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Plaisy MK, Minga AK, Wandeler G, Murenzi G, Samala N, Ross J, Lopez A, Mensah E, de Waal R, Kuniholm MH, Diero L, Salvi S, Moreira R, Attia A, Mandiriri A, Shumbusho F, Goodrich S, Rupasinghe D, Alarcon P, Maruri F, Perrazo H, Jaquet A. Metabolic causes of liver disease among adults living with HIV from low- and middle-income countries: a cross-sectional study. J Int AIDS Soc 2024; 27:e26238. [PMID: 38566493 PMCID: PMC10988113 DOI: 10.1002/jia2.26238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Liver disease is a leading cause of morbidity and mortality among persons living with HIV (PLHIV). While chronic viral hepatitis has been extensively studied in low- and middle-income countries (LMICs), there is limited information about the burden of metabolic disorders on liver disease in PLHIV. METHODS We conducted a cross-sectional analysis of baseline data collected between October 2020 and July 2022 from the IeDEA-Sentinel Research Network, a prospective cohort enrolling PLHIV ≥40 years on antiretroviral treatment (ART) for ≥6 months from eight clinics in Asia, Americas, and central, East, southern and West Africa. Clinical assessments, laboratory testing on fasting blood samples and liver stiffness measurement (LSM)/controlled attenuation parameter (CAP) by vibration-controlled transient elastography were performed. Multivariable logistic regression models assessed factors associated with liver fibrosis (LSM ≥7.1 kPa) and steatosis (CAP ≥248 dB/m). Population attributable fraction (PAF) of each variable associated with significant liver fibrosis was estimated using Levin's formula. RESULTS Overall, 2120 PLHIV (56% female, median age 50 [interquartile range: 45-56] years) were included. The prevalence of obesity was 19%, 12% had type 2 diabetes mellitus (T2DM), 29% had hypertension and 53% had dyslipidaemia. The overall prevalence of liver fibrosis and steatosis was 7.6% (95% confidence interval [CI] 6.1-8.4) and 28.4% (95% CI 26.5-30.7), respectively, with regional variability. Male sex at birth (odds ratio [OR] 1.62, CI 1.10-2.40), overweight/obesity (OR = 2.50, 95% CI 1.69-3.75), T2DM (OR 2.26, 95% CI 1.46-3.47) and prolonged exposure to didanosine (OR 3.13, 95% CI 1.46-6.49) were associated with liver fibrosis. Overweight/obesity and T2DM accounted for 42% and 11% of the PAF for liver fibrosis, while HBsAg and anti-HCV accounted for 3% and 1%, respectively. Factors associated with steatosis included overweight/obesity (OR 4.25, 95% CI 3.29-5.51), T2DM (OR 2.06, 95% CI 1.47-2.88), prolonged exposure to stavudine (OR 1.69, 95% CI 1.27-2.26) and dyslipidaemia (OR 1.68, 95% CI 1.31-2.16). CONCLUSIONS Metabolic disorders were significant risk factors for liver disease among PLHIV in LMICs. Early recognition of metabolic disorders risk factors might be helpful to guide clinical and lifestyle interventions. Further prospective studies are needed to determine the causative natures of these findings.
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Affiliation(s)
- Marie Kerbie Plaisy
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health CentreBordeauxFrance
| | - Albert K. Minga
- Blood Bank Medical Centre, the HIV care clinic of the National Blood Transfusion CentreAbidjanCôte d'Ivoire
| | - Gilles Wandeler
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
| | - Gad Murenzi
- Research for Development (RD Rwanda) and Rwanda Military HospitalKigaliRwanda
| | - Niharika Samala
- Department of MedicineSchool of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Jeremy Ross
- TREAT Asia/amfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Alvaro Lopez
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | | | - Renée de Waal
- Centre for Infectious Disease Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | - Mark H. Kuniholm
- Department of Epidemiology and BiostatisticsUniversity at AlbanyState University of New YorkRensselaerNew YorkUSA
| | - Lameck Diero
- Department of MedicineSchool of MedicineCollege of Health SciencesMoi UniversityEldoretKenya
| | - Sonali Salvi
- Byramjee Jeejeebhoy Government Medical CollegePuneIndia
| | - Rodrigo Moreira
- Evandro Chagas National Institute of Infectious Diseases‐Oswaldo Cruz Foundation (INI/FIOCRUZ)Rio de JaneiroBrazil
| | - Alain Attia
- University Hospital of YopougonAbidjanCôte d'Ivoire
| | | | - Fabienne Shumbusho
- Research for Development (RD Rwanda) and Rwanda Military HospitalKigaliRwanda
| | - Suzanne Goodrich
- Department of MedicineSchool of MedicineIndiana UniversityIndianapolisIndianaUSA
| | | | - Paola Alarcon
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Fernanda Maruri
- Department of MedicineDivision of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Hugo Perrazo
- Evandro Chagas National Institute of Infectious Diseases‐Oswaldo Cruz Foundation (INI/FIOCRUZ)Rio de JaneiroBrazil
| | - Antoine Jaquet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health CentreBordeauxFrance
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Badacho AS, Mahomed OH. Facilitators and barriers to integration of noncommunicable diseases with HIV care at primary health care in Ethiopia: a qualitative analysis using CFIR. Front Public Health 2023; 11:1247121. [PMID: 38145060 PMCID: PMC10748758 DOI: 10.3389/fpubh.2023.1247121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
Background The rise in non-communicable diseases (NCD), such as hypertension and diabetes among people living with human immunodeficiency virus (PLWH), has increased the demand for integrated care due to multiple chronic care needs. However, there is a dearth of evidence on contextual factors implementing integrated hypertension and diabetes care with HIV care. This study aimed to identify facilitators and barriers that could affect the integration of hypertension and diabetes with HIV care at primary health care in Ethiopia. Methods Five primary health facilities from five districts of the Wolaita zone of South Ethiopia were included in the qualitative study. Fifteen key informant interviews were conducted with healthcare providers and managers from the zonal, district, and facility levels from October to November 2022. Data collection and analysis were guided by a consolidated framework of implementation research (CFIR). Results Ten CFIR constructs were found to influence the integration. Perceived benefit of integration to patients, healthcare providers, and organization; perceived possibilities of integration implementation; availability of NCD guidelines and strategies; a supportive policy of decentralization and integration; perceived leaders and healthcare provider commitment were found to be facilitators. Perceived increased cost, insufficient attention to NCD care needs, inadequate number of trained professionals, inadequate equipment and apparatus such as blood pressure measurement, glucometers, strips, and NCD drugs, inadequate allocation of budget and weak health financing system and poor culture of data capturing and reporting were identified as barriers to integration. Conclusion It is important to address contextual barriers through innovative implementation science solutions to address multiple chronic care needs of PLWH by implementing integrated hypertension and diabetes with HIV care in primary healthcare. Training and task shifting, pairing experienced professionals, and strengthening the health care financing system to implement evidence-based integration of hypertension and diabetes are recommended.
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Affiliation(s)
- Abebe Sorsa Badacho
- School Public Health, Wolaita Sodo University, Sodo, Ethiopia
- School of Nursing and Public Health, Public Health Medicine Discipline, Durban, South Africa
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Ozayr Haroon Mahomed
- School of Nursing and Public Health, Public Health Medicine Discipline, Durban, South Africa
- Dasman Diabetes Institute, Kuwait City, Kuwait
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Yoo SGK, Chung GS, Bahendeka SK, Sibai AM, Damasceno A, Farzadfar F, Rohloff P, Houehanou C, Norov B, Karki KB, Azangou-Khyavy M, Marcus ME, Aryal KK, Brant LCC, Theilmann M, Cífková R, Lunet N, Gurung MS, Mwangi JK, Martins J, Haghshenas R, Sturua L, Vollmer S, Bärnighausen T, Atun R, Sussman JB, Singh K, Saeedi Moghaddam S, Guwatudde D, Geldsetzer P, Manne-Goehler J, Huffman MD, Davies JI, Flood D. Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries. JAMA 2023; 330:715-724. [PMID: 37606674 PMCID: PMC10445202 DOI: 10.1001/jama.2023.12905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/26/2023] [Indexed: 08/23/2023]
Abstract
Importance Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. Objective To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries. Design, Setting, and Participants Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years. Exposures Countries' per capita income levels and world region; individuals' socioeconomic demographics. Main Outcomes and Measures Self-reported use of aspirin for secondary prevention of CVD. Results The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries. Conclusion and Relevance Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.
