Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD–HIV model

Emily B Wroe, Noel Kalanga, Elizabeth L Dunbar, Lawrence Nazimera, Natalie F Price, Adarsh Shah, Luckson Dullie, Bright Mailosi, Grant Gonani, Enoch P L Ndarama, George C Talama, Gene Bukhman, Lila Kerr,
Emilia Connolly, Chiyembekezo Kachimanga

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BMJOpen_Malawi_ICCC_Oct-2020Non-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).

The study includes an HIV–NCD clinic across 14 primary care facilities in the rural district of Neno, Malawi.

The IC3 model, built on an HIV platform, Health Office, Ministry of Health, facilitated rapid decentralisation and access to NCD Neno, Malawi 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.