Tecla Temu, MD, PhD
Nominated From: University of Washington
Research Site: Kenya
Research Area: Cardiovascular Disease
Primary Mentor: Dr. Farquhar
Development of CVD risk reduction intervention for HIV infected individuals in Kenya
Cardiovascular diseases (CVD), particularly coronary heart disease (CHD), have become a major cause of mortality among people living with human immunodeficiency virus (PLWH) who respond well to antiviral therapy (ART) in developed countries. Individuals with HIV infection have a ~1.5-fold increased risk of myocardial infarction relative to uninfected individuals. In sub-Saharan Africa (SSA) where an estimated 22.5 million PLWH reside, the relative risk of cardiovascular diseases is unknown but similar trends are expected with the current rapid and large scale-up of ART. Epidemiologic studies reported that in addition to the HIV virus and some antiretroviral treatments, modifiable traditional risk factors such as hypertension, obesity, dyslipidemia, smoking and lack of physical activity continue to play a central role in accelerating the risk of CVD in this population. Therefore, proper control of the modifiable risk factors could substantially lessen the burden of cardiovascular diseases in PLWH.
Our preliminary research assessing cardiovascular disease (CVD) risk status and awareness in the largest HIV treatment center in Western Kenya, AMPATH, demonstrated high prevalence of those modifiable CVD risk factors, lack of awareness of CVD, and inappropriate attitudes towards heart diseases and prevention among PLWH. Despite these findings, CVD risk assessment is currently not an integrated part of care in HIV clinics in resource-limited settings (RLS). The high prevalence of CVD in people living with HIV (PLWH) in Kenya coupled with low self-risk perception and poor attitude towards prevention of heart diseases suggests a need for culturally relevant, effective, CVD risk reduction interventions for this high-risk group. To date, no theoretically driven integrated interventions have been developed and tested for HIV-infected individuals in Kenya. As a first step towards improving cardiovascular health in this population, we propose to combine lessons from the successful lifestyle modification intervention and results from the qualitative study to formulate a culturally tailored multicomponent peer mentor-led CVD lifestyle modification intervention for adults to be implemented in the HIV clinics.
The need for CVD preventive care in the HIV infected persons is particularly pressing in SSA where resources are scarce. This study hopes to develop CVD health promotion curriculum that are culturally tailored for PLWH. The integration of CVD intervention focusing on lifestyle behavior modification in the current HIV infrastructure is rare in these settings, but such integration would likely be an effective strategy to improve knowledge, personal risk perception, and self-efficacy and ultimately reduce CVD risk amongst PLWH. Indeed, a successful program could serve as a model to be implemented in other SSA countries. Primary prevention provides a cost effective opportunity to reduce CVD risk and CVD mortality.