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Affiliation(s)
- Sang Gune K. Yoo
- Cardiovascular Division, Department of Internal Medicine, Washington University in St Louis, St Louis, Missouri
| | - Grace S. Chung
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Silver K. Bahendeka
- Department of Internal Medicine, MKPGMS Uganda Martyrs University, Kampala, Uganda
- St Francis Hospital, Nsambya, Kampala, Uganda
| | - Abla M. Sibai
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Nucleo de Investigaçao, Departamento de Medicina, Hospital Central do Maputo, Maputo, Mozambique
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Khem B. Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Mohammadreza Azangou-Khyavy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maja E. Marcus
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Krishna K. Aryal
- Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Luisa C. C. Brant
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Renata Cífková
- Center for Cardiovascular Prevention, First Faculty of Medicine, and Thomayer University Hospital, Charles University in Prague, Prague, Czechia
- Department of Medicine II, First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Nuno Lunet
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Mongal S. Gurung
- Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
| | - Joseph Kibachio Mwangi
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Faculty of Medicine, The Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Joao Martins
- Faculty of Medicine and Health Sciences, National University of East Timor, Dili, Timor-Leste
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
- Public Health Department, Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Sebastian Vollmer
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
- Africa Health Research Institute, Somkhele and Durban, South Africa
| | - Rifat Atun
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jeremy B. Sussman
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Kavita Singh
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Centre for Chronic Disease Control, New Delhi, India
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, California
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark D. Huffman
- Department of Medicine and Global Health Center, Washington University in St Louis, St Louis, Missouri
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Justine I. Davies
- Institute for Applied Health Research, University of Birmingham, Birmingham, England
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
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Aifah AA, Hade EM, Colvin C, Henry D, Mishra S, Rakhra A, Onakomaiya D, Ekanem A, Shedul G, Bansal GP, Lew D, Kanneh N, Osagie S, Udoh E, Okon E, Iwelunmor J, Attah A, Ogedegbe G, Ojji D. Study design and protocol of a stepped wedge cluster randomized trial using a practical implementation strategy as a model for hypertension-HIV integration - the MAP-IT trial. Implement Sci 2023; 18:14. [PMID: 37165382 PMCID: PMC10173657 DOI: 10.1186/s13012-023-01272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND As people living with HIV (PLWH) experience earlier and more pronounced onset of noncommunicable diseases (NCDs), advancing integrated care networks and models in low-resource-high-need settings is critical. Leveraging current health system initiatives and addressing gaps in treatment for PLWH, we report our approach using a late-stage (T4) implementation research study to test the adoption and sustainability of a proven-effective implementation strategy which has been minimally applied in low-resource settings for the integration of hypertension control into HIV treatment. We detail our protocol for the Managing Hypertension Among People Living with HIV: an Integrated Model (MAP-IT) trial, which uses a stepped wedge cluster randomized trial (SW-CRT) design to evaluate the effectiveness of practice facilitation on the adoption of a hypertension treatment program for PLWH receiving care at primary healthcare centers (PHCs) in Akwa Ibom State, Nigeria. DESIGN In partnership with the Nigerian Federal Ministry of Health (FMOH) and community organizations, the MAP-IT trial takes place in 30 PHCs. The i-PARiHS framework guided pre-implementation needs assessment. The RE-AIM framework will guide post-implementation activities to evaluate the effect of practice facilitation on the adoption, implementation fidelity, and sustainability of a hypertension program, as well as blood pressure (BP) control. Using a SW-CRT design, PHCs sequentially crossover from the hypertension program only (usual care) to hypertension plus practice facilitation (experimental condition). PHCs will recruit and enroll an average of 28-32 patients to reach a maximum of 960 PLWH participants with uncontrolled hypertension who will be followed longitudinally for BP outcomes. DISCUSSION Given the need for integrated NCD-HIV care platforms in low-resource settings, MAP-IT will underscore the challenges and opportunities for integrating hypertension treatment into HIV care, particularly concerning adoption and sustainability. The evaluation of our integration approach will also highlight the potential impact of a health systems strengthening approach on BP control among PLWH. TRIAL REGISTRATION Clinicaltrials.gov ( NCT05031819 ). Registered on 2nd September 2021.
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Affiliation(s)
- Angela A Aifah
- Institute for Excellence in Health Equity, New York University (NYU) Grossman School of Medicine, New York, NY, USA.
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA.
| | - Erinn M Hade
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Calvin Colvin
- Institute for Excellence in Health Equity, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Daniel Henry
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Shivani Mishra
- Institute for Excellence in Health Equity, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Ashlin Rakhra
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Deborah Onakomaiya
- Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Anyiekere Ekanem
- Department of Community Medicine, Faculty of Clinical Sciences, University of Uyo, Uyo, Akwa Ibom State, Nigeria
| | - Gabriel Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, University of Abuja, Gwagwalada, Abuja, Nigeria
- Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Daphne Lew
- Washington University in St. Louis School of Medicine, St. Louis, USA
| | - Nafesa Kanneh
- Institute for Excellence in Health Equity, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Samuel Osagie
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Ememobong Udoh
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Esther Okon
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, USA
| | - Angela Attah
- Akwa Ibom Primary Healthcare Development Board, State Primary Health Care Development Board, Uyo, Akwa Ibom State, Nigeria
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Dike Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Gwagwalada, Abuja, Nigeria
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Wang Y, Ramos-Gomez F, Kemoli A, John-Stewart G, Wamalwa D, Benki-Nugent S, Slyker J, Seminario A. Oral Diseases and Oral Health-Related Quality of Life among Kenyan Children and Adolescents with HIV. JDR Clin Trans Res 2023; 8:168-177. [PMID: 35354307 PMCID: PMC10026160 DOI: 10.1177/23800844221087951] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Children and adolescents living with HIV (CALHIV) have a higher risk of hard and soft oral tissue diseases as compared with their healthy peers. It is important to increase awareness regarding the need to integrate oral health within medical care among pediatric HIV populations. Studies on associations of oral diseases with oral health-related quality of life (OHRQoL) in CALHIV are lacking. This study examined the association between oral diseases and OHRQoL in Kenyan CALHIV. METHODS This cross-sectional analysis was nested in a longitudinal cohort study of CALHIV in Nairobi. CALHIV received oral examinations, and the World Health Organization's Oral Health Surveys and Record Form was administered. OHRQoL was measured with the Parental-Caregiver Perceptions Questionnaire, with the subdomains of global, oral symptoms, function limitations, and emotional and social well-being, with higher scores indicating poorer OHRQoL. Linear regression was used to model associations between OHRQoL and oral diseases, adjusting for age at the time of oral examination, CD4 counts, and caregiver's education. RESULTS Among 71 CALHIV, the mean age was 12.6 y (SD, 2.9; range, 10 to <21), and the mean composite OHRQoL score was 12.6 (SD, 11.2). Ulcers (not herpes simplex virus or aphthous) were associated with the worst overall OHRQoL (mean, 21.8; SD, 11.1; P = 0.055) and oral symptoms subdomain (mean, 7.0, SD, 2.5; P = 0.003). Children with dry mouth and untreated caries had significantly higher mean global OHRQoL scores than those without disease (P < 0.0001). In the multivariate analysis, the OHRQoL composite score was 6.3 units (95% CI, -0.3 to 12.9) higher for those who had dry mouth and untreated dental caries; dry mouth accounted for the highest percentage of variability of OHRQoL (9.6%) and the global subdomain (31.9%). Ulcers accounted for the highest percentage of variability of the oral symptoms domain (15.4%). CONCLUSIONS Oral ulcers, dry mouth, and untreated caries were associated with poorer OHRQoL in CALHIV. Integrating oral health into the primary care of CALHIV may improve their OHRQoL. KNOWLEDGE TRANSFER STATEMENT This study aimed to determine the association of oral diseases with the oral health-related quality of life of children and adolescents living with HIV (CALHIV). The findings will form part of the evidence to incorporate oral health protocols into care programs for CALHIV. Oral health monitoring has the potential to increase the surveillance of HIV clinical status, monitor the effectiveness of antiretroviral therapy, and improve the oral health-related quality of life of CALHIV.
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Affiliation(s)
- Y. Wang
- Division of Infectious Diseases,
University of California Los Angeles, Los Angeles, CA, USA
| | - F. Ramos-Gomez
- Division of Preventative and
Restorative Sciences, School of Dentistry, University of California Los Angeles, Los
Angeles, CA, USA
| | - A.M. Kemoli
- Department of Paediatric Dentistry and
Orthodontics, University of Nairobi, Nairobi, Kenya
| | - G. John-Stewart
- Departments of Global Health, Medicine,
and Pediatrics, University of Washington, Seattle, WA, USA
| | - D. Wamalwa
- Department of Pediatrics and Child
Health, University of Nairobi, Nairobi, Kenya
| | - S. Benki-Nugent
- Department of Global Health, University
of Washington, Seattle, WA, USA
| | - J. Slyker
- Departments of Epidemiology and Global
Health, University of Washington, Seattle, WA, USA
| | - A.L. Seminario
- UW Timothy A. DeRouen Center for Global
Oral Health, School of Dentistry, University of Washington, Seattle, WA, USA
- Department of Pediatric Dentistry,
Universidad Peruana Cayetano Heredia, Lima, Peru
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Collins C, Isbell MT, Karim QA, Sohn AH, Beyrer C, Maleche A. Leveraging the HIV response to strengthen pandemic preparedness. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001511. [PMID: 36963061 PMCID: PMC10021388 DOI: 10.1371/journal.pgph.0001511] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic and the expectation of future pandemic threats have generated a global dialogue on strengthening pandemic preparedness and response (PPR). Thus far, this dialogue has largely failed to fully consider the critical role that established, disease-specific programs played in national and regional COVID-19 responses, and the potential for these programs to contribute to stronger pandemic preparedness for the future. The HIV response is an important example of a global health initiative that is already making substantial contributions to PPR. Both the infrastructure and core principles of the HIV response have much to contribute towards pandemic preparedness that is more effective and equitable than seen in the response to COVID-19. This review examines how HIV-related resources and principles can support communities and countries in being better prepared for emerging disease threats, with a specific focus on evidence from the COVID-19 pandemic. Drawing on the current literature, the review explores the clear, multi-faceted intersection between the HIV response and the central elements of pandemic preparedness in areas including surveillance; supply chain; primary care; health care workforce; community engagement; biomedical research; universal access without discrimination; political leadership; governance; and financing. There are many opportunities to be more strategic and purposeful in leveraging HIV programs and approaches for preparedness. Avoiding the longstanding temptation in global health to create new siloes, PPR initiatives, including the new Pandemic Fund at the World Bank, should invest in and build out from existing programs that are already making health systems more inclusive and resilient, including the global response to HIV.
