A content analysis of global and national policies, plans, and guidelines to integrate NCDs with HIV care in LMICs.

Authors

Reet Kapur, Abby Briggs, Dina Moinul, Teona Giorgadze, Gloria Guevara Alvarez, Kellen Nyamurungi Namusisi, Jonathan Purtle, Mari Armstrong-Hough, Donna Shelley

Published in

PLOS global public health. Volume 6. Issue 8. Pages e0007072. Epub Aug 07, 2026.

Abstract

The growing burden of non-communicable diseases (NCDs) among people living with HIV (PWH) in low- and middle-income countries (LMICs), threatens gains in life expectancy. Global organizations have called for integrating NCD management into existing HIV care systems, but it is unclear what actions countries are taking to accomplish this goal. To bridge this knowledge gap, we conducted a quantitative content analysis of HIV policy documents from the World Health Organization (WHO), the US President's Emergency Plan for AIDS Relief (PEPFAR) and 22 PEPFAR-sponsored LMICs to analyze mentions of: 1) screening and treatment of selected NCDs (hypertension, diabetes, cervical cancer, and depression) and/or two NCD risk factors (alcohol and tobacco use), and 2) health system-strengthening strategies when mentioned in relation to the selected NCDs and risk factors. We used the WHO's Building Blocks framework to identify these strategies. Screening and treatment for cervical cancer and mental health conditions were reported in the WHO and PEPFAR documents and in the majority of country documents. Strategies to strengthen service delivery (e.g., NCD care coordination across health facilities, establishing guidelines for integrated care) were frequently referenced across WHO, PEPFAR, and country-level documents. Far fewer documents mentioned strategies related to health information technology, medication access, and financing to support care integration. Although the WHO, PEPFAR and country-level documents illustrate a commitment to NCD-HIV health system integration, there was variation in which NCDs were being prioritized. Mentions of screening and treatment of NCD risk factors were rare, suggesting that tobacco and alcohol-related services may be comparatively under-resourced. Integrating NCD and HIV care requires sustained investments that align with local resources and attention to system-level enablers (e.g., improved information systems, stronger medicine supply chains) that support comprehensive care. Future research should focus on identifying the determinants of policy adoption, including factors that either drive or constrain integration of the full spectrum of NCD services within HIV care settings.

PMID:
42566400
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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