Integrating cardiovascular disease risk factor screening into HIV services in Swaziland: lessons from an implementation science study.

OBJECTIVE: To study the feasibility of cardiovascular disease risk factor (CVDRF) screening at an HIV clinic in Swaziland. METHODS: A sample of HIV-positive patients at least 40 years on antiretroviral treatment was screened for hypertension, diabetes, hyperlipidemia, and tobacco smoking. RESULTS: A total of 1826 patients were screened; 684 (39%) had at least one CVDRF. Screening volume varied markedly, and was limited by staffing, space, and supplies. DISCUSSION: CVDRF screening was feasible and prevalence of risk factors in people living with HIV at least 40 years was high.

A time-motion study of cardiovascular disease risk factor screening integrated into HIV clinic visits in Swaziland.

INTRODUCTION: Screening 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. METHODS: A 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. RESULTS: We 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. CONCLUSION: Provision 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.