CORE Group GHPC15 October 8, 2015 Concurrent Session: New Trends for HIV Clinical Platforms: Prevention, Care, and Treatment of NCDs

1. Experience from the field:
CVD/HIV integration
Rebecca Dirks
Senior Technical Officer, Program Sciences, FHI 360
8 October 2015

2. Overview: FHI 360 CVD/HIV Integration Programs
• CVD screening, treatment & services integrated in
various USAID-funded HIV programs
• Partnerships w/ MOH, USAID, local NCD institutions
• Target population for CVD risk assessment
1)HIV counseling & testing clients
2)HIV-positive clients in care
3)ART clients
4)PMCT clients

3. Zambia Chronic Care Screening Integration
Key Components
• Chronic care screening integration within USAID-funded ZPCTII project
• Screening provided in HIV counseling and testing, PMTCT, and ART
• Chronic Care Screening Checklist includes
– NCD-related risk factors: BMI, hypertension, diabetes
– Other health concerns: TB, gender-based violence, prevention w/ positives
• Implemented in variety of levels – health centers & hospitals
• From May 2010 – Dec 2013, approx 75,000 clients were screened

4. Zambia Chronic Care Screening Integration
Snapshot of Checklist

5. Next phase: Study of facilitated referrals for
depression within the chronic care model in Zambia
• Two hospitals will use facilitated referrals to support services for
diabetes and depression among HIV patients
• Screening for diabetes from HIV Chronic Care Checklist and adding a
depression screener for study (CES-D)
– Diabetes care by clinical officers and nutritionists following MOH
guidelines (additional training needed)
– Depression care by psychiatric nurses trained on group
counseling intervention (in line with WHO guidelines for
psychosocial services)

6. Cumulative Lessons in HIV/NCD Integration:
Kenya, Nigeria, and Zambia
• Integration of NCD & HIV is feasible, effective and cost-
effective
• Integration strengthens the capacity of the health system to
address the comprehensive needs of HIV patients
• Integration offers a platform for reaching patients regardless
of HIV status
• Integration offers an opportunity for de-stigmatization by
offering services to non HIV clients

7. Key Challenges to Integration
• Disparities in out-of-pocket expenses for NCD & HIV
• Health system capacity for NCD services inadequate
• Poor availability of NCD medications & reagents
• Frequent rotation of staff trained in NCD services out of
facilities
• Perception by health providers as additional work burden
• Poor funding for NCD programs – national & global

8. THANK YOU!