The co-occurrence of noncommunicable diseases and communicable diseases raises important challenges to the integration of public health and care delivery for more than one morbidity. Effective integration requires assessing needs, designing integrated systems, leveraging existing infrastructure, and addressing resource challenges through creative organizational and technological strategies.
This chapter uses the example of diabetes as a prototypical noncommunicable disease and highlights the urgent need for integrated approaches to addressing three key comorbidities in patients with diabetes: mental health disorders, tuberculosis, and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). We explore the epidemiology of joint burdens, risk factors, and prognoses of these co-occurring conditions. We summarize the available evidence and address the challenges of integrating public health and health services for persons jointly affected by diabetes and the three comorbidities. We focus on a case study for integrating care for diabetes and mental health disorders. Finally, we address gaps in data regarding combined burdens and effectiveness and cost-effectiveness of integrated interventions and make recommendations for closing those gaps.
© 2017 International Bank for Reconstruction and Development / The World Bank.