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Affiliation(s)
- Chris Collins
- Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, Washington, D.C., United States of America
| | | | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa, Durbin, South Africa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | | | - Chris Beyrer
- Duke Global Health Institute, Durham, NC, United States of America
| | - Allan Maleche
- Kenya Legal and Ethical Issues Network on HIV and AIDS, Nairobi, Kenya
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Borkowska T, Chkhartishvili N, Karkashadze E, Chokoshvili O, Gabunia P, Sharvadze L, Tsertsvadze T. The prevalence of hyperglycemia and its impact on mortality among people living with HIV in Georgia. PLoS One 2022; 17:e0276749. [PMID: 36301817 PMCID: PMC9612544 DOI: 10.1371/journal.pone.0276749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Life expectancy and quality of life of people living with HIV have been dramatically improved after introducing antiretroviral therapy, and the prevalence of non-communicable diseases has increased. Several studies have found that hyperglycemia with or without type 2 diabetes was associated with poor outcomes in people living with HIV. The study's objective was to determine the prevalence of hyperglycemia and assess its impact on mortality. MATERIALS AND METHODS A retrospective cohort study was conducted among people living with HIV diagnosed in 2012-2018 and followed through 2020 at the Infectious Diseases, AIDS and Clinical Immunology Research Center in Tbilisi, Georgia. Primary outcomes of interest included the prevalence of hyperglycemia and mortality. Causes of death were classified according to the Coding of Death in HIV (CoDe) protocol. RESULTS Our study included 2914 people living with HIV. Two hundred and forty-two (8.3%) patients had hyperglycemia, with an increasing prevalence by age. Three hundred one (9.7%) participants died over the median 3.71 (IQR: 2.14-5.37) years of follow-up. Among these, 139 (46.2%) were due to AIDS- related causes, 123 (40.9%)-were due to non-AIDS causes, and in 39 (12.9%) cases, the cause of death could not be determined. Overall, the cohort contributed to 11,148 person-years of follow-up (PYFU), translating into a mortality rate of 2.70 deaths per 100 PYFU. The mortality rate was significantly higher among individuals with hyperglycemia-11.17 deaths per 100 PYFU vs 2.07 deaths per 100 PYFU among normoglycemic patients(p<0.0001). CONCLUSIONS Hyperglycemia was associated with increased odds of mortality. Screening and management of hyperglycemia should be integrated into routine HIV clinical services as part of a comprehensive care package.
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Affiliation(s)
- Tea Borkowska
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
- * E-mail:
| | | | | | - Otar Chokoshvili
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
| | - Pati Gabunia
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
| | - Lali Sharvadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
- Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
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8
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Integrating Care for Diabetes and Hypertension with HIV Care in Sub-Saharan Africa: A Scoping Review. Int J Integr Care 2022; 22:6. [PMID: 35136387 PMCID: PMC8815447 DOI: 10.5334/ijic.5839] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
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Magodoro IM, Olivier S, Gareta D, Koole O, Modise TH, Gunda R, Herbst K, Pillay D, Wong EB, Siedner MJ. Linkage to HIV care and hypertension and diabetes control in rural South Africa: Results from the population-based Vukuzazi Study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001221. [PMID: 36962629 PMCID: PMC10021540 DOI: 10.1371/journal.pgph.0001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/07/2022] [Indexed: 03/26/2023]
Abstract
Non-communicable diseases (NCDs) account for half of all deaths in South Africa, partly reflecting unmet NCDs healthcare needs. Leveraging existing HIV infrastructure is touted as a strategy to alleviate this chronic care gap. We evaluated whether HIV care platforms are associated with improved NCDs care. We conducted a community-based screening of adults in rural KwaZulu-Natal, collecting BP, HbA1c, and health services utilization data. Care cascade indicators for hypertension and diabetes mellitus were defined as: 1) aware, if previously diagnosed, 2) in care, if seeing a provider within last 6 months; 3) treated, if reporting medication use within preceding 2 weeks; and 4) controlled, if BP<140/90mmHg or HbA1c<6.5%. We fit multivariable adjusted logistic regression models to compare successful completion of each step of the care cascade for hypertension and diabetes between people with virally suppressed HIV and HIV-negative comparators. Inverse probability sampling weights were applied to derive population-level estimates. The analytic sample included 4,933 individuals [mean age 58.4 years; 77% female]. Compared to being HIV-negative, having suppressed HIV was associated with lower adjusted prevalence of being aware (-6.0% [95% CI: -11.0, -1.1%]), in care (-5.7% [-10.6, -0.8%]), and in treatment (-4.8% [-9.7, 0.1%]) for diabetes; but higher adjusted prevalence of controlled diabetes (3.2% [0.2-6.2%]). In contrast, having suppressed HIV was associated with higher adjusted prevalence of being aware (7.4% [5.3-9.6%]), in care (8.0% [5.9-10.2%]), in treatment (8.4% [6.1-10.6%]) and controlled (9.0% [6.2-11.8%]), for hypertension. Overall, disease control was achieved for 40.0% (38.6-40.8%) and 6.8% (5.9-7.8%) of individuals with hypertension and diabetes, respectively. Engagement in HIV care in rural KwaZulu-Natal was generally associated with worse diabetes care and improved hypertension care. While further work should explore how success of HIV programs can be translated to NCD care, strengthening of primary healthcare will also be needed to respond to the growing NCDs epidemic.
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Affiliation(s)
- Itai M Magodoro
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Stephen Olivier
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Olivier Koole
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- London School of Tropical Medicine and Hygiene, London, United Kingdom
| | - Tshwaraganang H Modise
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- Witwatersrand University, Johannesburg, South Africa
| | - Resign Gunda
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Deenan Pillay
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- University College London, London, United Kingdom
| | - Emily B Wong
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mark J Siedner
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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10
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Integration of a task strengthening strategy for hypertension management into HIV care in Nigeria: a cluster randomized controlled trial study protocol. Implement Sci 2021; 16:96. [PMID: 34789277 PMCID: PMC8597211 DOI: 10.1186/s13012-021-01167-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background In regions with weak healthcare systems, critical shortages of the healthcare workforce, and increasing prevalence of dual disease burdens, there is an urgent need for the implementation of proven effective interventions and strategies to address these challenges. Our mixed-methods hybrid type II effectiveness-implementation study is designed to fill this evidence-to-practice gap. This study protocol describes a cluster randomized controlled trial which evaluates the effectiveness of an implementation strategy, practice facilitation (PF), on the integration, adoption, and sustainability of a task-strengthening strategy for hypertension control (TASSH) intervention within primary healthcare centers (PHCs) in Lagos State, Nigeria. Design Guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM), this study tests the impact of a proven effective implementation strategy to integrate hypertension management into the HIV care cascade, across 30 PHCs. The study will be conducted in three phases: (1) a pre-implementation phase that will use CFIR to develop a tailored PF intervention for integrating TASSH into HIV clinics; (2) an implementation phase that will use RE-AIM to compare the clinical effectiveness of PF vs. a self-directed condition (receipt of information on TASSH without PF) on BP reduction; and (3) a post-implementation phase that will use RE-AIM to evaluate the effect of PF vs. self-directed condition on adoption and sustainability of TASSH. The PF intervention components comprise (a) an advisory board to provide leadership support for implementing TASSH in PHCs; (b) training of the HIV nurses on TASSH protocol; and (c) training of practice facilitators, who will serve as coaches, provide support, and performance feedback to the HIV nurses. Discussion This study is one of few, if any trials, to evaluate the impact of an implementation strategy for integrating hypertension management into HIV care, on clinical and implementation outcomes. Findings from this study will advance implementation science research on the effectiveness of tailoring an implementation strategy for the integration of an evidence-based, system-level hypertension control intervention into HIV care and treatment. Trial registration ClinicalTrials.gov (NCT04704336). Registered on 11 January 2021.
