Strategies to integrate non-communicable disease interventions in HIV and tuberculosis care contexts in low- and middle-income countries: a scoping review.
Integration of management of tuberculosis (TB) and HIV with prevention and treatment of non-communicable diseases (NCDs) is a global priority. However, delivering the full spectrum of HIV/TB and NCD services is hindered by a lack of evidence regarding effective models and strategies for integrating NCDs and HIV/TB care services in varying contexts and across interventions. We conducted a scoping review to describe service delivery models and strategies used to facilitate integration of NCD care in HIV and/or TB care settings in low- and middle-income countries (LMICs).
We searched eight electronic databases for studies published from 2010 to 2025 that evaluated methods to integrate evidence-based screening and/or treatment of NCDs (diabetes, cervical cancer, hypertension and depression) and NCD risk factors (alcohol and tobacco use) in the context of HIV and/or TB care in LMICs. We applied a framework for categorising integration models ranging from coordination to full integration and used implementation science taxonomies to define implementation strategies and outcomes.
72 articles were included; 62.5% evaluated implementation of NCD interventions in HIV care settings, 31.9% in TB care and 5.6% in both. Less than a third (27.8%) reported a fully integrated service delivery model (shared systems and services). Commonly described implementation strategies included training (81.9%), evaluation strategies (43.1%), interactive assistance for providers (40.3%) and infrastructure change (eg, changing record systems) (37.5%).
Studies in LMICs are evaluating a range of strategies and service models for integrating NCD interventions into HIV and TB care in LMICs. This reflects differences in health system capacity and priorities. Greater alignment with WHO systems-integration models and implementation science frameworks could strengthen the evidence base and support progress towards global NCD goals through more consistent reporting of frameworks, integration strategies and implementation outcomes.
We searched eight electronic databases for studies published from 2010 to 2025 that evaluated methods to integrate evidence-based screening and/or treatment of NCDs (diabetes, cervical cancer, hypertension and depression) and NCD risk factors (alcohol and tobacco use) in the context of HIV and/or TB care in LMICs. We applied a framework for categorising integration models ranging from coordination to full integration and used implementation science taxonomies to define implementation strategies and outcomes.
72 articles were included; 62.5% evaluated implementation of NCD interventions in HIV care settings, 31.9% in TB care and 5.6% in both. Less than a third (27.8%) reported a fully integrated service delivery model (shared systems and services). Commonly described implementation strategies included training (81.9%), evaluation strategies (43.1%), interactive assistance for providers (40.3%) and infrastructure change (eg, changing record systems) (37.5%).
Studies in LMICs are evaluating a range of strategies and service models for integrating NCD interventions into HIV and TB care in LMICs. This reflects differences in health system capacity and priorities. Greater alignment with WHO systems-integration models and implementation science frameworks could strengthen the evidence base and support progress towards global NCD goals through more consistent reporting of frameworks, integration strategies and implementation outcomes.
Authors
Luo Luo, Kapur Kapur, Armstrong-Hough Armstrong-Hough, Alvarez Alvarez, Moucheraud Moucheraud, Purtle Purtle, Namusisi Namusisi, Yang Yang, Raghavan Raghavan, Lappen Lappen, Shelley Shelley
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