1. Linkages between CDs & NCDs: The African context Dr Frank J Mwangemi frank@achap.org,frank@achap.org ICASA 2011: 5 th December 2011 Addis Ababa, Ethiopia.

2. Background Common NCDs- Cardiovascular diseases – Diabetes – Cancers – Chronic respiratory diseases Common causes include: Aging population, Globalization of trade & marketing, urbanization negative effects These are referred to as lifestyle diseases, most share risk factors and are preventable

3. CDs & NCDs: where is the linkage? Uncontrolled HIV results in metabolic and inflammatory events that increase CVD risk: – Increased triglycerides – Decreased HDL cholesterol – Increased insulin resistance HIV and CVD synergies – HIV effects on CVD risk factors – HAART effects on CVD – HIV and tobacco smoking CVD risk factors and TB HIV and cancer – Kaposi, lymphomas, Cervical cancers etc

4. The Dual Epidemic Epidemiological transition in progress HIV/AIDS- 34M PLHAs ( 22.5 – SSA) – effects of increased access of care and treatment, currently 3.5 M on HAART 2008 – 57M deaths 36M (63%) due to NCDs predicted to reach 52M by 2030 ( 80% due to CVDs ) Risk factors – 1) General- behavioral – 2) Biological 3)Therapeutic - for HIV patients

5. NCDs: CVD Modifiable risk factors 1.Tobacco use 2.High blood cholesterol 3.High blood pressure 4.Physical inactivity 5. Obesity & overweight 6. Diabetes mellitus (type II ) 7. Stress 8.Excess alcohol

6. African example: Kenya case study Burden of CVD and HIV in Kenya: – NCD contributes to 50% morbidity and 32% mortality – HIV prevalence at 7.1%, about 460,000 on HAART currently Integration provides an opportunity to: – combine lessons learned in CVD & HIV – Improve efficiency of health care delivery – Comprehensive service menu for the patient 1.Behavioral & Biomedical CVD Risk Assessment 2.Referral for CVD prevention and care 1.Long-term monitoring of CVD complications of HIV and/or ART For all HIV+ clients in care For all HIV CT clients and HIV+ clients in care

7. Risk of high blood pressure according to duration on ART and HIV status P-value 0.003 Risk of elevated blood sugar according to ARV regimen

8. Conclusions: assessment suggests HIV and CVD integration is feasible Integration can identify undetected CVD risk factors Routine monitoring of blood pressure should be part of AIDS care and treatment Integration can help with the prevention and management of CVD risk factors What were success factors to this assessment?

9. The Epidemic is preventable Population wide interventions to address behavioral risk factors :- tobacco use, unhealthy diet, physical inactivity, excess alcohol use These interventions are: – Low cost, cost effective and income generating Challenges include: Inadequate political will Insufficient engagement of non-health sector Lack of resources Limited engagement of key stakeholders

10. NCDs Epidemic is preventable 1.Increase political commitment 2.Health system strengthening – leveraging on the available resources, information, governance, service delivery etc. 3.Inclusion of health in all policies- Multisectoral action 4.Increased community participation and engagement – a life course approach

11. THANK YOU FOR YOUR ATTENTION