Influence of institutional support and organisational culture on HIV and NCD integration.

Background: The integration of services for human immunodeficiency virus (HIV) and non-communicable diseases (NCDs) has gained increasing attention in recent years because of the overlapping prevalence and shared risk factors between these health conditions. However, successful integration requires more than just the alignment of clinical practices. The role of institutional support and organisational culture in promoting effective integration remains an underexplored area. Aim: This study aims to fill this gap by examining how institutional structures and organisational values influence the integration of HIV and NCD care. Setting: The study setting was Nakuru County in Kenya. Methods: This study employed a qualitative research design to capture the nuanced experiences and perceptions of healthcare providers involved in HIV and NCD care integration. A total of 99 key informant interviews were conducted with healthcare providers in levels 2 to 5 facilities in Nakuru County. The interviews lasting 45 min - 60 min were conducted sequentially. This study adopted a thematic analysis using NVivo 12. Results: Institutional support, including an improved provider efficiency, support from top management, capacity building, availability of essential commodities, maximum use of facility space, and monitoring of outcomes, has been shown to enhance integration efforts. Additionally, a supportive organisational culture characterised by adaptivity, embracing innovative or new culture, staff empowerment to propose new strategies, teamwork and performance monitoring contributes to successful integration outcomes. These factors improve patient workflow, ensure continuity of care, reduce patient wait times and reduce stigma. Conclusion: The findings highlight the importance of leadership commitment, resource allocation, communication, collaboration, stigma reduction and patient-centredness in achieving successful integration outcomes. Contribution: This study contributes to the body of knowledge surrounding the integration of HIV and NCD services, providing valuable insights that can be applied in other contexts and settings aiming to enhance healthcare delivery and outcomes for individuals living with these conditions.