1. Barbara Mukasa, Esther Kawuma, Ritah Nakigudde, Yvonne Karamagi, Micheal Ssonko, Daniel Mwehire, Sanni Yaya, Eric Druyts, Caroline MacLeod, Yvonne Karamagi, Edith Akankwasa, Jan Heusinkveld, Emmanuel Luyirika, Heiner Bucher, Mary Odiit, Edward Mills Utilizing available HIV/AIDS infrastructure as a gateway to effective case finding & management of Non-Communicable Diseases (NCDS) including hypertension, diabetes & mental disorders at Mildmay Uganda 1a

2. Background Uganda, like other countries with a high burden of HIV infection is facing a growing epidemics of NCDs Population of PLHIV achieving viral suppression on combination ART is growing, aging & experiencing a widening spectrum of non-AIDS diseases. Like HIV, NCDs are most frequent in low- & middle-income countries; age-adjusted death rates from NCDs are nearly twice as high in low- & middle-income countries compared to high- income countries. HIV & NCD care both require ongoing attendance at appointments, adherence to tests & medications, healthy living & self-management.

3. Issue In 2012/2013 cohort study, at Mildmay Uganda - Hypertension was diagnosed in 1551 patients The risk was higher among males & increased with age. Efforts needed to address multi- morbidity in HIV-positive persons - combine HIV treatment with vascular disease risk factor prevention & management

4. Description Mildmay Uganda fully integrated NCD screening & management in 2013, as part of routine HIV care 1. Active-case finding for all new clients 2. Provision of medical & behavioral interventions to reduce risk & control disease

5. Description A review of physical & electronic longitudinal data was conducted to identify & improve tracking of clients with HIV-NCD co-morbidity Data collection tools reviewed/developed to capture NCD specific data – Demographics, Clinical &Anthropometry Measures, Dietary Measures, significant Medical History, Physical Activity, Behavioural, Biochemical measures. SOPs developed/revised to support screening & management of HIV-NCD co-morbidity Data collection, cleaning & analysis has continued allowing for profiling of NCDs among HIV clients in care at MUg

6. Medical records/ files for HIV+ clients with NCDs have been tagged & clinicians sensitized on management of HIV-NCD co-morbidities. To maximize clinic capacity to deliver interventions including health education & client support groups (since 69% of those with HIV-NCD co- morbidity are also elderly) - Tuesday has been designated as NCD/Elderly Clinic Day.

7. Result as of March 2014 Active PLHIV in care at Mildmay Uganda main site - 10,285 34% were aged over 60 years; 69 % were females 73% are on ART 1058 were identified with Hypertension; 12.7% of whom had mental disorders, including depression, mania & epilepsy while, 8% had diabetes.

8. Lessons learnt Existing HIV care & treatment infrastructure provides a viable platform for screening & managing non-communicable disease Diagnosis, tracking & management of NCDs, particularly Hypertension, diabetes, cardiovascular disease & mental health as part of routine HIV care improves outcomes markedly.

9. Most pressing challenge Access to drugs for increasing no. of clients diagnosed with co-morbidities is a challenge as the drugs for co-morbidities are not always part of the commodities provided under the routine HIV programme Adherence for clients who have to buy their own medicines is a challenge

10. Next steps Community Volunteers trained to support follow up in & screening of other HH members of those with the NCDs. Continue lobbying for increased access to drugs through national & other mechanisms

11. Acknowledgment & disclaimer This work is supported by Cooperative Agreement Number 1UG2GPS002909-01from The Centers for Disease Control and Prevention (CDC) and the GACD Special acknowledgement The Clients of Mildmay Uganda who allow us continually to learn from their experiences The Staff who are the hands of Mildmay Uganda * The contents of this presentation are solely the responsibility of the authors and do not necessarily represent the official views of the CDC and the other supporters 11a