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11
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Hickey MD, Ayieko J, Owaraganise A, Sim N, Balzer LB, Kabami J, Atukunda M, Opel FJ, Wafula E, Nyabuti M, Brown L, Chamie G, Jain V, Peng J, Kwarisiima D, Camlin CS, Charlebois ED, Cohen CR, Bukusi EA, Kamya MR, Petersen ML, Havlir DV. Effect of a patient-centered hypertension delivery strategy on all-cause mortality: Secondary analysis of SEARCH, a community-randomized trial in rural Kenya and Uganda. PLoS Med 2021; 18:e1003803. [PMID: 34543267 PMCID: PMC8489716 DOI: 10.1371/journal.pmed.1003803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 10/04/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertension treatment reduces morbidity and mortality yet has not been broadly implemented in many low-resource settings, including sub-Saharan Africa (SSA). We hypothesized that a patient-centered integrated chronic disease model that included hypertension treatment and leveraged the HIV care system would reduce mortality among adults with uncontrolled hypertension in rural Kenya and Uganda. METHODS AND FINDINGS This is a secondary analysis of the SEARCH trial (NCT:01864603), in which 32 communities underwent baseline population-based multidisease testing, including hypertension screening, and were randomized to standard country-guided treatment or to a patient-centered integrated chronic care model including treatment for hypertension, diabetes, and HIV. Patient-centered care included on-site introduction to clinic staff at screening, nursing triage to expedite visits, reduced visit frequency, flexible clinic hours, and a welcoming clinic environment. The analytic population included nonpregnant adults (≥18 years) with baseline uncontrolled hypertension (blood pressure ≥140/90 mm Hg). The primary outcome was 3-year all-cause mortality with comprehensive population-level assessment. Secondary outcomes included hypertension control assessed at a population level at year 3 (defined per country guidelines as at least 1 blood pressure measure <140/90 mm Hg on 3 repeated measures). Between-arm comparisons used cluster-level targeted maximum likelihood estimation. Among 86,078 adults screened at study baseline (June 2013 to July 2014), 10,928 (13%) had uncontrolled hypertension. Median age was 53 years (25th to 75th percentile 40 to 66); 6,058 (55%) were female; 677 (6%) were HIV infected; and 477 (4%) had diabetes mellitus. Overall, 174 participants (3.2%) in the intervention group and 225 participants (4.1%) in the control group died during 3 years of follow-up (adjusted relative risk (aRR) 0.79, 95% confidence interval (CI) 0.64 to 0.97, p = 0.028). Among those with baseline grade 3 hypertension (≥180/110 mm Hg), 22 (4.9%) in the intervention group and 42 (7.9%) in the control group died during 3 years of follow-up (aRR 0.62, 95% CI 0.39 to 0.97, p = 0.038). Estimated population-level hypertension control at year 3 was 53% in intervention and 44% in control communities (aRR 1.22, 95% CI 1.12 to 1.33, p < 0.001). Study limitations include inability to identify specific causes of death and control conditions that exceeded current standard hypertension care. CONCLUSIONS In this cluster randomized comparison where both arms received population-level hypertension screening, implementation of a patient-centered hypertension care model was associated with a 21% reduction in all-cause mortality and a 22% improvement in hypertension control compared to standard care among adults with baseline uncontrolled hypertension. Patient-centered chronic care programs for HIV can be leveraged to reduce the overall burden of cardiovascular mortality in SSA. TRIAL REGISTRATION ClinicalTrials.gov NCT01864603.
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Affiliation(s)
- Matthew D. Hickey
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - James Ayieko
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Nicholas Sim
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Laura B. Balzer
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Jane Kabami
- Infectious Disease Research Collaboration, Kampala, Uganda
| | | | - Fredrick J. Opel
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Erick Wafula
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Marilyn Nyabuti
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lillian Brown
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Gabriel Chamie
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Vivek Jain
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - James Peng
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | | | - Carol S. Camlin
- Center for AIDS Prevention Studies & Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies & Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, United States of America
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Moses R. Kamya
- Infectious Disease Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Maya L. Petersen
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Diane V. Havlir
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
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Wudil UJ, Aliyu MH, Prigmore HL, Ingles DJ, Ahonkhai AA, Musa BM, Muhammad H, Sani MU, Nalado AM, Abdu A, Abdussalam K, Shepherd BE, Dankishiya FS, Burgner AM, Ikizler TA, Wyatt CM, Kopp JB, Kimmel PL, Winkler CA, Wester CW. Apolipoprotein-1 risk variants and associated kidney phenotypes in an adult HIV cohort in Nigeria. Kidney Int 2021; 100:146-154. [PMID: 33901548 PMCID: PMC8487768 DOI: 10.1016/j.kint.2021.03.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/17/2022]
Abstract
HIV-positive adults are at risk for various kidney diseases, and apolipoprotein 1 (APOL1) high-risk genotypes increase this risk. This study aimed to determine the prevalence and ethnic distribution of APOL1 risk genotypes among a cohort of HIV-positive Nigerian adults and explore the relationship between APOL1 risk variant status with albuminuria and estimated glomerular filtration rate (eGFR). We conducted a cross-sectional study among 2 458 persons living with HIV who attended an HIV clinic in northern Nigeria and had received antiretroviral therapy for a minimum of six months. We collected two urine samples four-eight weeks apart to measure albumin excretion, and blood samples to measure eGFR and determine APOL1 genotype. The frequency of APOL1 high-risk genotype was 6.2%, which varied by ethnic group: Hausa/Fulani (2.1%), Igbo (49.1%), and Yoruba (14.5%). The prevalence of microalbuminuria (urine/albumin creatinine ratio 30- 300 mg/g) was 37%, and prevalence of macroalbuminuria (urine/albumin creatinine ratio over 300 mg/g) was 3%. The odds of microalbuminuria and macroalbuminuria were higher for participants with the APOL1 high-risk genotype compared to those carrying the low-risk genotype ([adjusted odds ratio 1.97, 95% confidence interval 1.37-2.82] and [3.96, 1.95-8.02] respectively). APOL1 high-risk genotype participants were at higher risk of having both an eGFR under 60 ml/min/1.73m2 and urine/albumin creatinine ratio over 300 mg/g (5.56, 1.57-19.69). Thus, we found a high proportion of HIV-positive, antiretroviral therapy-experienced, and largely virologically suppressed adults had microalbuminuria. Hence, although the high-risk APOL1 genotype was less prevalent than expected, it was strongly associated with some level of albuminuria.
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Affiliation(s)
- Usman J Wudil
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heather L Prigmore
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donna J Ingles
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aima A Ahonkhai
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Baba M Musa
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria; Africa Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
| | - Hamza Muhammad
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mahmoud U Sani
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aisha M Nalado
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aliyu Abdu
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Kabiru Abdussalam
- Department of Chemical Pathology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Anna M Burgner
- Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - T Alp Ikizler
- Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christina M Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jeffrey B Kopp
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Paul L Kimmel
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Cheryl A Winkler
- Basic Research Laboratory, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - C William Wester
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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13
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Adeyemi O, Lyons M, Njim T, Okebe J, Birungi J, Nana K, Claude Mbanya J, Mfinanga S, Ramaiya K, Jaffar S, Garrib A. Integration of non-communicable disease and HIV/AIDS management: a review of healthcare policies and plans in East Africa. BMJ Glob Health 2021; 6:bmjgh-2020-004669. [PMID: 33947706 PMCID: PMC8098934 DOI: 10.1136/bmjgh-2020-004669] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/27/2021] [Accepted: 04/02/2021] [Indexed: 01/08/2023] Open
Abstract
Background Low-income and middle-income countries are struggling to manage growing numbers of patients with chronic non-communicable diseases (NCDs), while services for patients with HIV infection are well established. There have been calls for integration of HIV and NCD services to increase efficiency and improve coverage of NCD care, although evidence of effectiveness remains unclear. In this review, we assess the extent to which National HIV and NCD policies in East Africa reflect the calls for HIV-NCD service integration. Methods Between April 2018 and December 2020, we searched for policies, strategies and guidelines associated with HIV and NCDs programmes in Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. Documents were searched manually for plans for integration of HIV and NCD services. Data were analysed qualitatively using document analysis. Results Thirty-one documents were screened, and 13 contained action plans for HIV and NCDs service integration. Integrated delivery of HIV and NCD care is recommended in high level health policies and treatment guidelines in four countries in the East African region; Kenya, Rwanda, Tanzania and Uganda, mostly relating to integrating NCD care into HIV programmes. The increasing burden of NCDs, as well as a move towards person-centred differentiated delivery of services for people living with HIV, is a factor in the recent adoption of integrated HIV and NCD service delivery plans. Both South Sudan and Burundi report a focus on building their healthcare infrastructure and improving coverage and quality of healthcare provision, with no reported plans for HIV and NCD care integration. Conclusion Despite the limited evidence of effectiveness, some East African countries have already taken steps towards HIV and NCD service integration. Close monitoring and evaluation of the integrated HIV and NCD programmes is necessary to provide insight into the associated benefits and risks, and to inform future service developments.
