1. 1FHI 360 Nigeria. 2USAID Nigeria
Cardiovascular Disease Risk Factor Profiles of HIV-infected Clients: Findings from a pilot program to integrate CVD screening into HIV services at a secondary health facility in Kano, North-Western Nigeria. 1U.Gwarzo, 1T.Maji, 1S.Isa-Dutse, 1Y.Ahmed, 1K.Obayagbona, 2E. Okechukwu, 1S.Odafe, 1H.Khamofu, 1K.Torpey, 1O.Chabikuli
1FHI 360 Nigeria. 2USAID Nigeria

2. BACKGROUND
Growing evidence from previous studies have shown an increased prevalence of CVD in HIV infected persons
CVD in HIV infected persons arise from viral effects or antiretroviral medications (ART).
CVD risk factors, such as Hypertension, hyperlipidaemia, Diabetes Mellitus and Lipodystrophy are seen in HIV infected client

3. AIM
To implement a pilot study in a secondary health facility that will assess the feasibility of integrating routine screening for cardiovascular risk factors in an HIV clinic setting, in order to inform programmatic approaches.

4. Murtala Mohammed Specialist Hospital, Kano
Located in the Northern Nigeria’s largest city, capital of the most populous state in Nigeria [ 2006 census]
Established in 1922, >1000 bed capacity
Secondary health facility with about 100 doctors, > 800 nurses and hundreds of supporting staffs
An average of 7,000 General out-patients encounters daily
Has 6,547 enrolled HIV clients with 3,671 on ART [March 2012]

5. METHODOLOGY
Cross sectional study involving review of collected patient data
Male & female HIV infected clients enrolled for care between May August 2011 were randomly selected for CVD screening using a developed CVD screening tool
Those identified with specified CVD risk factors were referred for Laboratory evaluation of FBS & Lipid profile
The 10 year CVD risk of developing a fatal or non-fatal cardiovascular event using the WHO/ISH AFR-D risk assessment charts was then determined for the clients

6. METHODOLOGY
Targeted behavioral & biomedical interventions which included referrals to an onsite cardiac clinic were provided for clients with CVD risk of > 20% including bi-annual check
Follow-up CVD risk assessments were scheduled annually for clients with < 20% CVD risk

7. Data analysis
Data was cleaned, coded, entered into Statistical Package for the Social Sciences (SPSS), version 15 (SPSS Inc., Chicago IL).
Statistical association was determined using Chi- square, One-Way ANOVA and Tuskey Honest Significant Difference
Outcome variables include distribution of risk factor variables, duration on ART and the value (mean) of Cholesterol, HDL and LDL in both ART and ART naïve clients

8. RESULTS
A total of 1,033 HIV-positive male and female clients were screened
Age Range: 17 – 70 years
A total of 205 clients (19.8%) had 1 or more risk factors, and sent for laboratory evaluation
Most common modifiable risk factors identified were:
High BMI: %
Hypertension: %
Among those sent for laboratory evaluation:
42% had a CVD risk of < 20%
2.4% had a CVD risk of >/= 20%

9. Demographic characteristics of the study population
Age-group (yrs)
NON ART
RECEIVING ART
Female
Male
Total
< 25
28 (100%)
0 (0.0%) 28
84 (95.5%)
4 (4.5%) 88
39 (95.1%)
2 (4.9%) 41
180 (90%)
20 (10%)
200
30- 34
29 (78.4)
8 (21.6%) 37
146 (77.2%)
43 (22.8%)
189
20 (66.7%)
10 (33.3%) 30
96 (62.9%)
55 (37.1%)
151
10 (50%) 20
66 (58.4%)
47 (41.6%)
113
5 (45.5%)
6 (54.5%) 11
23 (41.8%)
32 (58.2%) 55
>50
5 (50%) 10
32 (55.2%)
26 (44.8%) 58

10. Frequency distribution of CVD risk factors by ART status
Variables
Total
n (%)
On ART
ART naïve
P-value
Sex
Female
Male
765 (74.1)
268 (25.9)
627 (82.2)
227 (84.7)
136 (17.8)
41 (15.3)
0.35
Age (years)
< 40
≥ 40
766 (74.3)
265 (25.7)
625 (82.2)
139 (18.2)
38 (14.3)
0.15
BMI (kg/m2)
<25
≥ 25
751 (78.2)
209 (21.8)
620 (82.6)
177 (85.1)
131 (17.4)
31 (14.9)
0.39
Blood pressure (mmHg)
≤140/90
>140/90
814 (84.8)
146 (15.2)
666 (82.0)
123 (84.3)
146 (18.0)
23 (15.8)
0.52
Smoking
Yes No
82 (8.0)
943 (92.0)
68 (82.9)
780 (82.9)
14 (17.1)
161 (17.1)
0.99

11. Analysis of relationship between hyperlipidaemia and duration on treatment
Duration on ART N
Mean F
Significance
Total Cholesterol
< 1Yr 33
3.93
4.038
0.02
1-<3Yrs 52
4.49
>=3Yrs 67
4.54
Total
152
4.39
HDL 34
1.10
0.729
0.484
1.13
2.25
153
1.61
LDL
2.88
0.472
0.624
3.36
2.29
2.78

12. RESULTS
Although all risk factors were more prevalent in those receiving ART, there was no statistical difference with the ART-naïve group
Mean serum total cholesterol levels were found to increase as duration on ART increased

13. Discussion
Developing countries are increasingly facing the double epidemics of CD and NCD, including CVD
BMI of > 25 kg/m2 found to be 28.1% and BP > 140/90 mmHg found to be 15.2%
The mean serum total cholesterol levels were observed to increase as the duration on ART increased

14. CONCLUSION
We conclude that integration of screening for cardiovascular diseases in ART clinic settings is feasible and essential, in order to improve the life expectancy of HIV-positive individuals.

15. THANK YOU