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 start
August 2022
Main applicant and principal investigator
Prof. Tengiz Tsertsvadze, Director General, IDACIRC
Deputy applicant and deputy principal investigator
Nino Rukhadze, Infectious Diseases physician, IDACIRC
Background
Improvements in HIV treatment and care have resulted in increasing life-expectancy of people living with HIV (PLHIV) in Georgia which in turn is accompanied by increases in the prevalence of non-AIDS comorbidities (NACM). Patterns of cause-specific mortality have changed, with more persons dying from non-AIDS than AIDS related causes. The existing HIV care model has primarily focused on ART provision and management of infectious complications of HIV, provided in specialty clinics by infectious diseases physicians. While people are screened for NACMs in the HIV clinic, they may not always seek required NCD care (diagnostics and/or treatment) because of costs related to services outside of the HIV system or fear of disclosure of HIV status. The prior absence of national policies on the management of non-infectious co-morbidities among people living with HIV created a gap in the knowledge about the burden of NACM in the country. In the stage 1 project, a representative cohort was established to estimate the prevalence of cardiovascular disease (CVD), chronic kidney disease (CKD), diabetes mellitus (DM) and dyslipidemia. The stage 1 phase also facilitated the integration of EACS recommendations on the prevention and management of NACM into national guidelines. However, it remains critically important to better understand the magnitude of the problem and develop an appropriate care model.
Objective
The overall aim of the study is to improve the management of non-AIDS co-morbidities among people living with HIV in Georgia, focusing particularly on CVD, CKD and DM. The specific objectives are to 1) Expand the research cohort established in stage 1 and re-assess prevalence of NACM among PLHIV in Georgia; 2) Estimate incidence of NACM among PLHIV in the established cohort; 3) Implement a pilot integrated model of HIV/NACM care, seeking to remove barriers for patients and meet complex care needs; 4) Promote implementation of EACS recommendations on NACM prevention and management and assess the quality of service delivery in regional AIDS centers; 5) Disseminate study findings through policy recommendations for health decision-makers and a scientific publication.
Method
The cohort will be expanded from 1200 to 2000 people living with HIV for the estimation of CVD, CKD, DM and dyslipidemia prevalence and incidence (twice per year). Data on clinical events, appropriately documented in accordance with national regulations on medical recordkeeping, will be extracted from the medical charts. In addition, a patient survey will collect information from enrolled patients about awareness of NACM, risk factors, and self-reported history of NACM and treatment. For the integrated HIV/NACM care model, three NCD physicians (a cardiologist, an endocrinologist, and a nephrologist) will be consulting patients in the HIV clinic. NCD screening and diagnostics will be covered through the national AIDS treatment program within allocated funding, and NCD physician consultations will be reimbursed through funds requested from WEEPI according to scales used within the national AIDS treatment program. Quality of service delivery, including impact of the stage 1 project activities, and implementation of EACS recommendations will be assessed via audits conducted in regional AIDS centers. Leading non-communicable diseases specialists will be involved in the planning and implementation of a national training-workshop on the management of NACM in PLHIV.
Output / impact
The study will facilitate adoption of an effective and patient-centered model of care to ensure appropriate management of NACMs integrated within HIV clinic settings, and will create a solid basis for building a sustainable care model for the prevention and management of NACM, both programmatically and financially. Such a model will improve the quality of care for people living with HIV and NACM and improve access to NCD treatment. The project will also expand the partnerships between local, national and international experts that were founded in the stage 1 project and thereby contribute to strengthening the capacity of Georgian healthcare providers.