Convergence of HIV and non-communicable disease epidemics: geospatial mapping of the unmet health needs in an HIV hyperendemic community in South Africa
Year: 2024
Type: article
Study design: Observational Study
Abstract: Background: As people living with HIV (PLHIV) are experiencing longer survival, the co-occurrence of HIV and non-communicable diseases has become a public health priority. In response to this emerging challenge, we aimed to characterize the spatial structure of convergence of chronic health conditions in a HIV hyperendemic community in KwaZulu-Natal, South Africa. Methods: We utilized data from a comprehensive population-based disease survey conducted in KwaZulu-Natal, South Africa, which collected data on HIV, diabetes, and hypertension. We implemented a novel health needs scale to categorize participants as: diagnosed and well-controlled (Needs Score 1), diagnosed and sub-optimally controlled (Score 2), diagnosed but not engaged in care (Score 3), or undiagnosed and uncontrolled (Score 4). Scores 2-4 were indicative of unmet health needs. We explored the geospatial structure of unmet health needs using different spatial clustering methods. Findings: The analytical sample comprised of 18,041 individuals. We observed a similar spatial structure for HIV among those with a combined needs Score 2-3 (diagnosed but uncontrolled) and Score 4 (undiagnosed and uncontrolled), with most PLHIV with unmet needs clustered in the southern peri-urban area, which was relatively densely populated within the surveillance area. Multivariate clustering analysis revealed a significant overlap of all three diseases in individuals with undiagnosed and uncontrolled diseases (unmet needs Score 4) in the southern part of the catchment area. Interpretation: In a HIV hyperendemic community in South Africa, areas with the highest needs for PLHIV with undiagnosed and uncontrolled disease are also areas with the highest burden of unmet needs for other chronic health conditions, such as diabetes and hypertension. The identification and prioritization of geographically clustered vulnerable communities with unmet health needs for both HIV and non-communicable diseases provide a basis for policy and implementation strategies to target communities with the highest health needs. Funding: Research reported in this publication was supported by the Fogarty International Center (R21 TW011687; D43 TW010543), the National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases (K24 HL166024; T32 AI007433) of the National Institutes of Health, and Heart Lung and Blood Institute (K24 HL166024, T32 AI007433). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the funders.
Source: BMJ Global Health
Institutions: University of Cincinnati, Africa Health Research Institute, University of KwaZulu-Natal, Harvard University, Massachusetts General Hospital, Emory University, University of Lincoln, New York University, University of Alabama at Birmingham, Stellenbosch University, Centre for the AIDS Programme of Research in South Africa
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,679
Awards: G1266804287, Quantification of patterns of multimorbidity to develop effective and efficient models of HIV, TB and NCD co-care in rural South Africa, G2209152605, G2874587748, G7690570263, The changing face of HIV in the era of COVID-19: Maximising HIV incidence reduction through dynamic targeting of current and future distributions of acquisition risk., Partnership for Global Health Research Training Program(Renewal), Program for AIDS Clinical Research Training (PACRT), Mentoring patient-oriented research to improve cardiovascular health among people with HIV in sub-Saharan Africa
OpenAlex ID: W4390631686