HIV 2016: HIV and Non-Communicable Diseases — Opportunities and Challenges

HIV 2016: HIV and Non-Communicable Diseases — Opportunities and Challenges

Thursday, May 26, 2016

The New York Academy of Sciences

The epidemiology of HIV is changing. The extraordinary scale-up of antiretroviral therapy means that people are living longer with HIV and increased incidence of noncommunicable diseases, including cardiovascular disease, diabetes and cancers, is being observed. These co-morbidities are driven by complex interactions between the inflammatory effects of HIV, biochemical consequences of antiviral medication and the confounding effects of behavioral influences. Together, these factors are changing the pattern of morbidity and mortality among people living with HIV.

In parallel, global targets to reduce premature mortality from noncommunicable diseases by 25% by 2025 have been proposed. However, to achieve this goal, a multi-sectoral response integrating structural, behavioral and medical initiatives, cutting across many domains of both state and non-state sectors, is needed. HIV and noncommunicable diseases therefore share many programmatic imperatives in common.

In this symposium, being held as we approach the United Nations General Assembly High-Level Meeting on Ending AIDS, taking place in New York in June 2016, we will describe the changing patterns of morbidity and mortality among people living with HIV and will explore the interactions between HIV, antiretroviral medication and noncommunicable diseases and the medications used to treat them. Furthermore, we will examine the evidence for programmes to improve life expectancy and quality of life among people living with HIV, and the benefits of unifying HIV and noncommunicable disease services in a range of geographic, political and epidemiological settings.

Registration Pricing

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Nonmember (Non-profit)$105
Nonmember (Student / Postdoc / Resident / Fellow)$70

This event will also be broadcast as a webinar; there is no charge for the webinar but registration is required.

Please note: Transmission of presentations via the webinar is subject to individual consent by the speakers. Therefore, we cannot guarantee that every speaker's presentation will be broadcast in full via the webinar. To access all speakers' presentations in full, we invite you to attend the live event in New York City where possible.

Agenda

* Presentation times are subject to change.


Thursday, May 26, 2016

8:30 AM

Registration and Continental Breakfast

9:00 AM

Welcome and Opening Remarks
Sonya Dougal, PhD, The New York Academy of Sciences
Peter Godfrey-Faussett, BA, MBBS, DTM&H, FRCP (UK), UNAIDS

Session I — HIV and NCDs: Biology and Epidemiology

9:15 AM

HIV and Non-Communicable Diseases: Defining the Path Forward
Peter Godfrey-Faussett, BA, MBBS, DTM&H, FRCP (UK), UNAIDS

9:30 AM

Understanding the Extent of Excess Risk of NCDs in People with HIV Suppression on ART: an Epidemiologic Perspective
Andrew Phillips, PhD, University College London

9:50 AM

Factors Associated with Healthy versus Unhealthy Aging in HIV-Infected Adults
Steven G. Deeks, MD, University of California, San Francisco

10:10 AM

Pharmacological Interactions Between Treatment for HIV and NCDs
Saye Khoo, MB, BS, MRCP, DTM&H, FRCP, MD, GDipEpi, University of Liverpool

10:30 AM

Panel Discussion

10:50 AM

Networking Coffee Break

Session II — HIV and NCDs: Two Epidemics but One Patient

11:20 AM

TBD
Anchalee Avihingsanon, MD, The HIV Netherlands Australia Thailand Research Collaboration

11:40 AM

Lessons for NCDs from TB and HIV
Mark Harrington, Treatment Action Group

12:00 PM

Opportunities, Benefits and Challenges of Integration
Rebecca Dirks, MA, FHI360

12:20 PM

Implementing HIV NCD Integration in a Program Setting: Synergies, Opportunities and Challenges
Kwasi Torpey, MD, PhD, MPH, FGCP, FHI360

12:40 PM

Discussion

1:00 PM

Lunch

Session III — Policy and Future Directions

2:00 PM

Building on HIV/AIDS Investments for NCD Prevention and Control
Timothy Mastro, MD, FACP, DTM&H, FHI 360

2:20 PM

Panel: Cross-Organizational Implications
Maureen M. Goodenow, PhD, University of Florida Health
Roy Small, United Nations Development Programme
David Hoos, MD, MPH, Mailman School of Public Health, Columbia University

3:20 PM

Networking Coffee Break

3:50 PM

Future Directions for Research and Practice
Linda Kupfer, PhD, Fogarty International Center, NIH
Wafaa El Sadr, MD, MPH, Mailman School of Public Health, Columbia University

