Management of non-communicable diseases

Clinical description

• HIV infection is associated with higher triglycerides, lower HDL (good cholesterol) and

hypertension. About 1/4 of adults ART patients from a study in Zomba had hypertension; about 4% had diabetes.

• DTG may increase risk of hyperglycaemia, particularly in patients with other risk factors for

diabetes.

• The 4 NCDs with the highest burden among PLHIV cardiovascular disease (CVD), cervical

cancer, depression, and diabetes.

o CVD events are more common because of risk factors such as obesity and age o In 2021, about 1/4 of ART patients were 50 years +

• Routinely screen all ART patients in the following groups for NCDs:

Group Screen When Adult 40 years + Blood glucose, blood pressure 12-monthly Women 15-49 years Cervical cancer 12-monthly Adolescents and adults with Depression and substance Targeted adherence challenges abuse Integration of NCD management and ART

• Integrate HIV and NCD education in ART clinic health talks.
• Integrate NCDs screening and management in ART services whenever possible.

o Refer NCD patients for end organ damage investigation.

• File ART and NCD patient cards at the ART clinic.
• Align ART and NCD clinic appointments if a full integration is not feasible.