FHI’s Experience in Integrating Cardio-Vascular Diseases (CVD) and

Underlying Risk Factors Screening and Services

into Existing HIV/AIDS Programs

Inoussa Kabore (ikabore@fhi.org), Director Strategic InformationRebecca Dirks (rdirks@fhi.org), 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

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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