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Kwasi Torpey MD PhD MPH FGCP Deputy Chief of Party, Technical FHI360/SIDHAS, Nigeria

Enhancing Comprehensive HIV Care: Addressing Cardiovascular Disease (CVD) and other Noncommunicable Diseases (NCDs). Kwasi Torpey MD PhD MPH FGCP Deputy Chief of Party, Technical FHI360/SIDHAS, Nigeria. Why integrate CVD into HIV services?. Global burden of CVD

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Kwasi Torpey MD PhD MPH FGCP Deputy Chief of Party, Technical FHI360/SIDHAS, Nigeria

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  1. Enhancing Comprehensive HIV Care:Addressing Cardiovascular Disease (CVD) and other Noncommunicable Diseases (NCDs) Kwasi Torpey MD PhD MPH FGCPDeputy Chief of Party, TechnicalFHI360/SIDHAS, Nigeria

  2. Why integrate CVD into HIV services? • Global burden of CVD • CVD is a leading cause of morbidity and mortality globally, claiming 17.3 million lives per year • CVD accounts for nearly 30% of deaths in low and middle income countries • Link between CVD and HIV • HIV-positive individuals are at increased risk of CVD due to effects of the virus itself and ART drugs • HIV is a chronic disease • HIV health infrastructure can be leveraged for other chronic diseases References: WHO. Global Atlas on Cardiovascular Disease Prevention and Control, 2011 Connor et al. Burden of stroke in black populations in sub-Saharan Africa. Lancet Neurology 2007;6:269-78. IOM. Promoting Cardiovascular Health in Developing Countries: A critical challenge to achieve global health, 2010.

  3. CVD Integration Models Across Various Contexts: Examples from FHI 360 HIV Programs Reference: WHO, Noncommunicable Disease Country Profiles, 2011.

  4. Kenya CVD/HIV Integration PilotKey Components • Partnership w/ MOH, Kenya Cardiac Society, and USAID • CVD screening, treatment, & referral services integrated in five APHIA II HIV treatment sites • Target population for behavioral and biomedical risk assessment • HIV counseling & testing clients • HIV-positive clients in care • ART clients

  5. Kenya CVD/HIV Integration PilotFindings • Between Sept 09 – Sept 10, over 4,000 HIV clients were screened • Health care providers and clients valued the addition of CVD and diabetes services • Integration of CVD and diabetes services allowed clients to receive all services at the same location • Behavioral risk factors were highest among HIV-negative counseling and testing clients • Tobacco use, physical inactivity and alcohol use • Biological CVD risk factors were highest among ART clients • Elevated blood pressure, high BMI, and high waist circumference

  6. Kenya CVD/HIV Integration PilotBiological CVD Risk Factors and Length on ART

  7. Nigeria CVD/HIV IntegrationThe Pilot • Began as a small pilot within USAID-funded GHAIN Project • CVD screening system was integrated within HIV care services at Murtala Mohammed Specialist Hospital in Kano • WHO/ISH guidelines were adopted for the CVD risk assessment • Risk factors assessed: age>40 yrs, male sex, BMI, history of smoking, hypertension, and diabetes • Lab investigations done for those identified with risk factors • 1033 HIV-positive clients enrolled in the ART clinic were screened

  8. Nigeria CVD/HIV IntegrationPilotFindings • Most common risk factors were: • age >40years (25.7%) • male sex (25.9%) • overweight/obese (21.8%) • blood pressure >140/90 mmHg (15.2%) • Linear relationship found between the mean levels of serum total cholesterol and duration on ART

  9. Nigeria CVD/HIV IntegrationScale-up within Strengthening Integrated Delivery of HIV/AIDS • CVD integration being scaled up in all SIDHAS-supported sites • Simplification of CVD screening based on level of health care facility and capacity • CVD integration implemented within the context of a HIV chronic care model

  10. Zambia Chronic Care Screening IntegrationKey Components • Chronic care screening integration within USAID-funded ZPCTII project • Screening provided in HIV counseling and testing, PMTCT, and ART • Chronic Care Screening Checklist includes • CVD-related risk factors: BMI, hypertension, diabetes • Other health concerns: TB, gender-based violence, prevention w/ positives • Implemented in all facilities regardless of level • Random blood sugar performed depending on capacity of the facility

  11. Zambia Chronic Care Screening IntegrationSnapshot of Checklist

  12. Key Messages • CVD/HIV integration is feasible and acceptable in resource limited settings • It can be offered from PHCs to tertiary facilities • Leveraging the platform of an existing HIV program - funding, infrastructure, staffing, and commodity management - allows for smooth integration of CVD services CVD/HIV integration site in Kenya: Comprehensive Care Center, Naivasha District Hospital

  13. Key Messages (2) • Integration strengthens the capacity of the health system to address the comprehensive needs of HIV patients, including their increased risk of CVD • Integration services can be offered to clients regardless of HIV status • Integration offers an opportunity for de-stigmatization by offering services to non HIV clients

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