Barbara Mukasa, Esther Kawuma, Ritah Nakigudde, Yvonne Karamagi, Micheal Ssonko, Daniel Mwehire, Sanni Yaya, Eric Druyts, Caroline MacLeod, Yvonne Karamagi, Edith Akankwasa, Jan Heusinkveld, Emmanuel Luyirika, Heiner Bucher, Mary Odiit, Edward Mills

Utilizing available HIV/AIDS infrastructure as a gateway to effective case finding & management of Non-Communicable Diseases (NCDS) including hypertension, diabetes & mental

disorders at Mildmay Uganda

1a

BackgroundUganda, like other countries with a high burden of HIV infection is facing a growing epidemics of NCDs

Population of PLHIV achieving viral suppression on combination ART is growing, aging & experiencing a widening spectrum of non-AIDS diseases.

Like HIV, NCDs are most frequent in low- & middle-income countries; age-adjusted death rates from NCDs are nearly twice as high in low- & middle-income countries compared to high-income countries.

HIV & NCD care both require ongoing attendance at appointments, adherence to tests & medications, healthy living & self-management.

Issue In 2012/2013 cohort study, at

Mildmay Uganda - Hypertension was diagnosed in 1551 patients

The risk was higher among males & increased with age.

Efforts needed to address multi-morbidity in HIV-positive persons - combine HIV treatment with vascular disease risk factor prevention & management

Description Mildmay Uganda fully integrated

NCD screening & management in 2013, as part of routine HIV care

1. Active-case finding for all new

clients2. Provision of medical &

behavioral interventions to reduce risk & control disease

DescriptionA review of physical & electronic longitudinal

data was conducted to identify & improve tracking of clients with HIV-NCD co-morbidity

Data collection tools reviewed/developed to capture NCD specific data – Demographics, Clinical &Anthropometry Measures, Dietary Measures, significant Medical History, Physical Activity, Behavioural , Biochemical measures.

SOPs developed/revised to support screening & management of HIV-NCD co-morbidity

Data collection, cleaning & analysis has continued allowing for profiling of NCDs among HIV clients in care at MUg

Medical records/ files for HIV+ clients with NCDs have been tagged & clinicians sensitized on management of HIV-NCD co-morbidities.

To maximize clinic capacity to deliver interventions including health education & client support groups (since 69% of those with HIV-NCD co-morbidity are also elderly) - Tuesday has been designated as NCD/Elderly Clinic Day.

Result as of March 2014Active PLHIV in care at Mildmay Uganda main

site - 10,285 34% were aged over 60 years; 69 % were

females 73% are on ART1058 were identified with Hypertension;

12.7% of whom had mental disorders, including depression, mania & epilepsy while, 8% had diabetes.

Lessons learntExisting HIV care & treatment infrastructure

provides a viable platform for screening & managing non-communicable disease

Diagnosis, tracking & management of NCDs, particularly Hypertension, diabetes, cardiovascular disease & mental health as part of routine HIV care improves outcomes markedly.

Most pressing challenge Access to drugs for increasing no. of

clients diagnosed with co-morbidities is a challenge as the drugs for co-morbidities are not always part of the commodities provided under the routine HIV programme

Adherence for clients who have to buy their own medicines is a challenge

Next steps

Community Volunteers trained to support follow up in & screening of other HH members of those with the NCDs.

Continue lobbying for increased access to drugs through national & other mechanisms

Acknowledgment & disclaimer

This work is supported by Cooperative Agreement Number 1UG2GPS002909-01from The Centers for

Disease Control and Prevention (CDC) and the GACD

Special acknowledgement The Clients of Mildmay Uganda who allow us continually to learn from their experiences

The Staff who are the hands of Mildmay Uganda

*The contents of this presentation are solely the responsibility of the authors and do not necessarily represent the official views of the CDC and the other

supporters

11a