NIHR RIGHT3: Integrated, person-centred approaches to multimorbidity in South African primary care A UK and low- and middle-income country (LMIC) research partnership will identify the commonest patterns of multiple long-term conditions (MLTC-M) in South Africa where high burdens of communicable diseases (HIV, TB, COVID-19), non-communicable diseases and mental health problems are colliding and disproportionately affecting people of working age. This information will inform improvements to an existing primary care clinical guidance and training package called PACK (Practical Approach to Care Kit). ‘PACK Multiple Long-Term Conditions’ will include enhanced clinical guidance and patient/ household information for the care of people living with MLTC-M. Implementation strategies will be co-developed that address barriers to system change and patient/ household priorities and will be tested in two provinces of South Africa (KwaZulu-Natal and Western Cape). We will model the cost and impact of the programme if it were to be scaled country wide. This four-year project commencing in September 2021 is being led by Principal Investigators from King’s College London and the University of Cape Town and brings together an interdisciplinary team with extensive experience of working in South African healthcare and in over 20 other LMICs. New models of care for people living with multiple long-term conditions are urgently needed worldwide, as health systems look to reform to realise Universal Health Coverage in the time of a pandemic. This project aims to deliver streamlined care that allows contacts with health services to be optimised and capacitates people and those living in their households to assume greater agency for their long-term health and wellbeing. The project’s overall aim is to produce evidence-based, scalable solutions for care, treatment and support systems for people living with multiple long-term conditions – multimorbidity (MLTC-M) in low- and middle-income countries (LMICs) to enhance their health and well-being. The project objectives are to:
1. Generate evidence on the prevalence and commonest configurations of MLTC-M, its determinants, associated healthcare utilisation and outcomes.
2. Systematically - and throughout the project - engage with people living with MLTC-M, communities and civil society partners to address their priorities for care.
3. With the health system, patient and community stakeholders, co-produce clinical tools (guidance + support materials) to enable providers to deliver streamlined, evidence-informed care to people living with MLTC-M.
4. With health system, patient and community stakeholders, co-produce optimised implementation strategies for people-centred health systems strengthening to support the successful integration of quality MLTC-M care into routine practice.
5. Evaluate the effectiveness of a co-produced intervention comprising these tools and implementation strategies on detection, treatment and control of MLTC-M; patient wellbeing; provider competence to deliver effective person-centred care; and costs, in two provinces in South Africa.
6. Estimate the health gain and cost-effectiveness that would result from implementation of this intervention country wide.