FHI’s Experience in Integrating Cardio-Vascular Diseases (CVD) and
Underlying Risk Factors Screening and Services
into Existing HIV/AIDS Programs
Inoussa Kabore ([email protected]), Director Strategic InformationRebecca Dirks ([email protected]), Technical Officer
May 12, 2011
Overview
• WHO definition Non-Communicable Diseases (NCD)• Global burden and projection on NCD• Rationale for integration of Non-Communicable Diseases (NCD) and HIV• Synopsis of FHI portfolio on NCD• Rational for integrating NCD/HIV programs• Description and findings of HIV/NCD integration programs in Kenya • Ways forward and questions
Definition of NCD
• Definition NCD according to WHO:– CVD, diabetes, cancers, chronic respiratory
diseases, neuropsychiatric disorders– Underlying causes of NCD
Beaglehole and Bonita, 2008
Overview: Projected global deaths by cause, 2008
• CVD: nearly one-third of global mortality
• Annual death projections over next 20 yrs:
• Infectious disease ↓ 7 million
• CVD ↑ 6 million • Cancer ↑ 4 million
• In LMIC, NCDs will be responsible for nearly 5X as many deaths as communicable diseases, maternal, perinatal and nutritional conditions combined by 2030
Synopsis of FHI’s Portfolio
• Participation in the Institute of Medicine’s Committee on Preventing the Global Epidemic of Cardiovascular Disease
• Ghana: CVD Prevention and Care Pilot
• Vietnam: Tobacco Control in Hospitals and Among Youth
• Nigeria: CVD/HIV Integration
• Kenya: CVD/HIV Integration
Rational for Integrating CVD and HIV services
• Burden of CVD/HIV in developing countries– Around 30 million people are living with HIV– HIV infection associated with abnormal blood lipids– High prevalence of CVD risk factors in HIV-infected
individuals– Patients on ART have a greater risk for CVD- risk for
heart attack is 70-80% higher – CVD substantially contributes to mortality in HIV+
patients receiving ART- risk increases with longer exposure to treatment
CVD/HIV Integration Pilot in Kenya
8
Kenya HIV/CVD Integration Pilot
• Launched in Sept 2009• CVD integration in HIV/AIDS services in 5 sites
– Assessment– Upgrading health facilities– Training of health care providers
• Biomedical CVD risks:– Blood pressure– Blood sugar– Cholesterol– Weight and height --- BMI
• Behavioral risk assessment:– Exercise – Smoking – Diet
For all HIV CT clients and HIV+ clients in care
For all HIV+ clients in care
Job Aid in Kenya (1)
Job Aid in Kenya (2)
Staging of Hypertension
Yes, > 2 drugs +
Refer if has chest pain, dyspnoea, confusion, visual disturbance, or motor weakness
Or >100>160Stage 2 Hypertension
YesOr 90 – 99140 – 159Stage I Hypertension
No unless DM, Kidney disease
Or 80 – 89120 – 139Pre-hypertension
NoOr < 80< 120Normal
Drugs Indicated?Diastolic BPSystolic BP
Preliminary Results of Kenya CVD/HIV Integration (1)
Preliminary Results of Kenya CVD/HIV Pilot (2)
High:
SBD >=140-159 & DBP>=90-99
Preliminary Results of Kenya CVD/HIV Integration (3)
Contribution of CVD/HIV integration to Health System Strengthening (HSS)• Human Resources: built capacity of staff in CVD• Service Delivery: integrated HIV and CVD prevention
and care services• Health Management Information Systems (HMIS):
adapted existing tools for CVD• Laboratory: enhanced lab capacity for CVD• Policy – Kenya National HIV/AIDS Strategic Plan
(KNASP) III: lessons and evidence derived from CVD/HIV integration being incorporated
Lessons Learned from Kenya CVD/HIV Integration
• Key inputs for CVD/HIV integration include:– Training existing staff– Building capacity of existing laboratories– Technical and management support– Government buy-in
• This pilot project was successful due to a partnership:– FHI: seed funding for adding CVD services– Kenya Cardiac Society: training & technical support– NASCOP: government support– USAID: funding for HIV services
Next Steps Forward
• Continued dissemination of findings– Conferences (GHC), and others relevant fora– Peer reviewed publications– Next UNGASS meeting
• Cost analysis of Kenya to inform scale-up• “How to” toolkit for integration of NCD into existing
programs– Facility assessment tool; steps and procedures; equipment;
capacity building; HMIS; QA/QI; M&E; research questions
Thank you