Establishing a Non-Communicable Disease (NCD) Screening Program at an HIV Clinic in Rural Africa

Abstract

Objectives: The objective of this study is to investigate the feasibility and outcomes of an integrated screening programme for risk factors associated with diabetes and hypertension in a busy HIV treatment clinic in rural Swaziland.
Methods: The screening programme identifies patients with risk factors for hypertension and diabetes mellitus (DM). Patients with one or more risk factor also had their blood glucose (BG) tested (random or fasting). High readings for BP or BG were referred for follow-up diagnostic tests at their local community health facility.
Results: Four hundred (6.9%) of 5,821 patients screened positive for at least one risk factor, of which most common was high body mass index (BMI) (5.5%), followed by high BP (3.2%), and relative with diabetes (0.7%). Three point six percent of patients with a risk factor had high BG, and a further 10% had a reading indicative of pre-diabetes. There were problems with patient’s attendance and information flow to/from the community facilities. Only 3.7% of patients with high BP, and 23% of patients with high BG, were known to have had full follow-up diagnostic tests. Only one patient was confirmed to have DM, and six patients were confirmed to be hypertensive.
Conclusions: This programme suggests it is feasible to integrate non-communicable diseases (NCD) screening programmes in low-resource sub-Saharan African HIV treatment services. However the known yield was low, and there were challenges to ensure follow-up diagnosis in the health centres. There is a need to do the confirmatory second test prior to a referral to community facilities for follow-up care. The screening of HIV clinic patients in this population may not be cost-effective, and a higher priority may be the general/outpatient population.