| Description |
- Background: Globally, persons living with HIV (PLWH) have approximately double the risk of cardiovascular disease (CVD) compared to those without HIV. This heightened risk, ranging from myocardial infarction (MI) and stroke to decompensated heart failure, is thought to be due to vascular inflammation and increased predisposition to dyslipidemia and insulin resistance. Over the past 2 decades, the burden of HIV-associated CVD has tripled. Given the advent of effective anti-retroviral therapy (ART) and other improvements in HIV care, CVDs like MI are now the leading cause of death among PLWH worldwide. The majority of PLWH live in sub-Saharan Africa (SSA), where, despite the large burden of both HIV and cardiovascular risk factors in the region, there has been less study of CVD. Timely HIV diagnosis and treatment are critical to the reduction of HIV-associated morbidity and mortality, aligning with the 95-95-95 goals set by the Joint United Nations. Tanzania has made strides in HIV testing and treatment, but gaps persist and provider-initiated testing remains effective. This raises the question as to whether targeted, provider initiated screening methods for patients presenting with cardiovascular complaints might identify new cases of HIV. Thus, the purpose of this study was to (1) determine the prevalence of diagnosed and undiagnosed HIV infection among patients presenting to a Tanzanian emergency department with acute MI and heart failure and (2) evaluate the utility of targeted, point-of-care HIV testing for this patient population.
Methods: This study was conducted in the emergency department (ED) of Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania, covering approximately 15 million people in northern Tanzania, with a local prevalence of HIV infection at 2.6%. Participants, aged 18 years and older, presenting with chest pain or shortness of breath, were prospectively screened from November 5th, 2020, to August 18th, 2023. Trained research assistants administered a standardized survey to collect sociodemographic and clinical data, including HIV history. Those without known HIV history underwent HIV testing with subsequent counseling. Additionally, vital signs were measured, electrocardiograms conducted, and troponin-T testing performed. Final discharge diagnoses were recorded from hospital records. Follow-up at thirty days assessed vital status. Acute myocardial infarction (MI) cases were defined based on troponin levels, ECG findings, or physician diagnosis, while heart failure cases were based on physician diagnosis. Newly identified HIV cases were confirmed through specific assays. Statistical analyses were performed using the R Suite, presenting continuous variables as means and categorical variables as proportions.
Results: Pending
Conclusion: Pending
Keywords: HIV, cardiovascular disease, Tanzania, HIV Screening, Emergency Department, sub-Saharan Africa
|
|---|
