Leveraging HIV, TB, and Malaria control programs to address NCDs – December 14-15, 2017

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Q4: What other platforms may be leveraged to screen/treat NCDs?

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    • #16016

      Tom Hall
      Moderator

      Given the magnitude of the challenges presented by NCDs, we must be creative in designing efficient and effective interventions to detect, screen, and treat these diseases. What other opportunities are there to strengthen early detection and treatment beyond service delivery platforms focused on TB, HIV, and malaria?

    • #16028

      Jane Andelman
      Participant

      Have you integrated NCD screening, detection, or treatment into child health services? Please describe.

      • #16046

        Muluken
        Moderator

        Let me say something here. In principle a patient does not come diagnosing his/her disease. It is the health worker who diagnoses the disease. In our medical education we are taught to take histories from head to toe and from the hair to the nail. We should also do our physical exam head to toe. The patient usually tells us the pressing symptoms s/he brought him to the health facility. It is our responsibility to find out if there are other diseases that might be related or un related to the current chief compliant of the patient. If we follow this established medical practice then NCDs or other disease are integrated by default for the health worker.
        At program level it is targeted in most cases. If I am working in malaria for sure I will be interested more in material, child health and general OPDs at health facility level but not directly to DM.

    • #16038

      Sarah Konopka
      Moderator

      I believe that maternal health platforms offer great opportunities for this. ANC is a very clear example that is already being leveraged to screen for diabetes, cervical cancer, hypertension, and other conditions. Integrating screenings into post-natal care and immunizations may also serve to create entry points to care. Two populations that may be harder to reach are adolescents and men. Does anyone have experience integrating services to address NCDs among these populations?

    • #16039

      Artur
      Participant

      Two populations that may be harder to reach are adolescents and men. Does anyone have experience integrating services to address NCDs among these populations?

      In Mozambique we encourage pregnant women to come with their husbands to ANCs, In this case they can also be screened HIV and Syphilis. I think its a good ground to screen for other diseases as well

      • #16047

        Muluken
        Moderator

        I agree reaching adolescents and men is always a challenge. The reasons for adolescent and men not seeking health services can vary depending on the countries situation, the disease type, urban and rural. I have one example on the TB field that might give some idea for your questions.
        Globally TB is higher among men than women. The reasons are not known exactly. The speculations are that men have no time to visit health facilities to seek care specially during the day time, or it could be other risk factors like smoking etc. One of the factors that can be amenable for intervention is giving alternative clinic hours like in the evenings so that they will go to health care when they finish their daily duty. May be also men are not well informed about disease then we should be able to design an IEC/BCC mechanisms that are suitable to men. It could be the digital technology or work place interventions.
        School health programs are effective in reaching the adolescent but it requires resources.

    • #16064

      Degu Jerene
      Participant

      Thank you Sarah for raising this important question.

      Adolescents are important key population groups for infectious disease programming (esp HIV) but there is limited experience with organized NCD services. This is a tricky age group. Most people do not realize that risk factors for adult NCDs emerge during adolescence (eg smoking). There is also a commonly held wrong perception that this age group represents a health population. As a result, this age group was not given the attention it deserved even in HIV programming. There was no adolescent age dis-aggregation in most global reports, until recently.

      I see some opportunities for integrating adolescent NCD care into existing programs. With most of perinatally HIV infected adolescents now growing to adulthood, most of these will need strong NCD services. Experiences from developed countries (eg, US) would be helpful in guiding future discussions on this topic.

      In Ethiopia, there are adolescent friendly reproductive health services given in certain clinics. These centers can be used as good entry points.

      We also attempted to organize adolescent specific services for adolescents living with HIV in selected health facilities. The magnitude of stigma among these group of patients was troubling. Also, TB burden was disproportionately high in this age group. It would be worth building on this experience to address the growing concern threat of NCDs. Here is a link to one of the publications from this experience:http://www.ingentaconnect.com/content/iuatld/ijtld/2017/00000021/00000001/art00008#

      Organizing services for men is even more challenging. Experiences from other countries would be helpful here.

    • #16068

      Amaechi Okafor
      Participant

      Networks of people living with HIV can be used as a platform to screen clients for NCDs, such as mental illnesses. PLHIV coordinators can be trained to screen their members during support group meetings which holds on monthly basis and during home visits to members. Those identified will be supported to access treatment at their usual health facility where they access ART while those with mild depression will be counselled by service providers who have been trained on the provision of psycho-social support and services to PLHIV.

      • #16072

        Tom Hall
        Moderator

        What about at the community level? Given that large segments of populations have limited access to health facilities, particularly those in rural areas, many components of health service delivery programs such as malaria, have extended activities to the community. What aspects of NCD management might be incorporated into the iCCM or related platform?

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