Abstract
IntroductionScreening of modifiable cardiovascular disease (CVD) risk factors is recommended but not routinely provided for HIV‐infected patients, especially in low‐resource settings. Potential concerns include limited staff time and low patient acceptability, but little empirical data exists. As part of a pilot study of screening in a large urban HIV clinic in Swaziland, we conducted a time‐motion study to assess the impact of screening on patient flow and HIV service delivery and exit interviews to assess patient acceptability.MethodsA convenience sample of patients ≥40 years of age attending routine HIV clinic visits was screened for hypertension, diabetes, hyperlipidemia and tobacco smoking. We observed HIV visits with and without screening and measured time spent on HIV and CVD risk factor screening activities. We compared screened and unscreened patients on total visit time and time spent receiving HIV services using Wilcoxon rank‐sum tests. A separate convenience sample of screened patients participated in exit interviews to assess their satisfaction with screening.ResultsWe observed 172 patient visits (122 with CVD risk factor screening and 50 without). Screening increased total visit time from a median (range) of 4 minutes (2 to 11) to 15 minutes (9 to 30) (p < 0.01). Time spent on HIV care was not affected: 4 (2 to 10) versus 4 (2 to 11) (p = 0.57). We recruited 126 patients for exit interviews, all of whom indicated that they would recommend screening to others.ConclusionProvision of CVD risk factor screening more than tripled the length of routine HIV clinic visits but did not reduce the time spent on HIV services. Programme managers need to take longer visit duration into account in order to effectively integrate CVD risk factor screening and counselling into HIV programmes.
Highlights
Screening of modifiable cardiovascular disease (CVD) risk factors is recommended but not routinely provided for HIV-infected patients, especially in low-resource settings
People living with HIV (PLWH) are at higher risk for CVD compared to the general population [8], given the effects of HIV replication on inflammatory and coagulation markers [9,10] as well as the increased risk of hyperlipidemia and diabetes mellitus associated with some antiretroviral drugs [11,12,13]
We found that screening for CVD risk factors (CVDRF) using two blood pressure measurements, point-ofcare testing for HbA1c and total cholesterol, and structured interview to elicit self-reported tobacco smoking and medication use required approximately 11 additional minutes per visit, more than tripling the length of the “refill appointment” component of routine antiretroviral therapy (ART) visits
Summary
HIV remains the leading cause of death among adults in sub-Saharan Africa, the burden of cardiovascular disease (CVD) is substantial and growing [1,2], due both to the increasing prevalence of CVD risk factors (CVDRF) such as hypertension [3,4], diabetes mellitus [5], and tobacco smoking [6], and to the persistence of infectious and congenital causes of heart disease [7]. People living with HIV (PLWH) are at higher risk for CVD compared to the general population [8], given the effects of HIV replication on inflammatory and coagulation markers [9,10] as well as the increased risk of hyperlipidemia and diabetes mellitus associated with some antiretroviral drugs [11,12,13] These epidemiologic trends manifest as dual co-occurring epidemics of HIV and CVD in many countries in sub-Saharan Africa. To the best of our knowledge, there are no data available about the time required to include CVDRF screening in routine HIV care in resource-limited settings where there is a documented shortage of healthcare workers [20] To explore this issue, we conducted a time-motion study and patient exit interviews to.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