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Affiliation(s)
- Olukemi Adeyemi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mary Lyons
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tsi Njim
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joseph Okebe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Kevin Nana
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Sayoki Mfinanga
- Muhimbili Medical Research Centre, National Institute of Medical Research, Dar es Salaam, United Republic of Tanzania
| | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania
| | - Shabbar Jaffar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Anupam Garrib
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Global burden of hypertension among people living with HIV in the era of increased life expectancy: a systematic review and meta-analysis. J Hypertens 2021; 38:1659-1668. [PMID: 32371769 DOI: 10.1097/hjh.0000000000002446] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although HIV infection and antiretroviral therapy (ART) increase the risk for hypertension in people living with HIV (PLHIV), the global and regional burden of hypertension in PLHIV is not well characterized. METHODS In this systematic review and meta-analysis, we searched multiple databases for studies reporting on hypertension in PLHIV and conducted between 2007 and 2018. Meta-analysis through random-effect models served to obtain the pooled prevalence estimates. Heterogeneity was assessed via the χ test on Cochran's Q statistic. RESULTS We included 194 studies (396 776 PLHIV from 61 countries). The global prevalence of hypertension was 23.6% [95% confidence interval (95% CI: 21.6-25.5)] with substantial heterogeneity. The regional distribution was Western and Central Europe and North America [28.1% (95% CI: 24.5-31.9)], West and Central Africa [23.5% (16.6-31.0)], Latin America and the Caribbean [22.0% (17.8-26.5)], Eastern and Southern Africa [19.9% (17.2-22.8)], and Asia and Pacific [16.5% (12.5-21.0)]; P = 0.0007. No study originated from the Middle East and North Africa, and Eastern Europe and Central Asia regions. The prevalence was higher in high-income countries than others (P = 0.0003) and higher in PLHIV taking ART than those ART-naive (P = 0.0003). The prevalence increased over time (mainly driven by Eastern and Southern Africa) and with age. There was no difference between men and women. We estimated that in 2018, there were 8.9 (95% CI: 8.3-9.6) million cases of hypertension in PLHIV globally, among whom 59.2% were living in Sub-Saharan Africa. CONCLUSION Cost-effective strategies to curb the dreadful burden of hypertension among PLHIV are needed.
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Kintu A, Sando D, Okello S, Mutungi G, Guwatudde D, Menzies NA, Danaei G, Verguet S. Integrating care for non-communicable diseases into routine HIV services: key considerations for policy design in sub-Saharan Africa. J Int AIDS Soc 2021; 23 Suppl 1:e25508. [PMID: 32562370 PMCID: PMC7305410 DOI: 10.1002/jia2.25508] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION There is great interest for integrating care for non-communicable diseases (NCDs) into routine HIV services in sub-Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the general population. We summarize opportunities and challenges related to leveraging HIV treatment platforms to address NCDs among PLHIV. We emphasize key considerations that can guide integrated care in SSA and point to possible interventions for implementation. DISCUSSION Integrating care offers an opportunity for effective delivery of NCD services to PLHIV, but may be viewed to unfairly ignore the larger number of NCD cases in the general population. Integration can also help maintain the substantial health and economic benefits that have been achieved by the global HIV/AIDS response. Implementing interventions for integrated care will require assessing the prevalence of common NCDs among PLHIV, which can be achieved via increased screening during routine HIV care. Successful integration will also necessitate earmarking funds for NCD interventions in national budgets. CONCLUSIONS An expanded agenda for addressing HIV-NCD comorbidities in SSA may require adding selected NCDs to conditions that are routinely monitored in PLHIV. Attention should be given to mitigating potential tradeoffs in the quality of HIV services that may result from the extra responsibilities borne by HIV health workers. Integrated care will more likely be effective in the context of concurrent health system reforms that address NCDs in the general population, and with synergies with other HIV investments that have been used to strengthen health systems.
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Affiliation(s)
- Alexander Kintu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David Sando
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Gerald Mutungi
- Department of Non-Communicable Diseases Prevention and Control, Ministry of Health, Kampala, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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16
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Ehrenkranz P, Grimsrud A, Holmes CB, Preko P, Rabkin M. Expanding the Vision for Differentiated Service Delivery: A Call for More Inclusive and Truly Patient-Centered Care for People Living With HIV. J Acquir Immune Defic Syndr 2021; 86:147-152. [PMID: 33136818 PMCID: PMC7803437 DOI: 10.1097/qai.0000000000002549] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Simplifying antiretroviral therapy for clinically stable people living with HIV (PLHIV) is important but insufficient to meet their health care needs, including prevention and treatment of tuberculosis and noncommunicable diseases, routine primary care, and family planning. Integrating these services into differentiated service delivery (DSD) platforms is a promising avenue to achieve such coverage. We propose a transition from an HIV-focused "DSD 1.0" to a patient-centered "DSD 2.0" that is inclusive of additional chronic care services for PLHIV. DISCUSSION The lack of coordination between HIV programs and these critical services puts a burden on both PLHIV and health systems. For individual patients, fractionated services increase cost and time, diminish the actual and perceived quality of care, and increase the risk that they will disengage from health care altogether. The burden on the health system is one of inefficiency and suboptimal outcomes resulting from the parallel systems required to manage multiple vertical programs. CONCLUSIONS DSD 2.0 provides an opportunity for the HIV and Universal Health Coverage agendas-which can seem to be at odds-to achieve greater collective impact for patients and health systems by integrating strong vertical HIV, tuberculosis and family planning programs, and relatively weaker noncommunicable disease programs. Increasing coordination of care for PLHIV will increase the likelihood of achieving and sustaining UNAIDS' goals of retention on antiretroviral therapy and viral suppression. Eventually, this shift to DSD 2.0 for PLHIV could evolve to a more person-centered vision of chronic care services that would also serve the general population.
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Affiliation(s)
| | - Anna Grimsrud
- HIV Programmes & Advocacy, International AIDS Society, Cape Town, South Africa
| | - Charles B. Holmes
- Center for Innovation in Global Health, Georgetown University, Washington, DC
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17
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Chamie G, Hickey MD, Kwarisiima D, Ayieko J, Kamya MR, Havlir DV. Universal HIV Testing and Treatment (UTT) Integrated with Chronic Disease Screening and Treatment: the SEARCH study. Curr HIV/AIDS Rep 2020; 17:315-323. [PMID: 32507985 DOI: 10.1007/s11904-020-00500-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The growing burden of untreated chronic disease among persons with HIV (PWH) threatens to reverse heath gains from ART expansion. Universal test and treat (UTT)'s population-based approach provides opportunity to jointly identify and treat HIV and other chronic diseases. This review's purpose is to describe SEARCH UTT study's integrated disease strategy and related approaches in Sub-Saharan Africa. RECENT FINDINGS In SEARCH, 97% of adults were HIV tested, 85% were screened for hypertension, and 79% for diabetes at health fairs after 2 years, for an additional $1.16/person. After 3 years, population-level hypertension control was 26% higher in intervention versus control communities. Other mobile/home-based multi-disease screening approaches have proven successful, but data on multi-disease care delivery are extremely limited and show little effect on clinical outcomes. Integration of chronic disease into HIV in the UTT era is feasible and can achieve population level effects; however, optimization and implementation remain a huge unmet need.
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Affiliation(s)
- Gabriel Chamie
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA.
| | - Matthew D Hickey
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA
| | | | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane V Havlir
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA
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18
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Reijer J. Employment trajectories of PLHIV on ART in Lusaka, Zambia: a short report. AIDS Care 2020; 33:693-696. [PMID: 32808538 DOI: 10.1080/09540121.2020.1808162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The introduction of antiretroviral therapy (ART) has helped mitigate many of the negative consequences of HIV. ART allows people living with HIV (PLHIV) to recover physically and become active members of society. Research thus far is positive about the potential economic impact of ART on household economies. In terms of employment, studies indicate that ART, when initiated early in disease progression, allows PLHIV to maintain their employment and, when initiated late in disease progression, allows PLHIV to return to work once they physically recover. This paper questions the latter by demonstrating that while the employment levels indeed return to normal or baseline levels, the type of employment that PLHIV obtain has undergone a shift. It demonstrates that the type of employment PLHIV are engaged in once they recover is largely less stable and less profitable than what they were doing prior to illness. It additionally demonstrates that PLHIV are engaged in work that is less stable and less profitable than their HIV-negative counterparts. I conclude that a closer inspection of the type of employment that PLHIV are engaged in is needed to provide a more accurate understanding of the impact of ART on the socio-economic status of PLHIV on ART.
