Non-Communicable Diseases: The Unheralded Global Epidemic_Kabore_5.12.11
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  • It is a great pleasure to be part of this distinguished panel and to present make this presentation on behalf of FHI I’d like to recognize my colleague Rebecca Dirks who is also here; and of course all my colleagues from the field who contributed to this effort.
  • The overview of the presentation: I’d like to go quickly over the definition of NCD according to WHO Discuss a bit the rational for integrating NCD and HIV since this is the topic of my presentation Discuss the
  • The World Health Organization (WHO) employs a simple classification that splits all diseases into three groups . Group I encompasses communicable diseases (infectious and parasitic), maternal and perinatal conditions, and nutritional deficiencies. Group II covers NCDs (CVD, cancers, chronic respiratory diseases, neuropsychiatric disorders and other NCD), while Group III is comprised of unintentional injuries and intentional injuries.
  • According to WHO recent global report on NCD in 2010, CVD represent nearly 1/3 of the global mortality It is projected that over the next 20 years, the mortality due to infectious diseases will decline substantially by around 7 millions However the CVD and Cancer death will increase respectively by 6 millions and 4 millions The grey area shows the burden of cardiovascular disease relative to other causes of death. This is compared across high, middle, and low income countries showing the 2004 rates and projections for 2015 and 2030. This projection predicts that if we stay on our current course, deaths due to CVD will increase in low and middle income countries even as other causes of death decline, such as infectious diseases (shown in the bottom in green). CVD is the largest contributor to mortality worldwide, and will continue to dominate mortality trends into the future.
  • Participating in global dialogue, advocacy and knowledge generation and use: IOM meeting where Peter Lamptey participated and generated the report (see in the slide) To contribute to tackling the aforementioned burden, FHI has embarked in design and implementing NCD programs in developing countries including, Ghana, Vietnam, Nigeria, and Kenya. Ghana: CVD prevention, risk assessment, treatment and case in one urban area in Accra and one rural district. The intervention is community-based linked to facility-based In Vietnam, FHI has supported cardiovascular health by collaborating with the Vietnam Committee on Smoking and Health (VINACOSH) on guidelines for establishing smoke-free hospitals. Together with VINACOSH and the Ho Chi Minh Communist Youth Union, we also encourage young people to support tougher tobacco control legislation through a multimedia campaign that includes a website, Click No Smoking , which allows youth to sign a petition supporting passage of Vietnam’s Tobacco Control Law. Murtala Mohammed Specialist Hospital (MMSH) ART: over 5,000 clients enrolled Began in May 2010 Targets all adult HIV+ clients enrolled in care & treatment program at MMSH Screening method combines clinical and laboratory tests
  • Kenya : NCD contributes to 50% morbidity and 32% mortality HIV prevalence at 7.1%, about 390,000 on HAART Integration provides an opportunity to: combine lessons learned in CVD & HIV Improve efficiency of health care delivery
  • In Kenya, in collaboration with the MOH and Kenya Cardiac Society, we introduced the integration of routine screening of CVD risk factors within existing HIV services in 5 facilities. Patients accessing counseling and testing are being screened for behavioral risk factors and biological risk factors, such as raised blood pressure, overweight and obesity, cholesterol, and diabetes. Patients in care and treatment are screened for behavioral and therapeutic factors, including type of HAART regimen and duration of therapy. Appropriate behavioral and biomedical interventions and referrals are being provided to patients at risk or suffering from CVD
  • Training session in Kenya.
  • This graph presents the blood pressure among HIV-, HIV positive on ARV, and HIV+ not ARV The proportion of patients on ARV who have high blood pressures increases with the duration of ART; furthermore, when comparing HIV negative to HIV+, the proportion of those who have high blood pressure is significatively high among HIV+; and so as among HIV positive on ART compared to those who are not on ART.
