Convergence of HIV and non-communicable disease epidemics: geospatial mapping of the unmet health needs in an HIV hyperendemic community in South Africa

• Type of Material: Article
• Authors: Diego F. Cuadros, University of Cincinnati; Chayanika Devi, University of Cincinnati; Urisha Singh, University of Kwazulu-Natal; Stephen Olivier, Africa Health Research Institute; Alison C. Castle, Harvard Medical School; Yumna Moosa, Africa Health Research Institute, KwaZulu-Natal, South Africa; Jonathan A. Edwards, Emory University; Hae-Young Kim, New York University; Mark J. Sniedner, University of Kwazulu-Natal; Emily B. Wong, University of Alabama Birmingham; Frank Tanser, University of Kwazulu-Natal
• Language: English
• Date: 2024-01-04
• Publisher: BMJ
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1136/bmjgh-2023-012730
• Title of Journal or Parent Work: BMJ Global Health
• Volume: 9
• Issue: 1
• Start Page: e012730
• Grant/Funding Agency: National Institutes of Health; Fogarty International CenterCentre; Heart Lung and Blood Institute; Wellcome
• Grant/Funding Information: Research reported in this publication was supported by the Fogarty International CenterCentre (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). FT and DFC were supported by NIH grant R01 MH131480. This research was funded in whole, or in part, by Wellcome (Grant number Wellcome Strategic Core award: 201433/Z/16/A /A).
• Keywords: Diabetes; Hypertension; Geographic information systems; HIV; Epidemiology
• Subject - Topics: Public health; HIV infections

Abstract

Introduction 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 characterise the spatial structure of convergence of chronic health conditions in an HIV hyperendemic community in KwaZulu-Natal, South Africa. Methods In this cross-sectional study, we used 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 categorise participants as: diagnosed and well-controlled (Needs Score 1), diagnosed and suboptimally 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. Results The analytical sample comprised 18 041 individuals. We observed a similar spatial structure for HIV among those with combined needs Score 2–3 (diagnosed but uncontrolled) and Score 4 (undiagnosed and uncontrolled), with most PLHIV with unmet needs clustered in the southern urban and peri-urban areas. Conversely, a high prevalence of need Scores 2 and 3 for diabetes and hypertension was mostly distributed in the more rural central and northern part of the surveillance area. A high prevalence of need Score 4 for diabetes and hypertension was mostly distributed in the rural southern part of 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. Conclusions In an 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. Our study has revealed remarkable differences in the distribution of health needs across the rural to urban continuum even within this relatively small study site. The identification and prioritisation 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.