4:30 PM

Closing Remarks
Peter Godfrey-Faussett, BA, MBBS, DTM&H, FRCP (UK), UNAIDS

5:00 PM

Reception

6:00 PM

Adjourn

Organizers

Peter Godfrey-Faussett, BA, MBBS, DTM&H, FRCP (UK)

UNAIDS

Peter Godfrey-Faussett is a professor at the LSHTM and consultant physician at the Hospital for Tropical Diseases. After training in clinical infectious diseases and molecular genetics, he spent five years leading the Zambian AIDS-related TB (ZAMBART) project, an interdisciplinary collaborative research programme between the LSHTM, Lusaka Urban District Health Management Team and the University of Zambia. Thereafter he spent a year working with the Global Tuberculosis Programme of the World Health Organization, where he was responsible for developing strategies to address the combined epidemic of TB and HIV. Following his return to London he has maintained an interest in global policies around TB and HIV and served as chairman for the Technical Review Panel of the Global Fund against AIDS, Tuberculosis and Malaria. A regular member of WHO expert groups, his research interests remain focused on the impact that the HIV epidemic is having on TB control and on interventions to reduce both diseases. He is currently seconded full-time to UNAIDS, where he is the Senior Science Adviser with a wide ranging portfolio including HIV cure, ARV-based HIV prevention, HIV vaccines and synergies between the HIV and the non-communicable disease response.

Maureen Goodenow, PhD

University of Florida Health

Jill A. Kanaley, PhD

University of Missouri

Linda Kupfer, PhD

NIH Fogarty International Center

Dr. Kupfer has spent over a decade at the Fogarty International Center (FIC) at the National Institutes of Health. She is currently a senior scientist at the Center for Global Health Studies, FIC. Dr. Kupfer recently spent two years (2011–2013) on detail at the US State Department, Office of the Global AIDS Coordinator, as a Senior Policy Advisor. In 2006, she served as the NIH Acting Director for Evaluation in the NIH Office of the Director. Dr. Kupfer's global research interests include the integration of non-communicable and communicable diseases in health delivery systems in low and middle income countries, implementation science and program evaluation, and she is particularly interested in the role of capacity building in international research. Dr. Kupfer received her bachelor's degree in Psychology from Cornell University and her MSc and PhD in Pharmacology from Columbia University before commencing a AAAS Science Diplomacy Fellowship at the State Department. Since receiving her doctorate Dr. Kupfer has held a number of posts focused on Science and Science Policy, including Program Officer for Bilateral Science Programs at the State Department and Director of Marine Biotechnology at the National Sea Grant College Program, NOAA.

Peter Lamptey, MD, DrPH, MPH

London School of Hygiene and Tropical Medicine, Centre for Global Non-Communicable Diseases

Timothy Mastro, MD, FACP, DTM&H

FHI 360

Dr. Timothy Mastro is Director of Global Health, Population & Nutrition at FHI 360, Durham, North Carolina, USA. He trained in primary care internal medicine in New York City. He is also Adjunct Professor of Epidemiology in the Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Dr. Mastro oversees FHI 360's health, population and nutrition research and program science conducted in the United States and through FHI 360's offices in 50 countries around the world. Dr. Mastro joined FHI in 2008 following 20 years in scientific leadership positions at the US Centers for Disease Control and Prevention (CDC) in Atlanta. He joined CDC in 1988 as an Epidemic Intelligence Service Officer. At CDC his work addressed HIV, TB and STI prevention research and programs in the United States and in 25 countries in Asia, Africa and Latin America. During 1993–2000, he served in Bangkok as Director of the CDC HIV/AIDS collaboration with the Thai Ministry of Public Health. Dr. Mastro began his international public health career on the Thai-Cambodian border, where he served as a physician and medical coordinator of the United Nations Border Relief Operation.

Dr. Mastro is author or co-author of more than 160 published articles and book chapters and has served on several committees for the World Health Organization, UNAIDS, PEPFAR and the US National Institutes of Health. Dr. Mastro trained in internal medicine in New York City at Metropolitan Hospital and Mount Sinai School of Medicine. He studied at the London School of Hygiene and Tropical Medicine and received a DTM&H from the Royal College of Physicians of London. He is board certified in internal medicine, a fellow of the American College of Physicians, and a member of the American Epidemiological Society.

