By 2035,  nearly three quarters of the  40 million people living with HIV worldwide will be living with one or more chronic disease, also referred to as noncommunicable diseases (NCDs). 

While there are encouraging examples of integrated HIV and NCD healthcare delivery,  this is yet to become the norm in low- and middle-income countries. 

As stakeholders convene for the 25th International AIDS Conference next week in Munich, more attention should be focused on this theme – and on scaling up the bright lights of success seen in parts of East Africa as well as India. People living with HIV face the same health challenges as everyone else

Revolutionary medicines and expanded access to screening and treatment around the world have transformed HIV from being a death sentence into a chronically manageable disease. People living with HIV now enjoy life spans equal to those who do not have the disease.

The cruel irony of that success is that many people living with HIV are thus faced with the same NCD challenges as all older adults: diabetes, hypertension, cardiovascular disease, and other chronic illnesses.  

NCDs account for seven of the 10 leading causes of death globally. But  the reality for people living with HIV is that they mainly live in countries whose health systems have not evolved enough to reflect and service what is essentially a new disease burden. 

Challenges in accessing NCD services

People living with HIV may visit a clinic for free antiretroviral therapy (ART), where they may also be screened for common NCD risk factors such as elevated blood pressure and blood glucose levels. But if an NCD risk is identified, it cannot be treated at the same clinic, and the patient faces immense challenges in seeking NCD care at another clinic, such as long wait times, costly transportation, a need to find childcare, or lost wages.   

Additionally, a hypertension or diabetes diagnosis can translate to expensive treatments that, unlike HIV medicines, are often paid for by the patients themselves.

Those who don’t have enough resources face difficult choices – placing medical necessities behind basic needs like feeding their household or educating their children. The time commitment can also be overwhelming, with many patients foregoing follow-up visits, thereby surviving HIV only to die prematurely of NCDs. 

We know a different reality is possible. As a company focused on pioneering life-changing medicines for many NCDs, Eli Lilly and Company is committed to improving NCD care for patients living in resource-limited settings around the world.

Lilly has a long history of investing in efforts to strengthen health systems and improve care delivery. Since 2016, it  has supported efforts to develop and scale integrated care solutions for patients with tuberculosis (TB). 

Linking to Care: A case study 

The Linking to Care project in Chennai, India— supported by Lilly and implemented by REACH with technical support from Advance Access and Delivery – has shown that TB can be used as an entry point to start screening patients for diabetes and hypertension and then linking them to care.

The project also screens patients’ close contacts for TB, diabetes and hypertension, and links them to care as well. By incorporating community healthcare workers (or TB Nanbans, as they are referred to in Chennai) to start delivering this integrated care to patients, the project makes care much more accessible in such resource-constrained settings.

This model, driven by a close partnership between public- and private-sector healthcare providers, has shown that comprehensive, holistic, patient-centered care not only improves public health efficiency but also delivers better health outcomes for people living with both communicable and noncommunicable diseases.

Progress in sub-Saharan Africa

There’s a long way to go before this kind of project becomes commonplace in low- and middle-income countries, but on the ground, the HIV and NCD communities have made some inroads into what is possible when it comes to integrated healthcare delivery.

There are some encouraging examples of this in Malawi, Zambia and Kenya, resulting in financing policy changes at PEPFAR and the Global Fund that were advocated for by civil society at the 2021 United Nations (UN) General Assembly High-Level Meeting on HIV/AIDS.

Member states committed to ensuring that 90% of people living with HIV would have access to NCD and mental health care by 2025.

This movement in policy is also increasingly being reflected in forums like the International AIDS Conference, and this year’s edition in Munich this month is expected to feature a number of sessions that address the crossover of NCDs and infectious diseases. This momentum needs to be built on so that soon all people living with an infectious disease, together with NCDs, can receive easily accessible and appropriate health care.

Katie Dain is the CEO of the NCD Alliance

Cynthia Cardona is the Head of Social Impact at Eli Lilly and Company

Image Credits: UNICEF Zimbabwe, NCD Alliance.