BACKGROUND: Anti-retroviral therapy (ART) has transitioned HIV into a chronic condition, coinciding with a global rise in longevity for people living with HIV (PLHIV) and increased susceptibility to comorbidities. These include cardiovascular diseases (CVDs), depression, cancers, and metabolic conditions like diabetes. The escalating prevalence of non-communicable diseases (NCDs) among PLHIV results from factors like aging, heightened traditional NCD risk, direct HIV-related effects, and exposure to specific antiretrovirals. Our project aims to seamlessly integrate and evaluate CVD risk factors, hypertension, and diabetes prevalence while estimating the 10-year CVD risk among PLHIV under routine programmatic settings.
DESCRIPTION: Initiated in November-2023, this ongoing initiative screens all adult PLHIV aged = 18 years at the ART center. An expert committee established a screening protocol aligned with prevailing national guidelines, and ART center staff received specialized training for streamlining participant flow. PLHIV are screened for CVD risk factors—tobacco use, alcohol consumption, physical inactivity as well as measurements of weight, height, blood pressure, blood glucose, and lipid levels. Utilizing this data, PLHIV are categorized into risk groups using the Framingham risk score, facilitating targeted intervention strategies.
LESSONS LEARNED: Between November-2023 and January-2024, 1,500 adult PLHIV underwent screening. The mean age was 43 (±11) years, with 45.2% belonging to the 30–45 age group; majority being males (64%). Prevalence rates among PLHIV were 37.8% (567/1500) for obesity, 17.8% (266/1500) for hypertension, 10.7% (160/1500) for diabetes, and 55.5% (667/1500) for dyslipidemia. The 10-year CVD risk estimates revealed 69.2% (1026/1482) at low risk, 19.7% (292/1482) at moderate risk, and 11.1% (164/1482) at high risk. Due to this screening initiative, 64.3% (171/266) of hypertensive cases and 22% (35/160) of diabetic cases were newly identified. Age, gender, BMI, alcohol, tobacco, duration of disease were identified as factors significantly associated with an elevated risk for CVD event.(p<0.5).
CONCLUSIONS: Our observations indicate that integration of HIV and NCD services is feasible and enhances accessibility to timely screening and management, potentially reducing mortality in PLHIV. Facilitating integration across national programs and service levels is pivotal for advancing this objective. The results support the inclusion of risk assessments in routine HIV programs, ensuring a comprehensive healthcare approach for PLHIV.