Nav: Home

Researchers borrow from AIDS playbook to tackle rheumatic heart disease

January 22, 2018

Billions of US taxpayer dollars have been invested in Africa over the past 15 years to improve care for millions suffering from the HIV/AIDS epidemic; yet health systems on the continent continue to struggle. What if the investments and lessons learned from HIV could be used to improve care for those with other serious chronic conditions?

With this question in mind, researchers from Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, along with investigators and clinicians based in Uganda, borrowed an HIV/AIDS innovation to seek inroads against rheumatic heart disease in sub-Saharan Africa.

Usually beginning as strep throat, if untreated, rheumatic heart disease can result in severe heart damage, even death. Monthly, long-term penicillin shots usually slow down its progression and reduce mortality. While largely eliminated in developed countries, rheumatic heart disease leads to over 320,000 deaths each year in Africa, the Middle East, Central and South Asia, and the South Pacific.

The borrowed tool, the HIV treatment-cascade, features a series of distinct, sequential steps for assessing supplied care. The Case Western-led team recently published a study of 1,500-plus patients in Circulation: Cardiovascular Quality and Outcome describing its use in combating rheumatic heart disease, one of the earliest attempts to adapt the model for another serious illness.

A central premise of the cascade is that if medical sites are broadly available and not confined to one location -- usually a big city -- patients will be more likely to comply with the demanding requirements that treatment can entail, whether taking several medications daily, as with AIDS, or tolerating recurrent needle injections, as with rheumatic heart disease.

In line with this premise, a chief finding of the new study is that difficulty getting to and from care was a more significant barrier to patient progress than either obtaining prescriptions for penicillin injections or patient-adherence to the monthly shot schedule. Of the 82 percent of patients who remained alive during the study, only 57 percent stayed in care for at least a year. But of those, more than 90 percent came for their shots at least nine months of the year. As expected, a key reason patients opted out of care was physical distance from a treatment center. But the researchers also found that for every kilometer closer they were to a health center, patients were six percent more likely to continue in care. Younger patient age and latent, as opposed to active disease status, were also strong independent predictors of patient retention and optimal adherence to care requirements.

"Patients in poorer nations who develop a chronic disease, whether it's AIDS, diabetes, or rheumatic heart disease, face similar obstacles to care," said the study's lead author, Chris Longenecker, MD, assistant professor of medicine at Case Western Reserve University School of Medicine. "We wanted to use the lessons learned in improving AIDS care to do the same for people living with rheumatic heart disease. As was true for people living with HIV in the early days, those living with rheumatic heart disease often have to come to the capital of Uganda, Kampala, for treatment. This means an expensive, five-to-six hour bus ride, assuming they even have the money to pay the fare. There are also the problems of poor roads, limited literacy, and bad weather during rainy season. But beginning in 2003, people living with HIV could get their treatments in health centers more widely dispersed throughout Uganda. We adopted this approach to help address rheumatic heart disease and our study confirms that it is effective. The message is clear: We need to take services to the people."

The ground work for the study was laid in 2012 when RHD Action Uganda, a collaboration of Case Western Reserve University School of Medicine, Children's National Medical Center (Washington, DC), and Makerere University, Uganda Heart Institute, Joint Clinical Research Center, Mbarara University of Science and Technology, and Gulu University School of Medicine -- all from Uganda -- was established with funding from the Medtronic Foundation. The program works to expand access to rheumatic heart disease care throughout the country. Core components include integrating rheumatic heart disease services into existing HIV/AIDS clinics and primary health care centers, establishing new regional care centers (four to date), training local health workers to deliver rheumatic heart disease services, and developing a national registry, which now keeps track of over 1,800 patients.

Because the new analysis adjusted for distance to the nearest health center, improved retention at regional sites is also likely attributable to more staff, funding, and ancillary resources per capita dedicated to tracking patients -- resulting from the decision to decentralize care. Said Longenecker, "By offering care at the HIV/AIDS clinics, and establishing new care sites, we were able to dramatically increase care options for people living with RHD throughout the country. If efforts such as ours can be expanded throughout Africa, and low-income countries elsewhere, rheumatic heart disease can become a thing of the past in those places, as it has throughout the western world."
-end-
This study was supported by the Medtronic Global Health Foundation, National Institutes of Health, Wolf Family Foundation, and Developing Excellence in Leadership, Training, and Science Africa Initiative.

For more information about Case Western Reserve University School of Medicine, please visit: case.edu/medicine

Case Western Reserve University

Related Hiv Articles:

Defective HIV proviruses reduce effective immune system response, interfere with HIV cure
A new study finds defective HIV proviruses, long thought to be harmless, produce viral proteins and distract the immune system from killing intact proviruses needed to reduce the HIV reservoir and cure HIV.
1 in 7 people living with HIV in the EU/EEA are not aware of their HIV status
Almost 30,000 newly diagnosed HIV infections were reported by the 31 European Union and European Economic Area (EU/EEA) countries in 2015, according to data published today by ECDC and the WHO Regional Office for Europe.
Smoking may shorten the lifespan of people living with HIV more than HIV itself
A new study led by researchers at Massachusetts General Hospital finds that cigarette smoking substantially reduces the lifespan of people living with HIV in the US, potentially even more than HIV itself.
For smokers with HIV, smoking may now be more harmful than HIV itself
HIV-positive individuals who smoke cigarettes may be more likely to die from smoking-related disease than the infection itself, according to a new study published in the Journal of Infectious Diseases.
Patients diagnosed late with HIV infection are more likely to transmit HIV to others
An estimated 1.2 million people live with HIV in the United States, with nearly 13 percent being unaware of their infection.
The Lancet HIV: New HIV infections stagnating at 2.5 million a year worldwide
A major new analysis from the Global Burden of Disease 2015 study, published today in The Lancet HIV journal, reveals that although deaths from HIV/AIDS have been steadily declining from a peak in 2005, 2.5 million people worldwide became newly infected with HIV in 2015, a number that hasn't changed substantially in the past 10 years.
NIH scientists discover that defective HIV DNA can encode HIV-related proteins
Investigators from the National Institutes of Health have discovered that cells from HIV-infected people whose virus is suppressed with treatment harbor defective HIV DNA that can nevertheless be transcribed into a template for producing HIV-related proteins.
Study examines risk of HIV transmission from condomless sex with virologically suppressed HIV infection
Among nearly 900 serodifferent (one partner is HIV-positive, one is HIV-negative) heterosexual and men who have sex with men couples in which the HIV-positive partner was using suppressive antiretroviral therapy and who reported condomless sex, during a median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission, according to a study appearing in the July 12 issue of JAMA, an HIV/AIDS theme issue.
HIV vaccine design should adapt as HIV virus mutates
Researchers from UAB, Emory and Microsoft demonstrate that HIV has evolved to be pre-adapted to the immune response, worsening clinical outcomes in newly infected patients.
Charlie Sheen's HIV disclosure may reinvigorate awareness, prevention of HIV
Actor Charlie Sheen's public disclosure in November 2015 that he has the human immunodeficiency virus (HIV) corresponded with the greatest number of HIV-related Google searches ever recorded in the United States, according to an article published online by JAMA Internal Medicine.

Related Hiv Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Climate Crisis
There's no greater threat to humanity than climate change. What can we do to stop the worst consequences? This hour, TED speakers explore how we can save our planet and whether we can do it in time. Guests include climate activist Greta Thunberg, chemical engineer Jennifer Wilcox, research scientist Sean Davis, food innovator Bruce Friedrich, and psychologist Per Espen Stoknes.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...