Celeste Sandoval, MHSS

UNAIDS

Sonya Dougal, PhD

The New York Academy of Sciences

Caitlin McOmish, PhD

The New York Academy of Sciences

Speakers

Anchalee Avihingsanon, MD

The HIV Netherlands Australia Thailand Research Collaboration

Steven G. Deeks, MD

University of California, San Francisco

Steven G. Deeks, MD, is a Professor of Medicine in Residence at the University of California, San Francisco (UCSF) and a faculty member in the Positive Health Program (AIDS Program) at San Francisco General Hospital. Dr. Deeks has been engaged in HIV research and clinical care since 1993. He is a recognized expert on HIV-associated immune dysfunction and its impact on HIV persistence (the "reservoir") and health during antiretroviral therapy. Dr. Deeks has published over 350 peer-review articles, editorials and invited reviews on these and related topics. He has been the recipient of several NIH grants, and one of the principal investigators of DARE (the Delaney AIDS Research Enterprise), which is a U19-funded international collaboratory aimed at developing therapeutic interventions to cure HIV infection. He is the co-chair of the "Towards an HIV Cure" International Working Group and a co-chair of the NIH Office of AIDS Research Research Toward a Cure Planning Group. He is also a member of the Office of AIDS Research Advisory Council (ORAC). He was elected to the American Society for Clinical Investigation (ASCI), and serves on the advisory board for Science Translational Medicine and eBioMedicine. In addition to his clinical and translational investigation, Dr. Deeks maintains a primary care clinic for HIV infected patients, and was recently a member of the Department on Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents.

Rebecca Dirks, MA

FHI360

Rebecca Dirks, MA, is a public health expert with over a decade of professional experience in program implementation, technical assistance, public health project management, and assessments of public health programs. Her expertise is in public health approaches to addressing noncommunicable disease, health service integration, HIV counseling and testing, and HIV prevention. At present Ms. Dirks serves as a Senior Technical Officer at FHI 360 in Washington, DC, where she provides technical assistance and project management for the organization's noncommunicable disease initiative. She is the Project Director of Abundant Health, a community-based hypertension and diabetes project in Vietnam and serves as a Technical Advisor for the Community-based Hypertension Improvement Project (ComHIP) in Ghana. She has contributed to a number of integrated NCD/HIV projects in African countries. Ms. Dirks has authored numerous publications on noncommunicable disease and HIV/AIDS in peer reviewed journals and presentations in international conferences. She has worked in over ten countries and is adept at working with community members and decision makers from across cultures.

Peter Godfrey-Faussett, BA, MBBS, DTM&H, FRCP (UK)

UNAIDS

Peter Godfrey-Faussett is a professor at the LSHTM and consultant physician at the Hospital for Tropical Diseases. After training in clinical infectious diseases and molecular genetics, he spent five years leading the Zambian AIDS-related TB (ZAMBART) project, an interdisciplinary collaborative research programme between the LSHTM, Lusaka Urban District Health Management Team and the University of Zambia. Thereafter he spent a year working with the Global Tuberculosis Programme of the World Health Organization, where he was responsible for developing strategies to address the combined epidemic of TB and HIV. Following his return to London he has maintained an interest in global policies around TB and HIV and served as chairman for the Technical Review Panel of the Global Fund against AIDS, Tuberculosis and Malaria. A regular member of WHO expert groups, his research interests remain focused on the impact that the HIV epidemic is having on TB control and on interventions to reduce both diseases. He is currently seconded full-time to UNAIDS, where he is the Senior Science Adviser with a wide ranging portfolio including HIV cure, ARV-based HIV prevention, HIV vaccines and synergies between the HIV and the non-communicable disease response.

