Integrated Care Models for HIV, Diabetes and Hypertension in Sub‐Saharan Africa: A Systematic Review of Effectiveness, Implementation and Real‐World Applicability

Abstract

BACKGROUND: Sub-Saharan Africa faces a syndemic of HIV and non-communicable diseases (NCDs), particularly diabetes and hypertension. Integrated care models have been promoted to improve service efficiency and patient outcomes; however, evidence on their effectiveness, implementation and real-world applicability remains fragmented. OBJECTIVE: This systematic review aimed to assess the clinical and service delivery effectiveness of integrated HIV-diabetes-hypertension care models in sub-Saharan Africa and to identify key implementation barriers and facilitators, and sustainability considerations. METHODS: We conducted a systematic review of studies published between January 2016 and June 2026 following PRISMA 2020 guidelines. PubMed, Scopus and African Index Medicus were searched. Eligible studies included randomized controlled trials, observational, qualitative and mixed-method studies evaluating integrated care models for HIV and NCDs in sub-Saharan Africa. Data were synthesized narratively, guided by implementation science frameworks. RESULTS: Sixteen studies from eight sub-Saharan African countries were included. Integrated care models, such as one-stop clinics, nurse-led service, adherence clubs and decentralized drug distribution, were consistently associated with high retention in care for people living with HIV (generally >80%) and sustained viral suppression (> 90%). Retention for diabetes and hypertension care was lower (70%-78%), and improvements in blood pressure and glycaemic control were reported but remained inconsistent and frequently suboptimal. Integrated care models improved service delivery outcomes, including appointment adherence, continuity of care and patient acceptability. Key implementation facilitators included task-shifting, co-located services, leadership support and leveraging existing HIV infrastructure. Common barriers were drug stockouts for NCDs, workforce shortages, fragmented data systems, stigma and confidentiality concerns, and long waiting times. Limited economic evidence indicates that personnel costs constituted the largest share of programme expenditure. While integrated care models were feasible and acceptable in routine settings, scalability and long-term sustainability were constrained by donor dependence, supply chain weaknesses and variable health system readiness. CONCLUSIONS: Integrated HIV-diabetes-hypertension care models in sub-Saharan Africa effectively maintain HIV treatment outcomes and improve service delivery, but clinical control of NCDs remains suboptimal. Sustainable and equitable integration will require deliberate strengthening of NCD-specific supply chains, workforce training and context-adapted implementation strategies aligned with health system readiness. Policy and programming should support differentiated, patient-centred integration that addresses both clinical and systemic barriers.