Summary

Program goals

Mortality rates associated with cardiovascular disease (CVD) are escalating quickly in low- and middle-income countries. Contributing factors include poverty, urbanization, tobacco use, inactivity, and consumption of salty, high-fat, processed foods. People living with HIV—particularly those on antiretroviral therapy (ART)—are also at an increased risk for CVD. As a result, CVD screening is being offered in this pilot to people who come for HIV prevention and treatment services, with the goals of demonstrating the feasibility and effectiveness of CVD/HIV integration, and assessing CVD risks that may be associated with HIV and ART.

Key program components

In the five facilities selected for the Kenya pilot, staff members that provide HIV services have been trained to screen for CVD risk factors. Using adapted behavior materials and job aids, they talk to clients about their medical histories, dietary practices, physical exercise regimes, alcohol and tobacco use, and biological and therapeutic risk factors for CVD. When needed, the health care providers also make available simple biomedical interventions and referrals to specialized treatment. As well as providing counseling, health care providers measure and record client body-mass index, blood pressure, blood glucose, and cholesterol levels. In doing this they aim at gathering data that evidences the relationship between HIV infection, ART, and CVD, while incorporating what they learn into existing service delivery and patient-level information systems. To ensure the sustainability of the services in Kenya, FHI has engaged the Ministry of Health and the National AIDS and STI Control Programme (NASCOP), including officials at provincial and district levels. FHI's efforts have paid off, since Kenya's National AIDS Strategic Plan III (2010–2013) now calls for the integration of CVD services into HIV programs. FHI has also established partnerships with the Kenya Cardiac Society and the Kenyan National Heart Foundation, which have helped to develop training modules and job aids and establish a referral network of specialists and facilities that offer specialized CVD care.