Maureen M. Goodenow, PhD

University of Florida Health

Mark Harrington

Treatment Action Group

Mark Harrington was born and raised in San Francisco, CA. He studied film, photography, history and literature at Harvard, where he graduated in 1983. In 1988 he joined the AIDS Coalition to Unleash Power (ACT UP)/New York, where he was a key member of its Treatment + Data (T+D) Committee, and with whom he helped lead the 1988 "Seize Control of the FDA" and 1990 "Storm the NIH" demonstrations. In 1992 along with other members of T+D he cofounded Treatment Action Group (TAG), where he has been executive directo since 2002. He cowrote AIDS Research at the NIH: A Critical Review with Gregg Gonsalves; its recommendations were included in the NIH Revitalization Act of 1993. He cowrote Problems with Protease Inhibitor Development Plans (1995) and wrote Viral Load in Vancouver (1996). He served as a member of the U.S. panel on Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (1997-2010) and the World Health Organization (WHO) writing groups on Scaling Up Antiretroviral Therapy in Resource-Limited Settings: Treatment Guidelines for a Public Health Approach (2003, 2006), the WHO Interim policy on collaborative TB/HIV activities (2004), and Recommendations to improve the diagnosis of smear negative pulmonary and extrapulmonary TB among adults in HIV prevalent and resource constrained settings (2007). He was a member of the Global TB/HIV Working Group in the Stop TB Partnership (2003–2014) and served on New York Governor Andrew Cuomo's Ending the Epidemic Task Force (October 2014–January 2015) that developed New York's plan to end AIDS as an epidemic by 2020. Currently he is a member of the AIDS Clinical Trials Group Tuberculosis Transformative Sciences Group (ACTG TB TSG), the International AIDS Society (IAS) Stakeholders' Advisory Board for a Global Scientific Strategy Towards a Cure, and the Ending the Epidemic Subcommittee of the New York State AIDS Advisory Council. He is a member of the PEPFAR Scientific Advisory Board (SAB) and co-chairs it's TB/HIV Expert Working Group.In 1997 he was awarded a MacArthur Foundation fellowship and in 2012 the HealthGAP Evan Ruderman Global Health Justice Award.

David Hoos, MD, MPH

Mailman School of Public Health, Columbia University

Dr. David Hoos is the project director for ICAP's PHIA Project, which is conducting population-based HIV impact assessments to measure HIV incidence and viral suppression in 20 PEPFAR-supported countries. He was senior implementation director at ICAP from 2004 to 2013 and was the director of the Multicountry Columbia Antiretroviral Program (MCAP), an eight-year cooperative agreement funded by the CDC, which supported the scale-up of HIV prevention, care and treatment in Cote d'Ivoire, Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, South Africa, and Tanzania. Dr. Hoos was an initial member of the MTCT Plus Secretariat at Columbia's Mailman School of Public Health and was responsible for establishing the procurement system for antiretroviral and other HIV-associated medications and diagnostics for the program sites. Dr. Hoos has been recognized as a technical expert in a number of areas related to HIV policy and programming. He served as a member of the Technical Review Panel for the Global Fund for AIDS, TB and Malaria (GFATM), as well as a co-chair for the Procurement and Supply Management Advisory Panel to the GFATM on procurement-related policy and country guidance. He has been a member of several WHO technical panels and was seconded to UNAIDS in Geneva as a treatment advocacy advisor for eight months in 2011. Dr. Hoos is a board-certified internist and holds a Master of Public Health degree.

Saye Khoo, MB, BS, MRCP, DTM&H, FRCP, MD, GDipEpi

University of Liverpool

Linda Kupfer, PhD

Fogarty International Center, NIH

Dr. Kupfer has spent over a decade at the Fogarty International Center (FIC) at the National Institutes of Health. She is currently a senior scientist at the Center for Global Health Studies, FIC. Dr. Kupfer recently spent two years (2011–2013) on detail at the US State Department, Office of the Global AIDS Coordinator, as a Senior Policy Advisor. In 2006, she served as the NIH Acting Director for Evaluation in the NIH Office of the Director. Dr. Kupfer's global research interests include the integration of non-communicable and communicable diseases in health delivery systems in low and middle income countries, implementation science and program evaluation, and she is particularly interested in the role of capacity building in international research. Dr. Kupfer received her bachelor's degree in Psychology from Cornell University and her MSc and PhD in Pharmacology from Columbia University before commencing a AAAS Science Diplomacy Fellowship at the State Department. Since receiving her doctorate Dr. Kupfer has held a number of posts focused on Science and Science Policy, including Program Officer for Bilateral Science Programs at the State Department and Director of Marine Biotechnology at the National Sea Grant College Program, NOAA.

Andrew Phillips, PhD

University College London

Andrew Phillips is Professor of Epidemiology in the HIV Epidemiology and Biostatistics Group at UCL (http://www.ucl.ac.uk/iph/research/hivbiostatistics) working on HIV observational cohorts (including EuroSIDA, D:A:D, CASCADE, COHERE), randomized trials (including INSIGHT SMART and START trials) and simulation modelling (HIV Synthesis model). Particular areas of interest have included HIV natural progression, virologic failure, drug resistance, adverse effects of ART, and the link between HIV and risk of non-AIDS diseases. He uses an individual-based simulation model of HIV transmission, progression and the effect of ART in an attempt to address public health questions not addressable in trials or analyses of observational studies, both in developed and developing country contexts. Much of his work involves close collaboration with Copenhagen HIV Programme (CHIP).

