV [1–4]. Among PLHIV, the prevalence of hypertension has been reported to range from 10–27% and the prevalence of diabetes is estimated at 2–5% [5–9]. Sub-Saharan Africa (SSA), where roughly two thirds of the world’s PLHIV reside [10], has increasingly reported a rising burden of both NCDs [6,8].
In many countries in SSA, healthcare systems have traditionally managed noncommunicable conditions separately from HIV [11,12]. Vertical programs for HIV, which primarily arose from global efforts and targeted funding to address the HIV crisis, generally have separate service locations within primary healthcare facilities, different clinic visit schedules, and even different providers dedicated to HIV patients [11–13]. NCD care is usually provided in the general outpatient clinic, which may or may not also offer maternal and child healthcare and/or acute healthcare [14].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Linda Sande, Mariet Benade, Timothy Tchereni, Aniset Kamanga, Vinolia Ntjikelane, Allison Morgan, Taurai Makwalu, Wyness Phiri, Priscilla Lumano-Mulenga, Prudence Haimbe, Hilda Shakwelele, Amy Huber, Sophie Pascoe, Mhairi Maskew, Nancy Scott, Sydney Rosen. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Availability and readiness of health facilities for non-communicable disease services in Ethiopia: Evidence from the nationally representative health facility survey 2022
- Evidence brief: Alcohol consumption and tobacco smoking associated with decreased antiretroviral therapy adherence among people living with HIV in Zambia: Evidence from a 2023 national NCDs/ HIV survey
- Evidence brief: The news media and the agenda for noncommunicable diseases before and during the COVID-19 pandemic: Losing the competition for coverage and framing responsibility for action in Malawi
