Building Bridges and adios DC

Building Bridges: HIV and non-communicable diseases.

My last day in Washington DC and although I am sorry to leave I am keen to return to Australia buoyed by the wonderful energy and optimism arising from both the conference findings and the attendees.  At our next conference in 2014 in Melbourne, we hope to hear a lot more from and about people who inject drugs, sex workers and transgender people.

Building Bridges was one of my favourite sessions at the conference (Session MOAE01). It addressed how best to link services for HIV testing and treatment to the diagnosis and management of non-communicable diseases (NCDs). The studies reported at the session were ambitious, well designed and showed promising results. It will be great to see similar studies coming out of the Asia Pacific region.

The first speaker was Miriam Rabkin from the Mailman School of Public Health at Columbia University. She gave an excellent overview on linking systems and services for HIV and chronic NCDs. She noted that 15% of patients at several ICAP sites are > 50 years of age. ICAP is the International Centre for AIDS Care and Treatment Programs http://www.columbia-icap.org/.

 Dr Rabkin posed the important questions:

• What are the best and most efficient ways to screen PLWH for NCD in resource-constrained     settings?
• Where should NCD prevention, care and treatment services for PLWH be delivered?
• Should they be integrated into the HIV clinic or provided elsewhere?
• Which health care providers should treat NCD in PLWH?

The second speaker was Dr Gabriele Chamie from UCSF and the UCSF- Makerere University Research Collaboration in Kampala who gave a superb presentation (MOAE0103) describing the results of a 5-day campaign undertaken in the Kakyere Parish, Uganda.

6,300 residents participated in the campaign, which represented 74% of the entire local community. The success of this study engagement was attributed to the fact that they partnered with local village leaders, designed and executed community mobile efforts through churches and mosques, put out posters and pamphlets and used radio announcements. Importantly the campaign focused on a number of illnesses for screening and did not focus solely on HIV, which they felt was important.

Each day they saw over 1,000 patients with a median waiting time of 90 minutes. Patients were offered comprehensive point-of-care screening for HIV, malaria, hypertension and diabetes. Patient diagnosed with HIV were offered immediate referral to on-site counselors and clinic staff.

30% of people had never been tested for HIV infection. The HIV prevalence in the study population was 8% and 46% of patients were unaware of their status prior to the campaign. The median CD4 cell count was 449 cells/uL, which is almost identical to the median CD4+ cell count at diagnosis in Australia.  Patients with CD4+ counts 100/uL were sent for intnsive counseling and rapid referral for ART. HIV+ patients were also tested with GeneXpert for TB screening.

Regarding hypertension, BP findings showed 23% had BP > 140/90 and 12% had BP > 150/100.  69% of patients were unaware that they were hypertensive before the campaign.  The prevalence of diabetes was 3.5 % and 23% of patients were newly diagnosed with diabetes.  Malaria was diagnosed in 10% of children.

The findings of linkage to care following diagnosis showed that with an active referral at 3 months only 59% of HIV+ patients had linked to follow-up care. However those patients with lower CD4 cell counts had received enhanced referral practices and 74% of patients linked up with care and started ART within a median of 2 days.

There were three other excellent presentations at this session and I would draw your attention to the presentation by Dr Elanore Mulenga on cervical cancer screening, ‘Integrating cervical cancer prevention services into mobile HIV counseling and testing services to reach more women with life-saving cancer interventions’ (MOAE0105).  This study was undertaken in Zambia and was an ambitious ‘screen and treat’ method for cervical cancer that was linked to HIV mobile testing and counseling units in 14 Zambian Defence Unit sites.  Cervical cancer remains a leading cause of death in women globally including within the Asia Pacific region in countries like Papua New Guinea.

Bye for now.