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Affiliation(s)
- Josien Reijer
- Department of Sociology & Department of Philosophy, University of Johannesburg, Johannesburg, South Africa
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19
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Achwoka D, Mutave R, Oyugi JO, Achia T. Tackling an emerging epidemic: the burden of non-communicable diseases among people living with HIV/AIDS in sub-Saharan Africa. Pan Afr Med J 2020; 36:271. [PMID: 33088400 PMCID: PMC7546015 DOI: 10.11604/pamj.2020.36.271.22810] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022] Open
Abstract
Sub-Saharan Africa (SSA) is at a crossroad. Over the last decade, successes in the scale up of HIV care and treatment programs has led to a burgeoning number of people living with HIV (PLHIV) in care. At the same time, an epidemiologic shift has been witnessed with a concomitant rise in non-communicable diseases (NCD) related morbidity and mortality. Against low levels of domestic financing and strained healthcare delivery platforms, the NCD-HIV syndemic threatens to reverse gains made in care of people living with HIV (PLHIV). NCDs are the global health disruptor of the future. In this review, we draw three proposals for low and middle-income countries (LMICs) based on existing literature, that if contextually adopted would mitigate against impending poor NCD-HIV care outcomes. First, we call for an adoption of universal health coverage by countries in SSA. Secondly, we recommend leveraging on comparably formidable HIV healthcare delivery platforms through integration. Lastly, we advocate for institutional-response building through a multi-stakeholder governance and coordination mechanism. Based on our synthesis of existing literature, adoption of these three strategies would be pivotal to sustain gains made so far for NCD-HIV care in SSA.
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Affiliation(s)
- Dunstan Achwoka
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), College of Health Sciences, Nairobi, Kenya
| | - Regina Mutave
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), College of Health Sciences, Nairobi, Kenya
| | - Julius Otieno Oyugi
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), College of Health Sciences, Nairobi, Kenya.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Thomas Achia
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), College of Health Sciences, Nairobi, Kenya.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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20
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Nurses' perceptions on implementing a task-shifting/sharing strategy for hypertension management in patients with HIV in Nigeria: a group concept mapping study. Implement Sci Commun 2020; 1:58. [PMID: 32885213 PMCID: PMC7427907 DOI: 10.1186/s43058-020-00048-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background People living with HIV (PWH) in Africa have higher burden of cardiovascular diseases (CVD) compared to the general population, probably due to increased burden of hypertension (HTN). In this study, we explored nurses’ perceptions of factors that may influence the integration of an evidence-based task-shifting/sharing strategy for hypertension control (TASSH) into routine HIV care in Lagos, Nigeria. Methods Using group concept mapping, we examined the perceptions of 22 nurses from HIV clinics in Lagos. Participants responded to a focused prompt on the barriers and facilitators of integrating TASSH into HIV care; next, separate focus groups generated relevant statements on these factors; and statements were then sorted and rated on their importance and feasibility of adoption to create cluster maps of related themes. The statements and cluster maps were categorized according to the Consolidated Framework for Implementation Research (CFIR) domains. Results All study participants were women and with 2 to 16 years’ experience in the provision of HIV care. From the GCM activities, 81 statements were generated and grouped into 12 themes. The most salient statements reflected the need for ongoing training of HIV nurses in HTN management and challenges in adapting TASSH in HIV clinics. A synthesis of the cluster themes using CFIR showed that most clusters reflected intervention characteristics and inner setting domains. The potential challenges to implementing TASSH included limited hypertension knowledge among HIV nurses and the need for on-going supervision on implementing task-shifting/sharing. Conclusions Findings from this study illustrate a variety of opinions regarding the integration of HTN management into HIV care in Nigeria. More importantly, it provides critical, evidence-based support in response to the call to action raised by the 2018 International AIDS Society Conference regarding the need to implement more NCD-HIV integration interventions in low-and middle-income countries through strategies, which enhance human resources. This study provides insight into factors that can facilitate stakeholder engagement in utilizing study results and prioritizing next steps for TASSH integration within HIV care in Nigeria.
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21
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Frieden M, Zamba B, Mukumbi N, Mafaune PT, Makumbe B, Irungu E, Moneti V, Isaakidis P, Garone D, Prasai M. Setting up a nurse-led model of care for management of hypertension and diabetes mellitus in a high HIV prevalence context in rural Zimbabwe: a descriptive study. BMC Health Serv Res 2020; 20:486. [PMID: 32487095 PMCID: PMC7268639 DOI: 10.1186/s12913-020-05351-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 05/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background In the light of the increasing burden of non-communicable diseases (NCDs) on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, context-adapted, cost-effective service delivery models are now required as a matter of urgency. We describe the experience of setting up and organising a nurse-led Diabetes Mellitus (DM) and Hypertension (HTN) model of care in rural Zimbabwe, a low-income country with unique socio-economic challenges and a dual disease burden of HIV and NCDs. Methods Mirroring the HIV experience, we designed a conceptual framework with 9 key enablers: decentralization of services, integration of care, simplification of management guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system. We selected 9 primary health care clinics (PHC) and two hospitals in Chipinge district and integrated DM and HTN either into the general out-patient department, pre-existing HIV clinics, or an integrated chronic care clinic (ICCC). We provided structured intensive mentoring for staff, using simplified protocols, and disease-specific education for patients. Free medication with differentiated periodic refills and regular monitoring with point of care (POC) glycosylated haemoglobin (HbA1c) were provided. Results Nurses in 7 PHC facilities and one hospital developed sufficient knowledge and skills to diagnose, initiate treatment and monitor DM and HTN patients, and 3094 patients were registered in the programme (188 with DM only, 2473 with HTN only, 433 with both DM and HTN). Major lessons learned from our experience include: the value of POC devices in the management of diabetes; the pressure on services of the added caseload, exacerbated by the availability of free medications in supported health facilities; and the importance of leadership in the successful implementation of care in health facilities. Conclusion Our experience demonstrates a model for nurse-led decentralized integrated DM and HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted efficient model of care is a dynamic process. We present our lessons learned with the intention of sharing experience which may be of value to other public health programme managers.
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Affiliation(s)
- Marthe Frieden
- Médecins Sans Frontières, 7 Bougainvillea close, Palmerstone, Mutare, Zimbabwe.
| | | | - Nisbert Mukumbi
- Médecins Sans Frontières, 7 Bougainvillea close, Palmerstone, Mutare, Zimbabwe
| | | | - Brian Makumbe
- Ministry of Health and Child Care, Manicaland, Zimbabwe
| | - Elizabeth Irungu
- Médecins Sans Frontières, 7 Bougainvillea close, Palmerstone, Mutare, Zimbabwe
| | - Virginia Moneti
- Médecins Sans Frontières, 7 Bougainvillea close, Palmerstone, Mutare, Zimbabwe
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22
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Bigna JJ, Noubiap JJ. The rising burden of non-communicable diseases in sub-Saharan Africa. LANCET GLOBAL HEALTH 2020; 7:e1295-e1296. [PMID: 31537347 DOI: 10.1016/s2214-109x(19)30370-5] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, PO Box 1274, Yaoundé, Cameroon; School of Public Health, Faculty of Medicine, University of Paris Saclay, Saint-Quentin-en-Yvelines, France.
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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23
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Muddu M, Tusubira AK, Sharma SK, Akiteng AR, Ssinabulya I, Schwartz JI. Integrated Hypertension and HIV Care Cascades in an HIV Treatment Program in Eastern Uganda: A Retrospective Cohort Study. J Acquir Immune Defic Syndr 2020; 81:552-561. [PMID: 31045649 DOI: 10.1097/qai.0000000000002067] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Persons living with HIV (PLHIV) are at increased risk of cardiovascular disease. Integration of services for hypertension (HTN), the primary cardiovascular disease risk factor, into HIV care programs is recommended in Uganda, though, uptake has been limited. We sought to compare the care cascades for HTN and HIV within an HIV program in Eastern Uganda. METHODS We conducted a retrospective cohort study of all PLHIV enrolled in 3 HIV clinics between 2014 and 2017. We determined the proportion of patients in the following cascade steps over 12 months: Screened, Diagnosed, Initiated on treatment, Retained, Monitored, and Controlled. Cascades were analyzed using descriptive statistics and compared using χ and t tests. RESULTS Of 1649 enrolled patients, 98.5% were initiated on HIV treatment, of whom 70.7% were retained in care, 100% had viral load monitoring, and 90.3% achieved control (viral suppression). Four hundred fifty-six (27.7%) participants were screened for HTN, of whom 46.9% were diagnosed, 88.1% were initiated on treatment, 57.3% were retained in care, 82.7% were monitored, and 24.3% achieved blood pressure control. There were no differences in any HIV cascade step between participants with HIV alone and those with both conditions. CONCLUSIONS The HIV care cascade approached global targets, whereas the parallel HTN care cascade demonstrated notable quality gaps. Management of HTN within this cohort did not negatively impact HIV care. Our findings suggest that models of integration should focus on screening PLHIV for HTN and retention and control of those diagnosed to fully leverage the successes of HIV programs.
