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Managing noncommunicable diseases in routine HIV care feasible
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Incorporating management of noncommunicable diseases into routine HIV care helped to facilitate the diagnosis of these diseases, according to data presented at AIDS 2014.
“In the context of resource-constrained settings, it makes natural sense to integrate services,” Barbara Namata Mbogga Mukasa, MD, of Mildmay Uganda in Kampala, told Infectious Disease News. “Patients with HIV are achieving viral suppression with ART and this population is aging and experiencing a spectrum of noncommunicable diseases. With a few health care workers, limited funds and patients with many diseases or conditions, integration is the sensible thing to do.”
Barbara Namata Mbogga Mukasa
The researchers reviewed physical and electronic longitudinal data to evaluate diagnoses of noncommunicable diseases and tracking clients with these diseases. They obtained data, including hereditary factors, alcohol or nicotine use, and clinical and laboratory assessments, of clients within the Mildmay Uganda system.
Among the 10,285 clients, 1,058 were diagnosed were hypertension. In addition, 12.7% of patients have mental disorders, including depression, mania and epilepsy, and 8% have diabetes. Thirty-four percent of the patients are older than 60 years, 69% are female and 73% receive ART.
Management for noncommunicable diseases is a standard process within Mildmay, established in 2013. Medical records for patients with HIV who have hypertension or other noncommunicable diseases are tagged for physician recognition. The organization also has established an elderly clinic day, since 69% of patients with HIV and a noncommunicable disease are elderly.
“These findings are very important,” Mukasa said. “Health systems strengthening cannot be achieved unless we integrate mainstream HIV care as part of routine service delivery. That way we will not only ensure access for all, but also quality services. I hope these data will change the practice of physicians treating patients with HIV.”
The diagnosis, tracking and management of noncommunicable diseases, particularly hypertension, diabetes, cardiovascular disease and mental health, have improved markedly since integration into HIV care, Mukasa said. — by Emily Shafer
For more information:
Mukasa B. Abstract MOAE0105LB. Presented at: 20th International AIDS Conference; July 20-25, 2014; Melbourne, Australia.
Barbara Namata Mbogga Mukasa, MD, can be reached at: Barbara.mukasa@mildmay.or.ug.
Disclosure: The study was funded by Grand Challenges Canada through the Global Alliance on Chronic Diseases.
Perspective
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Michael Horberg, MD, MAS
It is essential that high quality, comprehensive HIV care include care for non-communicable diseases. Our patients are doing better and living longer, and if well treated, they are not dying of HIV-related complications per se, but other diseases that are not "classically" associated with HIV. These diseases are typically associated with aging and other factors: non-AIDS defining cancers (for example, lung cancer due to smoking), liver disease due to hepatitis C, hypertension and diabetes. Good HIV care means caring for the whole patient and not just one aspect of the patient.
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