Strengthening Health Systems for Chronic Care: Intersection of Communicable and Non-communicable Disease Services in the Caribbean and South Africa

GA-CDRC Investigators:

T. Alafia Samuels (Principal Investigator, Barbados site)

External Investigators:

Madhuvanti Murphy, Natalie Greaves, Cave Hill Campus; Rainford Wilks (Principal Investigator, Jamaica site), Marshall Tulloch-Reid, Caribbean Institute of Health Research; Michelle Harris, Mona Campus; Shalini Pooransingh (Principal Investigator, Trinidad site), St Augustine Campus

Funding Obtained:

USD 20,000 from Pan University Network for Global Health (Penn State University)

Start Date:

May 2016

End Date:

April 2017

Rationale:

Africa and the Caribbean have the highest prevalence of HIV/AIDS in the world, concurrent with high prevalence of chronic non-communicable diseases (CNCD). Through a collaboration between The University of Limpopo, The University of Cape Town, Penn State University, and the University of the West Indies, the aim of the study is to examine patient workload and capacity for managing HIV/Diabetes co-morbidity in three diverse countries in the Caribbean, namely Trinidad, Barbados and Jamaica. It is expected that the factors related to workload and capacity are likely to be contextual and strongly influenced by socio-cultural factors, thereby making their identification crucial to inform interventions within the context of Caribbean communities and the health care system.
Results:
From the interviews with participants in both Trinidad (10 participants) and Barbados (10 participants), we have learnt that patient workload appears to be divided into broad concepts related to 1) clinic structure and service organization and 2) personal care.
Clinic structure: The emerging issues were related to processes within the clinics, for example making appointments, needing additional testing such as blood work without prior knowledge (testing may be in a different location), and wait times before being seen for appointments. Transportation emerged as an issue for attending and keeping appointments, particularly if additional services required going to a different health institution. Participants also had concerns around confidentiality of their medical information; stigma, particularly for HIV patients, and patient-provider communication.
Personal care: Communicable and non-communicable comorbidities are handled differently and have different issues. HIV was considered easier to manage than diabetes. Diabetes management was much more time intensive. HIV was considered to be “take your meds and go.” On the other hand, with HIV, there was more discussion around participants’ capacity to cope, which was intertwined with experiences of stigma and discrimination
Overall, priority areas around diabetes care centred squarely on managing the illness, while for HIV the main concerns were social determinants (e.g. housing issues, food insecurity), stigma and mental wellbeing.