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CVD/HIV Integration Initiative: Kenya Case Study 16 July 2010

CVD/HIV Integration Initiative: Kenya Case Study 16 July 2010. Dr. Frank Mwangemi , Acting Deputy Director, USAID APHIA II Coast, FHI/Kenya Dr. Peter Lamptey , President, Public Health Programs, FHI. Rationale for integration. CVD complications in HIV patients

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CVD/HIV Integration Initiative: Kenya Case Study 16 July 2010

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  1. CVD/HIV Integration Initiative:Kenya Case Study16 July 2010 Dr. Frank Mwangemi, Acting Deputy Director, USAID APHIA II Coast, FHI/Kenya Dr. Peter Lamptey, President, Public Health Programs, FHI

  2. Rationale for integration • CVD complications in HIV patients • Burden of CVD and HIV among developing countries; In Kenya: • HIV prevalence is 7.1%, with 1.5 Million PLWHA, and 390,000 on HAART • NCD contributes to 50% morbidity and 32% mortality (Kenya MOH, 2007) • Opportunity to combine lessons learned in CVD &HIV • Improve efficiency of health care delivery

  3. Objectives of CVD/HIV Integration Pilot • Assess CVD risk factors among: • HIV Counseling & Testing (CT) clients • HIV+ patients in care • HIV+ patients on ART • Provide behavioral and biomedical interventions (on site and/or through referral) • Document and disseminate lessons learned

  4. Start –up activities • Secure funding: FHI seed funding, USAID funding for APHIA II • Involve key MOH officials: NASCOP, provincial and district health officials • Establish partnership with KCS and KNHF • Select, assess & equip the selected facilities • Develop training modules, adopt job aids, develop record forms • Train health care workers & counsellors

  5. Implementation of integrated HIV/CVD services • Launched in September 2009 in 5 sites – Coast and Rift Valley provinces • CVD risk assessment • Behavioural factors: physical activity, diet, tobacco use, etc. • Biological factors • Therapeutic factors • Quarterly monitoring and support supervision by joint MOH/KCS/FHI staff

  6. Benefits of integrating CVD into HIV services • Strengthens the Health System! • Policy: KNASP III • Service Delivery • Health workforce • Health management information system • Supply chain management • Laboratory • Financing • Technical and program management leadership

  7. Demographic characteristics of clients

  8. Risk of high blood pressure according to HIV status (among CT clients) P-value 0.003

  9. Risk of high blood pressure according to duration on ART and HIV status P-value 0.003

  10. Risk of high blood pressure according to ARV regimen P-value 0.000

  11. Risk of elevated blood sugar according to ARV regimen P-value 0.058

  12. Risk of high cholesterol according to ARV regimen P-value 0.917

  13. Conclusions Preliminary assessment suggests: • HIV/CVD integration is feasible • Integration can identify undetected CVD risk factors • Integration can support the prevention and management of CVD risk factors • Routine monitoring of blood pressure should be part of AIDS care and treatment • Further analysis of data to be done • Further operations research and assessment of CVD risks in HIV patients in LMIC is required

  14. Acknowledgements Ministries of Medical Services and Public Health and Sanitation PEPFAR/USAID NASCOP Kenya Cardiac Society (KCS) Health providers at the 5 pilot sites

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