Timothy Mastro, MD, FACP, DTM&H

FHI 360

Wafaa El Sadr, MD, MPH

Mailman School of Public Health, Columbia University

Wafaa El-Sadr is University Professor of Epidemiology and Medicine and Mathilde Krim-amfAR Professor of Global Health at Columbia's Mailman School of Public Health and College of Physicians and Surgeons.

Through ICAP at Columbia University, the Center she established more than a decade ago, large scale programs have been established in sub Saharan Africa and Asia that integrate research, education, training and practice. ICAP works closely with US government agencies, international organizations, academic institutions, private sector, community-based organizations and civil society groups in the pursuit of responsive, inclusive, sustainable and innovative approaches to addressing global health threats and achieving public health impact.

Dr. El-Sadr's research interests are diverse and include research on the prevention and treatment of HIV, tuberculosis, non-communicable diseases, maternal-child health among others. She is focused on implementation science research as a means to taking discoveries to action, ensuring that the benefits of scientific discoveries are garnered by populations around the world.

She received her medical degree from Cairo University, a masters in public health from Columbia's Mailman School of Public Health and a masters in public administration from Harvard University's Kennedy School of Government. She was named as McArthur fellow and is a member of the National Academy of Medicine.

Roy Small

United Nations Development Programme

Kwasi Torpey, MD, PhD, MPH, FGCP

FHI360

Kwasi Torpey is a physician, public health program manager, researcher and an Associate Professor of Population, Family and Reproductive Health with 19 years of experience in public health programming in HIV, malaria, TB, reproductive health and non-communicable disease programs in several African countries

Professor Torpey served as Deputy Chief of Party, Technical for FHI360's USAID-funded Strengthening Integrated Delivery of HIV/AIDS (SIDHAS) project in Nigeria. Before this position, he was the Regional Senior Technical Advisor and Director, Technical Support for FHI/Zambia where he provided support to country programs in Africa. He has extensive experience in public health programming and implementation in HIV, malaria, TB and reproductive at different levels of the health care system as well as the community level in a number of African countries.

Professor Torpey has been a global thought leader in the integration of non-communicable diseases and reproductive health into HIV programming. He has published several scientific articles in international peer reviewed journals Professor Torpey received his medical training from the University of Ghana Medical School. He received his PhD from the Institute of Tropical Medicine/University of Antwerp in Belgium. He is a fellow of the Ghana College of Physicians and Surgeons.

Sponsors

Presented by

  • UNAIDS
  • The New York Academy of Sciences

Note: The HIV 2016: HIV and Non-Communicable Diseases — Opportunities and Challenges symposium is cosponsored by the Joint United Nations Programme on HIV/AIDS (UNAIDS). The views expressed in symposium materials or publications, by speakers and moderators, or by any symposium cosponsors do not necessarily reflect the official views or policies of UNAIDS; nor does mention of trade names, commercial practices, or organizations imply endorsement by UNAIDS.

Premiere Supporter

  • Pfizer

Grant Support

This program is supported by an educational grant from Gilead Sciences, Inc.

Promotional Partners

GAVI – The Vaccine Alliance

Global Health Strategies

Global HIV Vaccine Enterprise

International AIDS Vaccine Initiative (IAVI)

Journal of Clinical Virology

NCD Alliance

NCD Child

Abstracts

Understanding the Extent of Excess Risk of NCDs in People with HIV Suppression on ART: an Epidemiologic Perspective
Andrew Phillips, PhD, UCL, London

With good adherence and lack of pre-existing drug resistance, antiretroviral treatment is successful in suppressing HIV replication and leading to a gradual reversal of CD4 count immunodeficiency. There is concern, however, that even with long term virally suppressive ART there remains a residual on-going excess risk of non-communicable diseases, particularly including cardiovascular disease and diabetes (NCDs). This presentation will briefly discuss the potential sources of excess NCD risks due to HIV in people with viral suppression. These include HIV related exposures such as currently having a sub-normal CD4 count level, on-going inflammation and low previous CD4 count nadir / high previous cumulative viremia, and ART related exposures, considering both enduring effects of drugs a person has used in the past as well as those currently used. Also discussed will be studies that compare HIV positive people with selected controls of uninfected people, or with the general population. Such studies are important for helping us understand the extent of excess NCD risk, although the high potential for bias due to unmeasured confounding in such studies will be highlighted.

