2209 4526 1 SM

206 From Communicable to Noncommunicable Diseases and Injuries
Summary/Conclusion: While laypersons and hospital personnel Structure/Method/Design: We collected data on patients seen by
may receive and feel comfortable administering basic resuscitation HIV specialists on outreach to nine hospitals in southern Botswana.
techniques, further data must be collected to see if this intervention At each site, specialists saw outpatients referred by local general
improves mortality. Analysis of the newly implemented trauma reg- practitioners. Data collected from each encounter included HIV sta-
istry will evaluate mortality. tus and the reason for the encounter. Statistical analysis included
descriptive analyses and c2 test for categorical variables.
Results (Scientific Abstract)/Collaborative Partners (Program-
Esophageal cancer in Northern Tanzania: Geographical matic Abstract): Between March 2011 and February 2012, outreach
distribution and case characteristics physicians recorded 400 outpatient encounters. 56% (224/400) of
O.M. Munishi; Kilimanjaro Christian Medical Center, Community encounters occurred at primary hospitals and 44% (176/400) at
medicine, Moshi/TZ district general hospitals.
The majority (69%) of patients seen by specialists presented with
Structure/Method/Design: This was a descriptive retrospective two or more medical problems. The most frequent medical problems
study of histologically confirmed cases of esophageal cancer diagnosed encountered included hypertension, (17.5%, n ¼ 70), diabetes mel-
at the Kilimanjaro Christian Medical Centre, and identified through litus (8%, n ¼ 32), and congestive cardiac failure (5%, n ¼ 19).
its Cancer Registry and/or endoscopy unity, from 1998 to 2008. Cardiovascular diseases accounted for 29% of all diagnoses, neuro-
Demographic data (age, sex, village) were obtained from hospital re- logical diseases 15%, and endocrine diseases 12%. There was no
cords and a risk-factor questionnaire was administered to patient’s difference in either the spectrum of disease or the complexity of
relatives. medical problems seen at district versus primary hospitals.
Results (Scientific Abstract)/Collaborative Partners (Program- 27% of encounters were with patients with confirmed HIV
matic Abstract): 802 patients were diagnosed with esophageal cancer infection, the remainder had either unknown HIV status (32%, n ¼
during the study period, the majority of which was squamous cell car- 129) or were HIV-uninfected (40.3%, n ¼ 161). Among individuals
cinoma. 59% of cases were male. Mean age at diagnosis was 60 years with confirmed HIV-infection, 41% (n ¼ 41) of consultations related
(inter-quartile range 50-70). The age-standardized incidence rates (ASR to HIV management. The other most frequently encountered di-
to world population per 100,000) were 6.8 and 3.8 in men and women agnoses among HIV-infected individuals included hypertension
respectively. Large geographical variations were observed. ASRs were (10%), tuberculosis (7%), diabetes (5%), and meningitis (5%).
over 9 in men in Moshi Urban, Moshi Rural, and Hai and less than 3 in Summary/Conclusion: Over a 12-month period, physicians in
Rombo, Mwanga and Same districts. 96% of male cases and 92% of BUP’s outreach program saw a significant number of patients with
female cases had drank alcohol regularly; 38% and 5% had consumed NCDs at nine Botswana outreach facilities. Most patients were not
strong illicit moonshine spirits (gongo). Amongst drinkers, drinking HIV-infected and the most frequent conditions seen by physicians
started at mean age of 13 years, with 25% having started by age 8 and were hypertension, diabetes, and congestive cardiac failure.
mean lifetime years of drinking was 50 (SD 15.6). 87% of male and 36% This study is limited by referral bias. Nevertheless, the analysis
of female cases had smoked tobacco regularly. demonstrates how PEPFAR funding ensured access to physician con-
Summary/Conclusion: Within the high esophageal cancer area of sultations for NCDs as well as HIV. The data also supports growing
the Kilimanjaro region, the south and western districts adjacent to the evidence that Botswana faces a double-burden of infectious and non-
Kilimanjaro mountain peak have over 3-fold higher incidence rates infectious diseases. Given this epidemiologic transition, leveraging
than other districts in the region. Prevalence of alcohol and tobacco PEPFAR funded HIV-programing to expand access to care for patients
consumption is higher among cases than in previous population with NCDs is increasingly important. While long-term follow up is
surveys. These findings need further investigation in a broader necessary to assess the impact of PEPFAR on NCD services in Botswana,
analytical study. there is also an urgent need to build NCD capacity across the country.
Leveraging PEPFAR-funded HIV programming to Double-dipping: When your research answers

enhance to delivery of NCD care in southern Botswana unintended questions
M.J.A. Reid1, M. Haas2, M. Haverkamp1, P. Sedigeng1, W. Moloi3, A. Unger1, M. Reis2, A.I. Ko3; 1University of California San Francisco,
D. Ramogola-Masire1, H. Friedman2, A. Ho-Foster1; 1University of Medicine, San Francisco, CA/US, 2Oswaldo Cruz Foundation/Yale
Pennsylvania, Botswana-UPenn Partnership, Gaborone/BW, 2University School of Public Health, Salvador/BR, 3Yale School of Public Health,
of Pennsylvania, Botswana-UPenn Partnership, Philadelphia, PA/US, Epidemiolgy of Microbial Diseases, New Haven, CT/US
3
University of Botswana, School of Medicine, Department of Medicine,
Background: Global health research invests tremendous human
Gaborone/BW
and material resources into resource-poor settings. The scientific
Background: Botswana’s HIV prevalence is 19%, with antiretroviral model and the nature of IRB approval demand specific research hy-
drugs available to all eligible citizens. Through the President’s potheses, measured and carefully applied methods, and protection of
Emergency Plan for AIDS Relief (PEPFAR), the Botswana-UPenn participatnts and their health information. However, frequently the
Partnership (BUP) has provided HIV support to rural hospitals study of specific diseases leads to the collection of information that
across the country since 2006. Since the program’s inception, BUP’s may be relevant to other health problems. The investment to study
outreach has extended support to outpatient care for non- disease in often marginalized or hard-to-reach populations is sub-
communicable diseases (NCDs) to both HIV-infected and HIV-un- stantial, and the potential to use data collected, and resources created,
infected adults. Little data exists on how PEPFAR programming in for other purposes is an important consideration.
Africa impacts on the care for NCDs. We sought to describe the Structure/Method/Design: Our team has developed a community-
burden of disease referred to HIV specialists on outreach to hospitals based research project in 2003 in a large urban slum of 14,000
in southern Botswana. residents, called Pau da Lima, on the periphery of Salvador, the

2209 4526 1 SM

Uploaded by

Copyright:

Available Formats

2209 4526 1 SM

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2209 4526 1 SM

Uploaded by

Copyright:

Available Formats

206 From Communicable to Noncommunicable Diseases and Injuries

Leveraging PEPFAR-funded HIV programming to Double-dipping: When your research answers

You might also like