Integrated care for HIV and non-communicable diseases in Africa: a pilot study to inform a large-scale trial (MOCCA and MOCCA Extension Study)

Plain English summary of protocol

Background and study aims
Between 2018 and 2019 the Management of Chronic Conditions in Africa (MOCCA) study delivered care in an integrated approach whereby patients with either HIV infection, diabetes or hypertension (high blood pressure) were managed in a single clinic (i.e. with shared waiting and consultation rooms, shared pharmacy, and similar adherence counselling support, medical records, and tracing of patients lost from care). The study was done in 10 health facilities (five in Tanzania and five in Uganda) with varying clinical infrastructure, ranging from health centres to district hospitals offering primary care. In the MOCCA extension study, the researchers are re-establishing the integrated care clinics and inviting the participants of the original MOCCA study to attend the clinics again. The aim is to determine if the integrated care clinic remains acceptable to patients and to determine the clinical impact of participating in integrated care.

Who can participate?
Participants of the original MOCCA trial who were alive and in care at the end of the MOCCA follow-up

What does the study involve?
The integrated care clinic will be re-established (as was previously ran during the original MOCCA study) where patients who have either HIV, diabetes, hypertension or any combination of these conditions can receive care. Patients who have more than one condition will receive care in a single consultation. Patients will attend the clinic as directed by the health facility staff, following standard of care visit schedules. All aspects of clinical care, including blood testing, clinical monitoring and drug prescriptions will be according to the national guidelines and as prescribed by the health facility staff. In addition, cross-testing for diabetes, hypertension and HIV will be offered to recruited participants, for example, patients who have diabetes will be offered testing for hypertension and HIV. A blood lipid test for all patients will be done at enrolment. Biomedical measurements including blood glucose, blood pressure and plasma viral loads will be recorded according to the conditions that patients are being treated for at enrolment, the end of study follow up and if they are taken during any follow-up appointments.

What are the possible benefits and risks of participating?
Participants may have to change from the facility or clinic they were attending in order to re-attend at the integrated care clinic. As there will be cross-testing of conditions, participants will have the opportunity to be screened for diabetes, hypertension or HIV (as appropriate). Early diagnosis of any of these conditions is very important in order to prevent the development of poor health and complications. There will also be a test of blood cholesterol. If participants are found to have high cholesterol, they can make changes to their diet and lifestyle to prevent the development of heart disease.

Where is the study run from?
This study is run by a partnership of institutions including the Liverpool School of Tropical Medicine (UK), the National Institute of Medical Research (Tanzania), and the MRC/LSHTM/UVRI Uganda research institute.

When is the study starting and how long is it expected to run for?
February 2018 to December 2021

Who is funding the study?
National Institute for Health Research (NIHR) (UK)

Who is the main contact?
Dr Anupam Garrib
anupam.garrib@lstmed.ac.uk

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• Tanzania
• Uganda

Study participating centres

Results and Publications

Study outputs

Editorial Notes

12/12/2022: The following changes have been made:
1. Two publication references have been added.
2. The scientific contact has been changed.
28/09/2021: Trial's existence confirmed by the Liverpool School of Tropical Medicine ethics committee.