Factors Associated with Healthy versus Unhealthy Aging in HIV-Infected Adults
Steven G. Deeks, MD, University of California, San Francisco

Motivated individuals who can access and adhere to modern antiretroviral treatment regimens (ART) can expect to achieve life-long suppression of HIV replication. This in turn typically leads to improvement in immune function and over time and near-complete protection from developing classic AIDS-related infectious complications. Antiretroviral-treated HIV infection is now a chronic manageable disease.
 
Although the health of those who can access therapy is dramatically improved, there are residual concerns. Effectively treated HIV infected adults have a largely unexplained excess risk for several age-associated complications, including cardiovascular disease, osteopenia, cancer, liver dysfunction, renal dysfunction, and neurocognitive disease. Much of this excess risk is due to a greater burden of traditional risk factors—particularly tobacco use and obesity—but other factors are expected to contribute to these diseases, including antiretroviral drug toxicity and persistent immune dysfunction and inflammation. Indeed, the immune system during ART shares some similarities with that seen in the very old ("immunosenescence"). A number of the immunologic markers know to predict morbidity and mortality in the geriatric population are more present in relatively young (middle-aged) adults with treated HIV disease.
 
In addition to these concerns about co-morbidity, there are growing concerns in the popular and scientific press that HIV infection and/or its treatment affects "aging." That the biology of aging might be affected by HIV is perhaps not surprising, as many of the biologic factors known to influence cell and tissue aging are common in this disease (e.g., mitochondrial toxicity, metabolic abnormalities, telomere shortening, inflammation, stem cell dysfunction).
 
Geriatricians define aging in part as the inability to compensate to stressors. This failure to compensate is due in part to a redundancy in the various systems which contribute to normal day-to-day function. Peripheral neuropathy, for example, contributes to motor function, and dysfunction in this system might result in excess risk of classic geriatric syndromes, including incontinence, falls and frailty. A number of factors are known to predict the early onset of these geriatric syndromes. These include mutli-morbidity, polypharmacy, poverty, substance abuse and social isolation. All of these are common in many if not all of populations at risk for HIV infection.
 
It is hoped that awareness of these concerns will result aggressive preventative interventions. Strategies to enhance healthy aging will be discussed.

Pharmacological Interactions Between Treatment for HIV and NCDs
Saye Khoo, MB, BS, MRCP, DTM&H, FRCP, MD, GDipEpi, University of Liverpool

HIV-infected people are ageing. The rising prevalence of NCDs across high, middle and low-income settings means that multi-morbidity (MM) and polypharmacy (PP) are common. Yet, clinical guidelines do not adequately cater for HIV-infected people with MM. PP is associated with risk of harms, particularly in those who are clinically frail. The first step in limiting these risks is to acquire a complete medication history, and studies have repeatedly shown that medication records incompletely capture what HIV-infected individuals actually take. For example, UK Treatment Standards require as a minimum that a full medicines reconciliation should take place annually.
 
The risk-benefit of therapy needs to be individually tailored in patients with MM. Several tools exist to guide prescribing and de-prescribing in elderly patients (eg Beer's Criteria, STOPP-START, and UK NICE Guidelines on Multiple Morbidities [in draft 2016]). None are specifically tailored to HIV. Recognition of drug-drug interactions (DDI) against a background of increasing amount and complexity of co-medications is aided by use of available electronic prescribing support resources. These should not only alert the prescriber to potential DDIs but also aid selection of more appropriate alternatives. Examples of DDIs involving antithrombotic drugs, metformin, and how co-morbidities may affect the risk of developing harm from DDIs will be provided.

Implementing HIV and NCD Integration in Program Settings: Synergies, Opportunities, and Challenges
Kwasi Torpey, MD, PhD, FHI 360, Durham and Washington DC; University of Ghana College of Health Sciences

Cardiovascular Disease (CVD) is a leading cause of morbidity and mortality globally and accounts for nearly 30% of deaths in low- and middle-income countries. The burden of chronic CVD is growing and will continue to place an increasing burden on the health care systems as well as individuals, families and affected communities. HIV-infected persons are at increased risk of CVD due to the actions of the virus as well as adverse effects of antiretroviral drugs.
 
