Vol. 2004 No. 1 (2022)
A Theoretical Framework for Integrating Non-Communicable Disease Screening into HIV Care Platforms in Lesotho: A Synergistic Approach for Health Systems Strengthening
Abstract
**Background:** 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.
**Purpose and objectives:** 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.
**Methodology:** 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.
**Findings/Key insights:** 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%.
**Conclusion:** 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.
**Recommendations:** 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.
**Key words:** Health systems integration; non-communicable diseases; HIV; task-shifting; community health workers; Lesotho; primary health care.
**Contribution statement:** This article provides a novel, context-specific theoretical framework for integrating NCD and HIV services in Lesotho, directly informing national policy and implementation strategy.