Improving management of non-AIDS comorbidities among people living with HIV in Georgia
Grantee
Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC), Georgia
Project status: Completed
Main applicant and principal investigator
Prof. Tengiz Tsertsvadze, Director General, IDACIRC
Deputy applicant
Pati Gabunia, Head of HIB inpatient department, IDACIRC
Background
Increasing life-expectancy of people living with HIV (PLHIV) is accompanied by increases in the prevalence of non-AIDS comorbidities (NACM). Georgia has made significant accomplishments in effective delivery of HIV treatment and care. Patterns of cause-specific mortality has been changing following universal availability of HIV antiretroviral therapy (ART), with more persons dying from non-AIDS than AIDS related causes. However, little is known about the burden of NACM in Georgia. The existing HIV care model has primarily focused on ART provision and management of infectious complications of HIV. Management of NACM has not been integrated in national guidelines. It is therefore critically important to better understand the magnitude of the problem and develop an appropriate care model to effectively tackle the expected impact of NACM on clinical outcomes.
Objective
The study objective was to assess the prevalence of non-AIDS co-morbidities among HIV patients in Georgia, aiming to improve the management of NACM, particularly cardiovascular disease (CVD), chronic kidney disease (CKD) and diabetes mellitus (DM), and to integrate management of NACM into national guidelines.
Methods
The study enrolled 1,200 HIV patients into a representative cohort for the estimation of CVD, CKD, DM and dyslipidemia prevalence. It was based on routinely available data from medical records supplemented by a patient survey. EACS recommendations on managing NACM will be implemented and adapted to the Georgian setting, and actual service delivery was assessed by auditing medical records.
Results
The prevalence of hyperlipidemia was higher in the cohort of PLHIV compared with the general population. On the contrary, a higher prevalence of arterial hypertension and diabetes was found in the general population compared with the group of PLHIV. A national training workshop on the clinical management of NACM was conducted with participation of 23 HIV clinicians, experts in non-communicable diseases and a leading European expert from EACS. A clinical audit was conducted, leading to the implementation of new clinical quality assessment procedures.
Conclusions / impact
The study facilitated the adaption and integration of EACS recommendations on the prevention and management of non-AIDS co-morbidities into national HIV guidelines, approved by the Minister of health in Georgia It also helped establish new partnerships locally and internationally for improved sustainability, supported capacity building for Georgian HIV care providers and introduced new clinical quality assessment procedures. The finding that prevalence of arterial hypertension and diabetes was higher in the general population than in PLHIV is highly atypical and needs further investigation.
More information
A full publication entitled ‘The prevalence of non-AIDS comorbidities among people living with HIV in Tbilisi, Georgia’ is forthcoming and will be made available here once published.
The study findings have also been disseminated through meeting presentations, including:
Gabunia P, Nozadze T, Chokoshvili O, Chkhartishvili N, Tsertsvadze T. Assessment of the actual service delivery regarding non-AIDS comorbidities among people living with HIV by auditing of medical records in Georgia. Oral presentation. National AIDS meeting (online meeting), 2-3 February 2022.