Screening, treatment of non-communicable diseases among people living with HIV can increase their lifespan by 10 years

OPINION

By Dr. Innocent Ssemanda

Early screening and treatment of chronic diseases such as high blood pressure, diabetes, cancer of the cervix, and mental illness among people living with HIV (PLHIV) can increase their chances of living 10 years longer.

Until the past two decades, the main disease burden in much of the developing world has been diseases that are spread from person to person, including HIV.

However, HIV treatment being one of science’s greatest achievements has transformed HIV from a death sentence into a chronically manageable illness.

In those 20 years, Uganda has stopped over 600,000 deaths due to HIV and its related complications. However, these gains are threatened by chronic diseases also known as non-communicable diseases (NCDs).

As people living with HIV live longer world over, they face the same increasing threat from chronic diseases as the general population. In many cases, they face a greater risk because of their status.

By 2035, it is estimated that seven out of every 10 people living with HIV will also live with one or more chronic illnesses, versus six out of every 10 people without HIV. And death rates from NCDs are nearly twice as high in low- and middle-income countries compared to high-income countries.

The world has undergone disease burden changeovers that included an increase in chronic diseases with high blood pressure estimates showing that in every 10 people, three have high blood pressure while one has diabetes.

These estimates are also increasing among people living with HIV in Uganda. Thus, understanding the strategies for early detection and treatment of chronic diseases would be important for improving health service delivery and the quality of life among people living with HIV.

Studies have shown that integrating services for high blood pressure, diabetes and high cholesterol for HIV patients on antiretroviral therapy (ART) in Uganda, would decrease the risk of getting a stroke among these patients by 10 years on average.

The good news is, in 2020, the Ugandan Ministry of Health, rolled out guidelines for the prevention and treatment of chronic diseases among PLHIV. They have since been updated in 2022 to improve the chances of early disease detection among all eligible persons.

These guidelines recommended that stable HIV patients with chronic diseases and without complications should be seen in a single appointment by the same clinician (where possible), with patient records available in the same location, and that both HIV and NCD health education should be available in the clinic.

The proposed integration would occur across all levels including community and home-based care.

The Ministry of Health has embarked on building capacity and awareness among healthcare workers to improve screening for chronic diseases within this population of patients. With support from its partners, the Ministry of Health has also gone ahead to equip several health facilities with the necessary screening tools and standard operating procedures (SOPs).

Despite these strategies being put in place, it’s been noted that many eligible ART clients do not demand these life-saving services. This can be attributed to knowledge gaps and low client awareness and concern for potential risk.

For people living with HIV to realise the 10-year lifespan addition, they and their carers are encouraged by the Ministry of Health to habitually engage their primary service providers in conversations to do with screening for non-communicable diseases including but not limited to high blood pressure, diabetes, mental illness and cervical cancer among women on every visit.

The writer is a field epidemiology fellow with the Uganda Public Health Fellowship Programme hosted at the AIDS Control Programme, Ministry of Health