  • Human resource capacity development is an important part of HSS, specifically to deal with patients health as whole, but not just seen as HIV patients Improving the efficiency of service delivery: integration of services HMIS

Non-Communicable Diseases: The Unheralded Global Epidemic_Kabore_5.12.11 Non-Communicable Diseases: The Unheralded Global Epidemic_Kabore_5.12.11 Presentation Transcript

  • FHI’s Experience in Integrating Cardio-Vascular Diseases (CVD) and Underlying Risk Factors Screening and Services into Existing HIV/AIDS Programs Inoussa Kabore (ikabore@fhi.org), Director Strategic Information Rebecca Dirks (rdirks@fhi.org), Technical Officer May 12, 2011
  • Overview
    • WHO definition Non-Communicable Diseases (NCD)
    • Global burden and projection on NCD
    • Rationale for integration of Non-Communicable Diseases (NCD) and HIV
    • Synopsis of FHI portfolio on NCD
    • Rational for integrating NCD/HIV programs
    • Description and findings of HIV/NCD integration programs in Kenya
    • Ways forward and questions
  • Definition of NCD
    • Definition NCD according to WHO :
      • CVD, diabetes, cancers, chronic respiratory diseases, neuropsychiatric disorders
      • Underlying causes of NCD
    • Overview: Projected global deaths by cause, 2008
    Beaglehole and Bonita, 2008
    • CVD: nearly one-third of global mortality
    • Annual death projections over next 20 yrs:
      • Infectious disease ↓ 7 million
      • CVD ↑ 6 million
      • Cancer ↑ 4 million
    • In LMIC, NCDs will be responsible for nearly 5X as many deaths as communicable diseases, maternal, perinatal and nutritional conditions combined by 2030
  • Synopsis of FHI’s Portfolio
    • Participation in the Institute of Medicine’s Committee on Preventing the Global Epidemic of Cardiovascular Disease
    • Ghana: CVD Prevention and Care Pilot
    • Vietnam: Tobacco Control in Hospitals and Among Youth
    • Nigeria: CVD/HIV Integration
    • Kenya: CVD/HIV Integration
  • Rational for Integrating CVD and HIV services
    • Burden of CVD/HIV in developing countries
      • Around 30 million people are living with HIV
      • HIV infection associated with abnormal blood lipids
      • High prevalence of CVD risk factors in HIV-infected individuals
      • Patients on ART have a greater risk for CVD- risk for heart attack is 70-80% higher
      • CVD substantially contributes to mortality in HIV+ patients receiving ART- risk increases with longer exposure to treatment
  • CVD/HIV Integration Pilot in Kenya
  • Kenya HIV/CVD Integration Pilot
    • Launched in Sept 2009
    • CVD integration in HIV/AIDS services in 5 sites
      • Assessment
      • Upgrading health facilities
      • Training of health care providers
    • Biomedical CVD risks:
      • Blood pressure
      • Blood sugar
      • Cholesterol
      • Weight and height --- BMI
    • Behavioral risk assessment:
      • Exercise
      • Smoking
      • Diet
    For all HIV CT clients and HIV+ clients in care For all HIV+ clients in care
  •  
  • Job Aid in Kenya (1)
  • Job Aid in Kenya (2)
  • Preliminary Results of Kenya CVD/HIV Integration (1)
  • Preliminary Results of Kenya CVD/HIV Pilot (2) High: SBD >=140-159 & DBP>=90-99
  • Preliminary Results of Kenya CVD/HIV Integration (3)
  • Contribution of CVD/HIV integration to Health System Strengthening (HSS)
    • Human Resources: built capacity of staff in CVD
    • Service Delivery: integrated HIV and CVD prevention and care services
    • Health Management Information Systems (HMIS): adapted existing tools for CVD
    • Laboratory: enhanced lab capacity for CVD
    • Policy – Kenya National HIV/AIDS Strategic Plan (KNASP) III: lessons and evidence derived from CVD/HIV integration being incorporated
  • Lessons Learned from Kenya CVD/HIV Integration
    • Key inputs for CVD/HIV integration include:
      • Training existing staff
      • Building capacity of existing laboratories
      • Technical and management support
      • Government buy-in
    • This pilot project was successful due to a partnership :
      • FHI: seed funding for adding CVD services
      • Kenya Cardiac Society: training & technical support
      • NASCOP: government support
      • USAID: funding for HIV services
  • Next Steps Forward
    • Continued dissemination of findings
      • Conferences (GHC), and others relevant fora
      • Peer reviewed publications
      • Next UNGASS meeting
    • Cost analysis of Kenya to inform scale-up
    • “ How to” toolkit for integration of NCD into existing programs
      • Facility assessment tool; steps and procedures; equipment; capacity building; HMIS; QA/QI; M&E; research questions
  • Thank you