Linkage to HIV care and hypertension and diabetes control in rural South Africa: Results from the population-based Vukuzazi Study

• Type of Material: Article
• Authors: Itai M Magodoro, Emory University; Stephen Olivier, Africa Health Research Institute, Somkhele; Dickman Gareta, Africa Health Research Institute, Somkhele; Olivier Koole, Africa Health Research Institute, Somkhele; Tshwaraganang H Modise, Africa Health Research Institute, Somkhele; Resign Gunda, Africa Health Research Institute, Somkhele; Kobus Herbst, Africa Health Research Institute, Somkhele; Deenan Pillay, Africa Health Research Institute, Somkhele; Emily B Wong, Africa Health Research Institute, Somkhele; Mark J Siedner, Africa Health Research Institute, Somkhele
• Language: English
• Date: 2022-11-02
• Publisher: PLOS
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Magodoro et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pgph.0001221
• Title of Journal or Parent Work: PLOS Global Public Health
• Volume: 2
• Issue: 11
• Grant/Funding Information: This research was funded by the Wellcome Trust [grant number 201433/Z/16/A]. For the purpose of open access, the author has applied a CC BY public copyright license to any author accepted manuscript version arising from this submission. Additional support was provided by the Bill & Melinda Gates Foundation (OPP1175182), the South African Department of Science and Innovation, South African Medical Research Council, and South African Population Research Infrastructure Network to IMM. IMM received career development support from the Fogarty International Center of the National Institutes of Health (D43 TW010543). EBW receives funding from the National Institute of Allergy and Infectious Diseases (K08AI118538) and Fogarty International Center (TW011687) of the National Institutes of Health. MJS is supported by the National Institutes of Health (K24 HL166024). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: Non-communicable diseases (NCDs)
• Research Categories: Health Sciences, Public Health

Abstract

Non-communicable diseases (NCDs) account for half of all deaths in South Africa, partly reflecting unmet NCDs healthcare needs. Leveraging existing HIV infrastructure is touted as a strategy to alleviate this chronic care gap. We evaluated whether HIV care platforms are associated with improved NCDs care. We conducted a community-based screening of adults in rural KwaZulu-Natal, collecting BP, HbA1c, and health services utilization data. Care cascade indicators for hypertension and diabetes mellitus were defined as: 1) aware, if previously diagnosed, 2) in care, if seeing a provider within last 6 months; 3) treated, if reporting medication use within preceding 2 weeks; and 4) controlled, if BP<140/90mmHg or HbA1c<6.5%. We fit multivariable adjusted logistic regression models to compare successful completion of each step of the care cascade for hypertension and diabetes between people with virally suppressed HIV and HIV-negative comparators. Inverse probability sampling weights were applied to derive population-level estimates. The analytic sample included 4,933 individuals [mean age 58.4 years; 77% female]. Compared to being HIV-negative, having suppressed HIV was associated with lower adjusted prevalence of being aware (-6.0% [95% CI: -11.0, -1.1%]), in care (-5.7% [-10.6, -0.8%]), and in treatment (-4.8% [-9.7, 0.1%]) for diabetes; but higher adjusted prevalence of controlled diabetes (3.2% [0.2–6.2%]). In contrast, having suppressed HIV was associated with higher adjusted prevalence of being aware (7.4% [5.3–9.6%]), in care (8.0% [5.9–10.2%]), in treatment (8.4% [6.1–10.6%]) and controlled (9.0% [6.2–11.8%]), for hypertension. Overall, disease control was achieved for 40.0% (38.6–40.8%) and 6.8% (5.9–7.8%) of individuals with hypertension and diabetes, respectively. Engagement in HIV care in rural KwaZulu-Natal was generally associated with worse diabetes care and improved hypertension care. While further work should explore how success of HIV programs can be translated to NCD care, strengthening of primary healthcare will also be needed to respond to the growing NCDs epidemic.