The burden of non-communicable diseases like hypertension and diabetes is increasing globally, especially in low-income and middle-income countries where they occur alongside epidemics of communicable diseases like HIV.
This is according to a study -“The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey” by Emily Wong, Urisha Singh, Stephen Olivier, Diego Cuadros, et al – that appeared in The Lancet Global Health.
Here, the researchers analyzed data from the community-based, cross-sectional multimorbidity Vukuzazi survey of 18,041 participants collected from 2018 to 2020. The framework created by the researchers gave the following needs scores to five health states for each disease: 0, free of the condition; 1, diagnosed, engaged in care and optimally treated; 2, diagnosed, engaged in care and sub-optimally treated; 3, diagnosed but not engaged in care; and 4, undiagnosed but had a positive screening test in the Vukuzazi study. The rural area surveyed — covering about 185 square miles — has high HIV prevalence, but antiretroviral therapy has been available through public health clinics since 2004.
Researchers found that 54.9% of the 18,041 participants, or 9,898 people, had had at least one of the three chronic diseases measured. Of these 9,898 people, 49.9% had at least one unmet health need — 18.2% needed treatment optimization, 13.0% needed engagement in care, and 18.8% needed a diagnosis.
Unmet health needs varied by disease — there were unmet health needs in 93.1% of the 1,737 people who screened positive for diabetes, in 58.2% of the 4,603 people who screened positive for hypertension, and in 21.7% of the 6,096 people who screened positive for HIV. Geospatially, the met health needs for HIV were widely distributed, while the unmet health needs for all three conditions had specific sites of concentration.
“This analysis revealed a discrepancy between the ability of the… health system to respond to the health needs of people with communicable diseases and the health needs of people with non-communicable diseases — 11.5% of participants with only HIV required a diagnosis, whereas 33.1% of participants with HIV and a comorbid non-communicable disease required a diagnosis,” Wong said. As such, the results “highlight the substantial need for improved non-communicable disease care in rural (places). With health systems currently reaching a wide target population for HIV care, creative adaptation of existing health programs and frameworks could be successful in treating multiple chronic diseases concurrently.”