FHI 360's has developed programs to integrate NCD and HIV services Kenya, Nigeria and Zambia. In Kenya the CVD/HIV Pilot operates through a partnership between the Ministry of Health, the Kenya Cardiac Society and USAID. Findings from the Pilot show that healthcare providers and clients valued the addition of CVD and diabetes services. In Nigeria the CVD/HIV program began as a small pilot project within the USAID-funded Global HIV/AIDS Initiative Nigeria (GHAIN). Due to the success of CVD control integration within the context of an HIV chronic care model the program has been scaled up in all Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS)-supported health facilities in the country. In Zambia integrated chronic care screening integration operates in collaboration with the Government through the USAID-funded Zambia Care and Treatment Partnership (ZPCT II) project.
 
The CVD integration models in Kenya, Nigeria and Zambia have demonstrated the feasibility of leveraging HIV care and treatment infrastructure to manage other chronic diseases.
 
Coauthors: Peter Lamptey1,3, Rebecca Dirks1, and Timothy D. Mastro1.
 
1. FHI 360, Durham and Washington DC.
2. University of Ghana College of Health Sciences.
3. London School of Hygiene and Tropical Medicine.

Building on HIV/AIDS Investments for NCD Prevention and Control
Timothy D. Mastro, MD, FHI 360, Durham and Washington, DC

Over the last two decades, unprecedented disease control investments have been made to prevent and treat HIV infection and AIDS. HIV is now a chronic condition requiring lifelong treatment. Health systems in many resource limited settings have been strengthened to manage HIV care and treatment; in many such settings HIV treatment has been the first chronic disease program established. NCDs must be managed in people living with HIV infection and can be managed in the much larger HIV-uninfected population, building on the progress made addressing HIV.
 
FHI 360 has integrated into HIV programs services to diagnosis and treat cardiovascular diseases (CVD), diabetes, cervical cancer and mental illness in several countries, including Ghana, Kenya, Nigeria, Vietnam, and Zambia. In Ghana, we developed a community-based hypertension management program and CVD screening, referral and treatment for a general outpatient population.
 
The cascade of prevention, screening, diagnosis, linkage to care and treatment that has been demonstrated to be effective for guiding HIV management has been adapted for NCD management. Large scale, community-based HIV control programs in Africa have integrated NCD diagnosis and treatment into the system. These offer platforms upon which to build feasible, sustainable, and cost-effective community-based models for controlling NCDs at the population level. Implementation science approaches can be used to refine modalities to enhance the various steps in the NCD prevention and treatment cascade.
 
Coauthors: Rebecca Dirks, Kwasi Torpey, and Peter Lamptey; FHI 360, Durham and Washington, DC.

Future Directions for Research and Practice
Linda Kupfer, PhD, Fogarty International Center, NIH
Wafaa El Sadr, MD, MPH, Mailman School of Public Health, Columbia University

The National Institutes of Health (NIH), in collaboration with the President's Emergency Plan for AIDS Relief (PEPFAR) and LMICs, is leading a project to articulate research priorities to incorporate prevention, care, and treatment for non-communicable diseases (NCDs) into HIV/AIDS platforms in low- and middle-income countries (LMICs). PEPFAR-NCD Project focuses on people living with HIV (PLHIV), many of whom are being treated successfully for HIV, but who are increasingly experiencing co-morbid preventable and treatable NCDs.
 
Today's talk will present the research questions generated during the April 2016 PEPFAR-NCD Project sponsored workshop held at the NIH in Bethesda Maryland. At this workshop, scientists, policy makers, and implementers of HIV-NCD enhanced model programs in LMICs met to discuss best practices, gaps in knowledge, and research needs which would enable scale up of these pilots. The results of expert panels and small working groups at this workshop as well as two earlier meetings and an initial landscape analysis resulted in the list of priority research questions which will be reported. This presentation will be framed by the ground breaking 2011 publication by M. Rabkin and W. El-Sadr " Why reinvent the wheel? Leveraging the lessons of HIV scale-up to confront non-communicable diseases." (1)
 
1. Miriam Rabkin & Wafaa M. El-Sadr (2011) Why reinvent the wheel? Leveraging the lessons of HIV scale-up to confront non-communicable diseases. Global Public Health, 6:3, 247-256, DOI: 10.1080/17441692.2011.552068

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