1. HIV and NCD overview 21 st International AIDS Conference Durban 2106 Dr Tolu Oni Senior Lecturer & Public Health Medical Specialist University of Cape Town tolullah.oni@uct.ac.za @drtolullah

2. Context of epidemiological transition

3. Classic transition  Falling incidence and mortality from infectious diseases  Rise in chronic “degenerative” conditions BUT  Reality is one of protracted transition in many LMIC  Emerging NCD epidemics alongside high rates of infectious disease

4. Oni, T and Unwin, N. Int Health. 2015 Nov;7(6):390-9. Burden of disease in 12 low and middle-income regions

5. 2. Why is this important?

6. 2.1 HIV and NCD co-exist

7. 106 5 315 81.1% 75% 27% 4% 8% 2% 77% 24% 17% HPT HIV T2DM TB DMHIV TB HPT Number of patients among patients with a given disease 80% 37% 12% Patient numbers 97% 32.7% 19.3% 88.1% MM Prevalence % DM HIV TB HPT TB DM HPT HIV TB HIV HPT DM Co-morbid Disease Pattern % 231 6 303 4 Oni T et al. BMC Infect Dis. 2015:17;15:20. Multimorbidity at earlier ages

8. 2.2 HIV and NCD interact

9. Disease-disease interactions  Association between diseases  HIV and COPD, dyslipidaemia, neurocognitive disorders  Shared end organ damage  HIV, DM and Neuropathy  HIV, HPT and nephropathy

10. Disease-drug & Drug-drug  ARV and metabolic syndrome  Hepatoxicity, ARV/sulphonylureas inhibition and induction

11. 2.3 HIV and NCD share common risk factors

12. Nutrition* # Alcohol # Tobacco # Diabetes Cerebrovascular CVD IHD Cancers # Tuberculosis High BP Unsafe sex # Physical inactivity # Urban/indoor air pollution # COPD Socio- environmental ^ # 35% of cancer deaths caused by these factors *Encompasses underweight, overweight/obesity, low fruit/veg consumption, high glucose intake ^Conditions associated with informality: overcrowding, unsafe water & sanitation HIV Chronic kidney disease Oni, T and Unwin, N. Int Health. 2015 Nov;7(6):390-9. Implications for integrated 1 o and 2 o prevention

13. Conclusion  Changing patterns of population health in high HIV- burden settings  Impact of disease control and outcomes  Implications for health systems incl. service delivery, prevention strategies, and drug discovery  Need for more integrated research to inform integrated implementation across chronic care cascade

14. Thank you tolullah.oni@uct.ac.za @drtolullah