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Affiliation(s)
- Martin Muddu
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Andrew K Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | | | - Ann R Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda.,Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Jeremy I Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda.,Section of General Internal Medicine, Yale School of Medicine, CT
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24
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Safreed-Harmon K, Kall M, Anderson J, Azzopardi-Muscat N, Behrens GMN, d'Arminio Monforte A, Davidovich U, Noori T, Lazarus JV. Ability to Monitor National Responses to the HIV Epidemic "Beyond Viral Suppression": Findings From Six European Countries. Front Public Health 2020; 8:36. [PMID: 32266194 PMCID: PMC7098908 DOI: 10.3389/fpubh.2020.00036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/05/2020] [Indexed: 12/25/2022] Open
Abstract
Objective: With more people living with HIV (PLHIV) ageing into their 50s and beyond in settings where antiretroviral therapy is widely available, non-AIDS comorbidities and health-related quality of life (HRQoL) are becoming major challenges. Information is needed about whether national HIV monitoring programmes have evolved to reflect the changing focus of HIV care. Methods: We created a 56-item English-language survey to assess whether health systems report on common health-related issues for people with HIV including physical and mental health comorbidities, HRQoL, psychosocial needs, and fertility desires. One expert was identified via purposive sampling in each of six countries (Estonia, Italy, the Netherlands, Slovenia, Sweden, and Turkey) and was asked to participate in the survey. Results: Three respondents reported that the current monitoring systems in their countries do not monitor any of four specified aspects of 10 comorbidities including bone loss, cardiovascular disease, and neurocognitive disorders. Two respondents stated that their countries potentially can report on leading causes of hospital admission among PLHIV, and five on leading cases of death. In three countries, respondents reported that there was the ability to report on the HRQoL of PLHIV. In two countries, respondents provided data on the percentage of PLHIV denied health services because of HIV status in the past 12 months. Conclusions: This study identified areas for potential HIV monitoring improvements in six European countries in relation to comorbidities, HRQoL, discrimination within health systems, and other issues associated with the changing nature of the HIV epidemic. It also indicated that some countries either currently monitor or have the ability to monitor some of these issues. There are opportunities for health information systems in European countries to expand the scope of their HIV monitoring in order to support decision-making about how the long-term health-related needs of PLHIV can best be met.
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Affiliation(s)
- Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Meaghan Kall
- Public Health England, National Infection Service, London, United Kingdom
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, Jonathan Mann Clinic, London, United Kingdom
| | - Natasha Azzopardi-Muscat
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Georg M N Behrens
- Department for Clinical Immunology and Rheumatology, Hannover Medical School, Hanover, Germany
| | - Antonella d'Arminio Monforte
- Institute of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e VCarlo, University of Milan, Milan, Italy
| | - Udi Davidovich
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands.,Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AIII), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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25
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Aifah A, Okeke NL, Rentrope CR, Schexnayder J, Bloomfield GS, Bosworth H, Grover K, Hileman CO, Muiruri C, Oakes M, Webel AR, Longenecker CT, Vedanthan R. Use of a human-centered design approach to adapt a nurse-led cardiovascular disease prevention intervention in HIV clinics. Prog Cardiovasc Dis 2020; 63:92-100. [PMID: 32092444 PMCID: PMC7237285 DOI: 10.1016/j.pcad.2020.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
Stakeholder-informed strategies addressing cardiovascular disease (CVD) burden among people living with HIV (PWH) are needed within healthcare settings. This study provides an assessment of how human-centered design (HCD) guided the adaptation of a nurse-led intervention to reduce CVD risk among PWH. Using a HCD approach, research staff guided two multidisciplinary "design teams" in Ohio and North Carolina, with each having five HCD meetings. We conducted acceptability and feasibility testing. Six core recommendations were produced by two design teams of key stakeholders and further developed after the acceptability and feasibility testing to produce a final list of 14 actionable areas of adaptation. Acceptability and feasibility testing revealed areas for adaptation, e.g. patient preferences for communication and the benefit of additional staff to support patient follow-up. In conclusion, along with acceptability and feasibility testing, HCD led to the production of 14 key recommendations to enhance the effectiveness and scalability of an integrated HIV/CVD intervention.
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Affiliation(s)
- Angela Aifah
- New York University Grossman School of Medicine, United States of America.
| | | | - Cynthia R Rentrope
- Frances Payne Bolton School of Nursing, Case Western Reserve University, United States of America
| | - Julie Schexnayder
- Frances Payne Bolton School of Nursing, Case Western Reserve University, United States of America
| | | | - Hayden Bosworth
- Duke University School of Medicine, United States of America; Durham VA Medical Center, United States of America
| | - Kiran Grover
- Duke University School of Medicine, United States of America
| | - Corrilynn O Hileman
- Case Western Reserve University School of Medicine, United States of America; MetroHealth Medical Center, United States of America
| | - Charles Muiruri
- Duke University School of Medicine, United States of America
| | - Megan Oakes
- Duke University School of Medicine, United States of America; Durham VA Medical Center, United States of America
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, United States of America
| | - Chris T Longenecker
- Case Western Reserve University School of Medicine, United States of America; University Hospitals Harrington Heart & Vascular Institute, United States of America
| | - Rajesh Vedanthan
- New York University Grossman School of Medicine, United States of America
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26
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Young CR, Arnos DM, Matthews LT. A scoping review of interventions to address intimate partner violence in sub-Saharan African healthcare. Glob Public Health 2019; 14:1335-1346. [PMID: 30648466 PMCID: PMC6635092 DOI: 10.1080/17441692.2019.1567802] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
Intimate partner violence (IPV) is a widespread global health problem, with negative effects on women's health and HIV transmission and treatment. There is little evidence on how to address IPV effectively in lower-resourced healthcare settings, particularly those that are impacted by significant HIV epidemics. We conducted a scoping review to provide an overview of the literature on IPV screening and intervention programmes in sub-Saharan African healthcare. The included studies used mainly qualitative methods. We identified five main themes: the acceptability to female clients, the importance of confidentiality, provider concerns, barriers due to gender norms, and need for referrals and comprehensive services. Research in this field is limited, and a robust research agenda is needed to provide effective IPV interventions for women seeking healthcare in sub-Saharan Africa.
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Affiliation(s)
- Cynthia R. Young
- Division of Women’s Health, Brigham and Women’s Hospital, 1620 Tremont St, Boston, MA 02120
| | - Diane M. Arnos
- The Urban Institute, 2100 M Street NW, Washington, DC 20037
| | - Lynn T. Matthews
- Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Boston, MA 02114
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27
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Abstract
OBJECTIVE Causes of morbidity and mortality of people living with HIV are changing with access to antiretroviral therapy and increased life expectancy. Age-related data on comorbidities and their impact on mortality in sub-Saharan Africa are scarce. DESIGN This prospective analysis evaluated comorbidities, assessed by means of International Classification of Diseases and Related Health problems 10th revision codes and clinical variables, derived from data collected from the Kilombero & Ulanga antiretroviral cohort of people living with HIV in rural Tanzania. METHODS We calculated prevalences and incidences of comorbidities in patients enrolled from 2013 to 2017 and evaluated their association with a combined endpoint of death and loss to follow-up (LTFU) in various age groups (15-29, 30-49 and ≥50 years) using Cox regression analysis. RESULTS Of 1622 patients [65% females, median age 38 years (interquartile range 31-46)], 11% were at least 50 years. During a median follow-up of 22.1 months (interquartile range 10.6-37.3), 48 (2.9%) patients died and 306 (18.9%) were LTFU. Anaemia was the most prevalent comorbidity (66.3%) irrespective of age and was associated with increased mortality/LTFU [hazard ratios 2.02 (95% confidence interval (CI) 1.57-2.60); P < 0.001]. In patients aged at least 50 years, arterial hypertension was highly prevalent (43.8%), but not associated with mortality/LTFU [hazard ratios 1.04 (95% CI 0.56-1.93), P = 0.9]. Undernutrition ranged from 25.5% in the youngest to 29.1% in the oldest age group and contributed to mortality/LTFU [hazard ratios 2.24 (95% CI 1.65-3.04); P < 0.001]. Prevalence of tuberculosis was 21.4% with hazard ratios of 2.54 (95% CI 1.72-3.75, P < 0.001) for mortality/LTFU. CONCLUSION We show that anaemia, arterial hypertension and undernutrition are the most relevant comorbidities with different age-associated frequencies and impact on death/LTFU in this population.
