Integrating Non-Communicable Disease Screening into HIV Programmes: A Policy Analysis of Diabetes and Hypertension Case-Finding within HIV Testing Services in Zambia's Copperbelt Province

The concurrent epidemics of HIV and non-communicable diseases (NCDs), such as diabetes and hypertension, strain health systems in sub-Saharan Africa. Vertical programme structures often lead to inefficiencies in managing this comorbidity. This analysis explores the policy environment for incorporating NCD screening into established HIV services in Zambia’s Copperbelt Province. This study aimed to analyse the policy feasibility, acceptability, and health system implications of integrating routine diabetes and hypertension screening within existing HIV Testing Services (HTS). Its objective was to identify principal policy barriers and enablers to guide national strategic planning. A qualitative policy analysis was undertaken, comprising a desk review of relevant national and provincial health policies, strategic frameworks, and programme guidelines. This was complemented by key informant interviews with policymakers, programme managers, and health facility in-charges from both HIV and NCD domains. Data were analysed using thematic analysis. Analysis revealed high-level policy endorsement for integration but identified substantial operational gaps. A predominant theme was the misalignment of dedicated HIV funding with under-resourced NCD activities. Staff capacity was a critical concern, with most interviewees highlighting insufficient training for HTS counsellors on NCD equipment and patient counselling. While integrating NCD screening into HTS is politically supported and could enhance service efficiency and case detection, implementation is constrained by vertical financing, separate monitoring systems, and an absence of practical guidance for frontline workers. Develop unified clinical and operational guidelines for combined HIV/NCD screening. Advocate for blended financing mechanisms within health sector budgets. Implement targeted training and supportive supervision for HTS staff. Pilot integrated data collection tools to harmonise reporting. Health policy, health systems integration, non-communicable diseases, HIV, screening, Zambia. This analysis provides evidence on specific health system barriers to integrating NCD and HIV services, offering practical recommendations for policymakers and programme managers seeking to operationalise such integration within similar resource-limited settings.