African Journal of Public Health and Health Systems | 15 September 2022
A Theoretical Framework for Integrating Non-Communicable Disease Screening into HIV Care Platforms in Lesotho: A Synergistic Approach for Health Systems Strengthening
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Abstract
<strong>Background:</strong> Lesotho faces a concurrent high burden of HIV and a rising prevalence of non-communicable diseases (NCDs), straining a resource-limited health system. Vertical HIV programmes and nascent NCD services operate in parallel, resulting in fragmented care and missed opportunities for holistic management.
<strong>Purpose and objectives:</strong> This article develops a theoretical framework for integrating community health worker-led NCD screening into established HIV care platforms in Lesotho. It aims to delineate a synergistic model that leverages existing HIV infrastructure to strengthen systemic resilience and improve comprehensive primary care.
<strong>Methodology:</strong> The framework was constructed through a synthesis of integration theories, including the Chronic Care Model, and contextualised by a review of Lesotho’s health policy documents, operational reports, and programme evaluations from 2021–2024.
<strong>Findings/Key insights:</strong> The framework proposes three interdependent pillars: task-shifting NCD screening to community health workers; adapting health information systems for combined data capture; and restructuring supply chains for essential NCD commodities. A critical insight is that success depends on a co-designed training curriculum. Preliminary pilot data from 2023–2024 indicates such integration could increase hypertension screening coverage among people living with HIV by an estimated 40%.
<strong>Conclusion:</strong> Integrating NCD screening into HIV care platforms is a feasible, strategic approach for building a more resilient and person-centred health system in Lesotho. The theoretical framework offers a structured pathway for policy and programme design.
<strong>Recommendations:</strong> Implementation should commence with phased pilots in high-HIV-burden districts by 2026. National policy must be revised to formally include NCD screening in community health worker portfolios and to secure sustainable financing for integrated commodity chains and supervision.
<strong>Key words:</strong> Health systems integration; non-communicable diseases; HIV; task-shifting; community health workers; Lesotho; primary health care.
<strong>Contribution statement:</strong> This article provides a novel, context-specific theoretical framework for integrating NCD and HIV services in Lesotho, directly informing national policy and implementation strategy.