Tackling Africa’s Dual Epidemic: AIDS and Non-Communicable Disease

October 16, 2013

By Catherine Kyobutungi, Research Scientist & Head of Health Challenges and Systems Program, APHRC

November 30, 2012

Today non-communicable diseases like heart disease, cancers and diabetes are competing with HIV/AIDS as Africa’s number one killer—in fact Cardiovascular diseases cause up to 1.32 million deaths in sub-Saharan Africa annually, 100,000 more than HIV/AIDS—yet HIV/AIDS continues to devastate families and communities across the continent.

On World AIDS Day, December 1, 2012, the question is: How can the global health community tackle the dual epidemic of AIDS and chronic non-communicable diseases simultaneously moving forward?

Back in July just before the start of The International AIDS Conference in Washington, D.C., Dr. Jonathan Quick, President and CEO of Management Sciences for Health, lead a session entitled “Beyond MDG 6: HIV and Chronic Non-Communicable Diseases (NCDs): Integrating Health Systems Toward Universal Health Coverage.” (Watch the session here.)

This session brought together representatives from MSH, The Pan-American Health Organization, the World Health Organization, Harvard School of Public Health, Tanzania Ministry of Health, AMPATH and The Pink Ribbon Red Ribbon Initiative to discuss this exact challenge and determine how developing countries should move forward with developing strong, integrated systems that provide universal health coverage.

Dr. Jemima Kamano from AMPATH based at Moi Teaching and Referral Hospital, described her experience as a practicing physician in Kenya that illustrated the type of disheartening challenges doctors are facing across the global south.  “One of the hardest thing for me as a practicing clinician in Africa is to sit at the HIV clinic and treat the HIV patients, counsel them and give them drugs and see them improving, but the minute they develop diabetes or hypertension, then I tell them unfortunately I can’t help them,”  she explained.

One session participant, Sir George Alleyne, who serves as United Nations Secretary-General’s Special Envoy for HIV/AIDS in the Caribbean region, made clear that this is not a battle against diseases, but an opportune time to integrate services.

Six million people die each year of AIDS, TB and malaria, while 30 million people in low- and middle-income countries die from heart disease, diabetes, cancer, and chronic lung disease.

One way to design cost-effective, integrated systems for universal health coverage to help people affected both by AIDS and NCDs is by utilizing or building on systems that are already working.

Ayoub Magimba, Ministry of Health in Tanzania, explained that his success with integration was possible due to utilization of the existing structure of the HIV/AIDS program in Tanzania.

We must also increase the quality and quantity of research that goes into understanding the impact of NCDs in developing countries, and research that goes into finding solutions that work in combating NCDs while dealing with the challenges posed by HIV and other infectious diseases in sub-Saharan Africa.

APHRC focuses its health research on two major areas that we hope will help to combat the NCDs epidemic, strengthening health systems as a means to provide better integrated health services to Africans, better understanding of the inter-linkages between infectious and non-communicable diseases and how best to produce health, not just by treating one category of diseases in one population, but by preventing them and providing a whole continuum of services for all people across the life cycle.

At the NCD session, Sir George Alleyne said that it is “operationally feasible, socially desirable and economically achievable” to combat both killers at once. But this can only be done through strengthening existing health systems, leveraging existing platforms and ensuring access at an affordable cost in the context of universal health coverage. Furthermore, we must increase the volume of the NCDs dialogue to convince policymakers and development partners—including the HIV/AIDS advocacy community—that NCDs are a threat to development today and that a dual effort will only improve the length and quality of the same people they are already working to treat.

Right now at APHRC, we are in the process of implementing a community based intervention program in a Nairobi urban slum that aims to develop an efficient and effective model for primary prevention of cardiovascular diseases that is sustainable and scalable in resource poor settings. This project involves community based screening for cardiovascular disease risk, while at the same time raising awareness, through door-to-door counseling, about the dangers of unhealthy lifestyle among the urban poor, referral for those at high risk and incentive mechanisms to keep them in care and treatment. If the model proves cost-effective, it is our hope that it will be adopted by the Government of Kenya and scaled up to other slums across the country and even beyond. The project borrows from lessons learnt from HIV prevention especially on how to keep people that are not feeling sick in long term or lifelong care.

As researchers, advocates, practitioners and government officials in the global health community we must all ask ourselves, why we have prevented HIV/AIDS or treated HIV/AIDS patients for this long if those same individuals are going to die of heart disease or cancer or diabetes by middle age instead?

Thanks to Nicole Palmer, intern with the ASH project for her help in drafting this piece.