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Cardiovascular Diseases in People Living with HIV attending clinic and admitted at tertiary hospital in Mwanza region, Tanzania in the time of changing climate

James Chrispin1 , Robert Peck2

1 Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.

2Center for Global Health, Department of Internal Medicine and Pediatrics, Weill Cornell Medicine, New York, USA.

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13th December 2023

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� Introduction�

  • HIV has contributed to over 39 million deaths worldwide.
  • Sub-Saharan Africa has accounted for more than 70% of global HIV burden, in Tanzania estimated total of 1.7 million People Living with HIV (PLHIV) in 2019.
  • Worldwide it is estimated 17.9 million people died from cardiovascular diseases (CVDs) in 2015
  • PLHIV are at 1.5 -2 times more likely to develop CVDs compared to non-infected individuals

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Introduction

  • The world ambitious goal on HIV (90% diagnosed, 90% on treatment, 90% suppressed viral load.
  • To address the growing burden of NCDS, can we use the existing HIV infrastructure to address NCDs without compromising HIV programs ?

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Climate change and HIV

  • Climate change threatens global response to HIV which make the community to suffer more from HIV burden.
  • Climate change interfere with HIV treatment and prevention services.
  • It caused food insecurities, forced migration, destruction of healthcare infrastructure, and risk behaviors such as transactional sex for money and food.
  • Climate change has increased susceptibility to comorbidities and opportunistic infection that worsen and cause poor outcome in people with HIV

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Climate change and HIV

Climate change impact on the health care system

  • Healthcare sector is the main driver in HIV prevention and treatment, while at the same time extreme weather events such as flooding, storms are contributing in destruction of healthcare facilities infrastructure, supply chain of essential medication and accessibility of HIV preventive services

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Climate change and HIV

Forced migration

  • People are forced to migrate to other areas due to flooding, droughts and other extreme weather events relating to climate change.
  • Migration of people increase the risk of HIV transmission and decreases outcome to those living with HIV as they miss proper visits to CTC clinic, affect access to HIV treatment services.

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Climate change and HIV

Food Insecurity

  • Food insecurity results from draught, floods, extreme weather events and other climatic factors such as temperature and precipitation variabilities.
  • Food insecurity drives transactional sex for money and food together with other forms of gender violence that predispose them to develop HIV
  • Food insecurity is associated with malnutrition and high risk of vertical transmission of HIV from mother to child

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Climate change and HIV

Climate change related comorbidities and opportunistic infections

  • Vector borne diseases such as malaria and dengue, water borne diseases including diarrhea and zoonotic diseases which are climatic related have severe and serious complication in individuals with HIV.
  • People living with HIV are immune suppressed and are more vulnerable to this disease compared to the general population
  • Opportunistic infection and outbreaks of fungal infections such as cryptococcosis, pneumocystis and histoplasmosis are related to climatic changes such as decreased precipitation and increased temperature

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Objectives

  • To determine prevalence and distribution of cardiovascular diseases in PLHIV attending clinic and admitted at Bugando Medical Center (BMC).
  • To access the predictors of cardiovascular diseases in PLHIV attending clinic and admitted at BMC.
  • To show the gape in environmental measurers in the fight against HIV and Non Communicable Diseases

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Methodology

  • This was a hospital based cross sectional study, conducted on January 2023 at BMC involving both outpatients and inpatients.
  • A simple random sampling technique was used to recruit 203 participants.
  • The study population were adult HIV infected patients above 18 years attending CTC clinic and admitted at BMC during the study period.
  • Data was collected using pre-tested WHO-stepwise semi structured questionnaire.
  • Physical measurements included the information related to anthropometric indices of weight, height, abdominal circumference and blood pressure was measured.

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Results

  • The majority of study participants were female n=152 (75%) with female to male ratio of 3:1.
  • The median age was 47 years, age range (19-83)

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�Behavioral Assessment �

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�Diagnosed with Cardiovascular Diseases�

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�Pattern of Cardiovascular Diseases�

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�Physical Measurements�

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�Physical Measurements�

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�Reflection and Action Points �

  • Stroke and hypertensive heart disease were leading CVDs in PLHIV.
  • Hypertension, alcohol consumption, obesity were risk factors.
  • There is need to integrate NCDs services in the existing HIV programs.
  • Community screening and awareness programs to increase community health seeking behaviors and preventive measurers.

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Conclusion

  • Climate change, HIV and Non Communicable Diseases are global triple crisis which need holistic approach in the fight to end both of them.
  • Multidisciplinary approach through collaborations and partnership between different sectors, organizations and institutions in conducting joints programs which addresses both NCDs, HIV and Climate change

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Contact Details

jameschrispn@gmail.com