Abstract:
Introduction In Kenya, non-communicable diseases
(NCDs) are estimated to account for almost one-third of
all deaths and this is likely to rise by over 50% in the
next 10 years. The Primary Health Integrated Care for
Chronic Conditions (PIC4C) project aims to strengthen
primary care by integrating comprehensive NCD care
into existing HIV primary care platform. This paper
evaluates the association of PIC4C implementation on
clinical outcomes.
Methods Outcomes included proportion of new
patients, systolic blood pressure (SBP), fasting plasma
glucose (FPG), diastolic blood pressure, hypertension
control, random plasma glucose, diabetes control, viral
load and HIV viral suppression. We used interrupted
time series and binomial regression with random
effects for facility-level data and generalised mixed-
effects regression for visit-level data to examine the
association between PIC4C and outcomes between
January 2017 and December 2021. We conducted
sensitivity analysis with restrictions on sites and the
number of visits.
Results Data from 66 641 visits of 13 046 patients
with hypertension, 24 005 visits of 7267 patients with
diabetes and 84 855 visits of 21 186 people with HIV
were analysed. We found evidence of association
between PIC4C and increase in proportion of new
patients per month with hypertension (adjusted OR
(aOR) 1.57, 95% CI 1.39 to 1.78) and diabetes (aOR
1.31, 95% CI 1.19 to 1.45), small increase in SBP
(adjusted beta (aB) 1.7, 95% CI 0.8 to 2.7) and FPG (aB
0.6, 95% CI 0.0 to 1.1). There was no strong evidence of
association between PIC4C and viral suppression (aOR
1.20, 95% CI 0.98 to 1.47). In sensitivity analysis, there
was no strong evidence of association between PIC4C
and SBP (aB 1.74, 95% CI −0.70 to 4.17) or FPG (aB
0.52, 95% CI −0.64 to 1.67)
Conclusions PIC4C implementation was associated
with increase in proportion of new patients attending
clinics and a slight increase in SBP and FPG. The
immediate post-PIC4C implementation period coincided
with the COVID-19 pandemic, which is likely to explain
some of our findings.