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Achwoka D, Waruru A, Chen TH, Masamaro K, Ngugi E, Kimani M, Mukui I, Oyugi JO, Mutave R, Achia T, Katana A, Ng’ang’a L, De Cock KM. Noncommunicable disease burden among HIV patients in care: a national retrospective longitudinal analysis of HIV-treatment outcomes in Kenya, 2003-2013. BMC Public Health 2019; 19:372. [PMID: 30943975 PMCID: PMC6448214 DOI: 10.1186/s12889-019-6716-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/27/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Over the last decade, the Kenyan HIV treatment program has grown exponentially, with improved survival among people living with HIV (PLHIV). In the same period, noncommunicable diseases (NCDs) have become a leading contributor to disease burden. We sought to characterize the burden of four major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) among adult PLHIV in Kenya. METHODS We conducted a nationally representative retrospective medical chart review of HIV-infected adults aged ≥15 years enrolled in HIV care in Kenya from October 1, 2003 through September 30, 2013. We estimated proportions of four NCD categories among PLHIV at enrollment into HIV care, and during subsequent HIV care visits. We compared proportions and assessed distributions of co-morbidities using the Chi-Square test. We calculated NCD incidence rates and their confidence intervals in assessing cofactors for developing NCDs. RESULTS We analyzed 3170 records of HIV-infected patients; 2115 (66.3%) were from women. Slightly over half (51.1%) of patient records were from PLHIVs aged above 35 years. Close to two-thirds (63.9%) of PLHIVs were on ART. Proportion of any documented NCD among PLHIV was 11.5% (95% confidence interval [CI] 9.3, 14.1), with elevated blood pressure as the most common NCD 343 (87.5%) among PLHIV with a diagnosed NCD. Despite this observation, only 17 (4.9%) patients had a corresponding documented diagnosis of hypertension in their medical record. Overall NCD incidence rates for men and women were (42.3 per 1000 person years [95% CI 35.8, 50.1] and 31.6 [95% CI 27.7, 36.1], respectively. Compared to women, the incidence rate ratio for men developing an NCD was 1.3 [95% CI 1.1, 1.7], p = 0.0082). No differences in NCD incidence rates were seen by marital or employment status. At one year of follow up 43.8% of PLHIV not on ART had been diagnosed with an NCD compared to 3.7% of patients on ART; at five years the proportions with a diagnosed NCD were 88.8 and 39.2% (p < 0.001), respectively. CONCLUSIONS: PLHIV in Kenya have a high prevalence of NCD diagnoses. In the absence of systematic, effective screening, NCD burden is likely underestimated in this population. Systematic screening and treatment for NCDs using standard guidelines should be integrated into HIV care and treatment programs in sub-Saharan Africa.
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Affiliation(s)
- Dunstan Achwoka
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Anthony Waruru
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Tai-Ho Chen
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Kenneth Masamaro
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Evelyn Ngugi
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Maureen Kimani
- National AIDS and STI Control Program (NASCOP), Ministry of Health, Nairobi, Kenya
| | - Irene Mukui
- National AIDS and STI Control Program (NASCOP), Ministry of Health, Nairobi, Kenya
| | - Julius O. Oyugi
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), Nairobi, Kenya
| | - Regina Mutave
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), Nairobi, Kenya
| | - Thomas Achia
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Lucy Ng’ang’a
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Kevin M. De Cock
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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Drain PK, Hong T, Hajat A, Krows M, Govere S, Thulare H, Moosa MYS, Bassett I, Celum C. Integrating hypertension screening at the time of voluntary HIV testing among adults in South Africa. PLoS One 2019; 14:e0210161. [PMID: 30735518 PMCID: PMC6368277 DOI: 10.1371/journal.pone.0210161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 12/18/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Guidelines recommend integrating hypertension screening for HIV-infected adults, but blood pressure measurements may be dynamic around the time of HIV testing. METHODS We measured a seated resting blood pressure in adults (≥18 years) prior to HIV testing, and again after receiving HIV test results, in an ambulatory HIV clinic in KwaZulu-Natal, South Africa. We assessed sociodemographics, smoking, body mass index, diabetes, substance abuse, and anxiety/depression. We used blood pressure categories defined by the Seventh Joint National Committee (JNC 7) classifications, which includes normal, pre-hypertension, stage 1 hypertension, and stage 2 hypertension. RESULTS Among 5,428 adults, mean age was 31 years, 51% were male, and 35% tested HIV-positive. Before HIV testing, 47% (2,634) had a normal blood pressure, 40% (2,225) had prehypertension, and 10% (569) had stage 1 or 2 hypertension. HIV-infected adults had significantly lower blood pressure measurements and less hypertension, as compared to HIV-negative adults before HIV testing; while also having significantly elevated blood pressures after HIV testing. In a multivariable model, HIV-infected adults had a 30% lower odds of hypertension, compared to HIV-uninfected adults (aOR = 0.70, 95% CI: 0.57-0.85). In a separate multivariable model, HIV-infected adults with CD4 ≤200 cells/mm3 had a 44% lower odds of hypertension (aOR = 0.56, 95% CI: 0.38-0.83), as compared to adults with CD4 >200 cells/mm3. The mean arterial blood pressure was 6.5 mmHg higher among HIV-infected adults after HIV testing (p <0.001). CONCLUSIONS HIV-infected adults experienced a transient blood pressure increase after receiving HIV results. Blood pressure measurements may be more accurate before HIV testing and repeated blood pressure measurements are recommended after ART initiation before formally diagnosing hypertension in HIV-infected adults.
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Affiliation(s)
- Paul K. Drain
- Department of Global Health, University of Washington, Seattle, United States of America
- Department of Medicine, University of Washington, Seattle, United States of America
- Department of Epidemiology, University of Washington, Seattle, United States of America
| | - Ting Hong
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, United States of America
| | - Meighan Krows
- Department of Global Health, University of Washington, Seattle, United States of America
| | | | | | | | - Ingrid Bassett
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, United States of America
- Department of Medicine, University of Washington, Seattle, United States of America
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Knight L, Schatz E, Mukumbang FC. "I attend at Vanguard and I attend here as well": barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases. Int J Equity Health 2018; 17:147. [PMID: 30227859 PMCID: PMC6145370 DOI: 10.1186/s12939-018-0863-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/03/2018] [Indexed: 12/22/2022] Open
Abstract
Background HIV and non-communicable disease (NCD) are syndemic within sub-Saharan Africa especially among older persons. The two epidemics interact with one another within a context of poverty, inequality and inequitable access to healthcare resulting in an increase in those aged 50 and older living with HIV and experiencing an NCD co-morbidity. We explore the challenges of navigating healthcare for older persons living with HIV and NCD co-morbidity. Methods In-depth semi-structured interviews were conducted with a small sample of older persons living with HIV (OPLWH). The perspectives of key informants were also sought to triangulate the evidence of OPLWH. The research took place in two communities on the outskirts of Cape Town, South Africa. All interviews were conducted by a trained interviewer and transcribed and translated for analysis. Thematic content analysis guided data analysis. Results OPLWH experienced an HIV-NCD syndemic. Our respondents sought care and accessed treatment for both HIV and other chronic (and acute) conditions, though these services were provided at different health facilities or by different health providers. Through the syndemic theory, it is possible to observe that OPLWH and NCDs face a number of physical and structural barriers to accessing the healthcare system. These barriers are compounded by separate appointments and spaces for each condition. These difficulties can exacerbate the impact of their ill-health and perpetuate structural vulnerabilities. Despite policy changes towards integrated care, this is not the experience of OPLWH in these communities. Conclusions The population living with HIV is aging increasing the likelihood that those living with HIV will also be living with other chronic conditions including NCDs. Thus, it is essential that health policy address this basic need to integrate HIV and NCD care.
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Affiliation(s)
- Lucia Knight
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa.
| | - Enid Schatz
- Department of Health Sciences and Department of Women's & Gender Studies, University of Missouri, Columbia, Missouri, USA
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa
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Vorkoper S, Kupfer LE, Anand N, Patel P, Beecroft B, Tierney WM, Ferris R, El-Sadr WM. Building on the HIV chronic care platform to address noncommunicable diseases in sub-Saharan Africa: a research agenda. AIDS 2018; 32 Suppl 1:S107-S113. [PMID: 29952796 DOI: 10.1097/qad.0000000000001898] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The remarkable progress made in confronting the global HIV epidemic offers a unique opportunity to address the increasing threat of noncommunicable diseases (NCDs). However, questions remain about how to enhance the HIV platforms to deliver integrated HIV and NCD care to people living with HIV (PLHIV) in sub-Saharan Africa (SSA). We aimed to develop a priority research agenda to advance this effort. METHODS Researchers, policymakers, and implementers from the United States and SSA conducted three scoping reviews on HIV/NCD prevention and care focused on clinical, health system, and community levels. Based on the review findings and expert inputs, we conducted iterative consensus-development activities to generate a prioritized research agenda. RESULTS Population-level data on NCD prevalence among PLHIV in SSA are sparse. The review identified NCD screening and management approaches that could be integrated into HIV programs in SSA. However, few studies focused on the effectiveness, cost, and best practices for integrated chronic care platforms, making it difficult to derive policy recommendations. To address these gaps, we propose a prioritized research agenda focused on developing evidence-based service delivery models, increasing human capacity through workforce education, generating data through informatics platforms and research, managing the medication supply chain, developing new financing and sustainability models, advancing research-informed policy, and addressing other crosscutting health system issues. CONCLUSION Based on collaborative, interdisciplinary efforts, a research agenda was developed to provide guidance that advances efforts to adapt the current health system to deliver integrated chronic care for PLHIV and the population at large.
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