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

1. Linda Kupfer & Susan Vorkoper, NIH/FIC

2. HIV & NCDs
Early 1980s: HIV was a death sentence world wide
Late 1980s: ARTs changed all that – for developed
countries
2002-3 PEPFAR and Global Fund invest in building
health infrastructure in LMICs to deliver
treatment for HIV/AIDS
Currently: HIV is a chronic disease that people live with.
PLHIV die of co-morbid diseases such as
diabetes and cancer.

3. Enhancing PEPFAR
Platforms
• Leverage what’s there to address patient management
and prevention of NCDs for PLHIV
• Utilize existing human capital, health infrastructure, and data
systems developed to confront the HIV/AIDS crisis
• Lessons Learned:
• Monitoring and record keeping
• Affordable drugs and a reliable drug delivery system
• Community outreach and community testing
• Task shifting- development and training of a cadre of
community health workers
• link between research, policy and care delivery

4. Research to Guide Practice:
Enhancing HIV/AIDS Platforms to
Address NCDs in Low Resource Settings

5. Goal of the Project
To bring together researchers, implementers, and government
representatives to articulate practical goals, approaches, and
related research agenda to incorporate prevention, care and
treatment for NCDs into HIV/AIDS platforms in LMICs.

6. Slide from Ambassador Deborah Birx

7. • Priority NCDs among people
living with HIV
▫ Cervical Cancer
▫ CVD/Stroke
▫ Depression
▫ Diabetes
Areas of Focus

8. First Steps
Sept, 2014 - July, 2015
Landscape analysis for each TOG
◦ Literature search and analysis
◦ Identification of priority research questions
Key informant interviews with MOH and academics in four countries
Review of countries’ NCD and HIV policies
Contributed to IeDEA network survey on health sites’ NCDs capacity
Technical Operating Groups (TOG)
Health Systems
Integration
Disease/Condition
Questions
Awareness, Education, and
Dissemination

9. Priority Research Questions
• What are the most effective/ cost-effective AED interventions
(e.g., peer and expert training models, CHW programs, and e-
health and m-health)?
• How can AED best be incorporated into and provide support for
existing prevention, care, and treatment interventions?
• What factors allow for successful implementation and scale-up of
evidence-based small-scale interventions?
Priority Research Questions
• What is the prevalence of NCDs and their risk factors in HIV
populations in SSA?
• How can we evaluate and improve the screening and
treatment of NCDs among PLHIV in resource-poor countries?
• How can we evaluate the potential for population-level scale
up of NCD prevention, screening, care, and treatment
programs?
Priority Research Questions
• What is needed for successful integration?
• What are the optimal program models to link PLHIV to
care/management and retention of those patients in HIV
programs?
• What kind of systemic interventions might be used to promote
readiness and capacity for integration of NCD diagnosis and
treatment strategies into current health care structures?
Landscape Outcomes:
Priority Research Questions
Health Systems
Integration
Disease/Condition
Questions
Awareness, Education,
and Dissemination

10. Landscape Analysis to Action
2nd Annual Meeting July 29-30, 2015
Objectives:
• Identify key research questions regarding the integration
of NCD services into HIV programs
• Develop an actionable strategy to address these questions
• Leverage the skills and influence of the people and
organizations at this meeting

11. 1. Incorporate NCD-PLHIV questions into existing surveys (e.g.,
IeDEA, WHO STEPS) and model NCD prevalence in PLHIV in
nine project focus countries.
2. Develop country-level compendium of existing NCD protocols
policies and guidelines for PLHIV with three countries.
3. Refine and prioritize HIV-NCD integration implementation
science research questions in collaboration with researchers
and funders in HIC and LMIC.

12. 4. Compare current HIV-NCD integration models by creating a
harmonized set of indicators, a framework, and an evaluation
paradigm for integration.
5. Prioritize and develop NCD awareness resources for PLHIV by
conducting a needs assessment with three focus countries and
develop resources for a country specific toolbox.
6. Edit and publish landscape analyses that project members
have collaboratively developed.

13. Thanks to our Steering Committee!
Atalay Alem, Addis Ababa University in Ethiopia
Wafaa El-Sadr, Columbia University
Eric Goosby, University of California, San Francisco
Naomi Levitt, University of Cape Town in South Africa
Beatrice Matanje-Mwagomba, Ministry of Health, Malawi
Miriam Rabkin, Columbia University
Doreen Ramogola Masire, University of Botswana
William Tierney, Dell Medical School in Austin, Texas
Gerald Yonga, Aga Khan University in Kenya

14. Thanks to Our Partners!
NIH
NCI, NHLBI, NIAID, NICHD, NIDDK, NIMH, NIMHD, NINDS, OAR
USG Agencies
CDC, DOD, OGAC, Peace Corps, USAID
Implementers
AMPATH, FHI-360, IeDEA, Jhpiego, Malawi, MOH, MSH, PATH, PIH
Additional Experts
CUNY, Global Fund, UNAIDS, University of Chicago, University of Washington