The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey
The convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health need...
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| Veröffentlicht in: | The Lancet global health 2023-09, Vol.11 (9), p.e1372-e1382 |
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| creator | Moosa, Yumna Zulu, Thando Gunda, Resign Surujdeen, Ashmika Gareta, Dickman Munatsi, Day Modise, Tshwaraganang H Dreyer, Jaco Nxumalo, Siyabonga Smit, Theresa K Ordering-Jespersen, Greg Mpofana, Innocentia B Moodley, Sashen Shen, Yen-Ju Bucibo, Sanah Baisley, Kathy J Herbst, Kobus Seeley, Janet Wong, Emily B. Olivier, Stephen Gunda, Resign Gareta, Dickman Munatsi, Day Dreyer, Jaco Nxumalo, Siyabonga Smit, Theresa K. Ording-Jespersen, Greg Khan, Khadija Sikhosana, Zizile E.L. Moodley, Sashen Khoza, Thandeka Mhlongo, Ngcebo Bucibo, Sana Nyamande, Kennedy Baisley, Kathy J. Cuadros, Diego Tanser, Frank Grant, Alison D. Hanekom, Willem A. Ndung'u, Thumbi Suleman, Mosa Jackpersad, Ramesh Mfolo, Boitsholo Buthelezi, Nompilo Ngubane, Hloniphile Ntuli, Sphiwe Zondi, Nombuyiselo Nene, Siboniso Ndlovu, Bongumenzi Ntimbane, Talente Mbuyisa, Mbali Sibiya, Melusi Ntombela, Ntombiyenkosi Dlamini, Mandisi Chonco, Hlobisile Mzimela, Nonhlahla Mthembu, Zinhle Bhengu, Thokozani Mbatha, Zamashandu Mthembu, Welcome Petros Sikhali, Mandlakayise Mkhwanazi, Ntombiyenhlahla Myeni, Rose Mfeka, Fezeka Mfeka, Nonceba Zungu, Ayanda Mfekayi, Nonhlahla Buthelezi, Mzamo Mkhwanazi, Senzeni Madolo, Tumi Nkosi, Thengokwakhe Mkhwanazi, Sibusiso Steto, Mpumelelo Mhlongo, Sibusiso Vellem, Velile Kwinda, Jabu Mthombeni, Skhumbuzo Mthembu, Sphiwe Clement Cousins, Jade Zondi, Thabile Padayachi, Nagavelli Ntshangase, Simphiwe Ngcobo, Sithembile Ndlela, Sizwe Ngema, Nomfundo Ntshakala, Nokukhanya Singh, Anupa Singh, Rochelle Pillay, Logan Govender, Asthentha Mabaso, Nondumiso Perumal, Kimeshree Zitha, Nondumiso Gqaleni, Nceba Ngcobo, Phumla Criticos, Costa Zondo, Raynold Kalyan, Dilip Ramnanan, Anand Harilall, Sashin |
| description | The convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health needs for individuals living with infectious and non-communicable diseases.
We analysed data collected between May 25, 2018, and March 13, 2020, from participants of a large, community-based, cross-sectional multimorbidity survey (Vukuzazi) that offered community-based HIV, hypertension, and diabetes screening to all residents aged 15 years or older in a surveillance area in the uMkhanyakude district in KwaZulu-Natal, South Africa. Data from the Vukuzazi survey were linked with data from demographic and health surveillance surveys with a unique identifier common to both studies. Questionnaires were used to assess the diagnosed health conditions, treatment history, general health, and sociodemographic characteristics of an individual. For each condition (ie, HIV, hypertension, and diabetes), individuals were defined as having no health needs (absence of condition), met health needs (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimisation). We analysed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution.
Of 18 041 participants who completed the survey (12 229 [67·8%] were female and 5812 [32·2%] were male), 9898 (54·9%) had at least one of the three chronic diseases measured. 4942 (49·9%) of these 9898 individuals had at least one unmet health need (1802 [18·2%] of 9898 needed treatment optimisation, 1282 [13·0%] needed engagement in care, and 1858 [18·8%] needed a diagnosis). Unmet health needs varied by disease; 1617 (93·1%) of 1737 people who screened positive for diabetes, 2681 (58·2%) of 4603 people who screened positive for hypertension, and 1321 (21·7%) of 6096 people who screened positive for HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed and unmet health needs for all three conditions had specific sites of concentration; all three conditions had an overlapping geographical pattern for the need for diagnosis.
Although people living with HIV predominantly have a well controlled condition, there is a high burden of unmet health needs for people living with hypertension and diabe |
| doi_str_mv | 10.1016/S2214-109X(23)00239-5 |
| format | Article |
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Zulu, Thando ; Gunda, Resign ; Surujdeen, Ashmika ; Gareta, Dickman ; Munatsi, Day ; Modise, Tshwaraganang H ; Dreyer, Jaco ; Nxumalo, Siyabonga ; Smit, Theresa K ; Ordering-Jespersen, Greg ; Mpofana, Innocentia B ; Moodley, Sashen ; Shen, Yen-Ju ; Bucibo, Sanah ; Baisley, Kathy J ; Herbst, Kobus ; Seeley, Janet ; Wong, Emily B. ; Olivier, Stephen ; Gunda, Resign ; Gareta, Dickman ; Munatsi, Day ; Dreyer, Jaco ; Nxumalo, Siyabonga ; Smit, Theresa K. ; Ording-Jespersen, Greg ; Khan, Khadija ; Sikhosana, Zizile E.L. ; Moodley, Sashen ; Khoza, Thandeka ; Mhlongo, Ngcebo ; Bucibo, Sana ; Nyamande, Kennedy ; Baisley, Kathy J. ; Cuadros, Diego ; Tanser, Frank ; Grant, Alison D. ; Hanekom, Willem A. ; Ndung'u, Thumbi ; Suleman, Mosa ; Jackpersad, Ramesh ; Mfolo, Boitsholo ; Buthelezi, Nompilo ; Ngubane, Hloniphile ; Ntuli, Sphiwe ; Zondi, Nombuyiselo ; Nene, Siboniso ; Ndlovu, Bongumenzi ; Ntimbane, Talente ; Mbuyisa, Mbali ; Sibiya, Melusi ; Ntombela, Ntombiyenkosi ; Dlamini, Mandisi ; Chonco, Hlobisile ; Mzimela, Nonhlahla ; Mthembu, Zinhle ; Bhengu, Thokozani ; Mbatha, Zamashandu ; Mthembu, Welcome Petros ; Sikhali, Mandlakayise ; Mkhwanazi, Ntombiyenhlahla ; Myeni, Rose ; Mfeka, Fezeka ; Mfeka, Nonceba ; Zungu, Ayanda ; Mfekayi, Nonhlahla ; Buthelezi, Mzamo ; Mkhwanazi, Senzeni ; Madolo, Tumi ; Nkosi, Thengokwakhe ; Mkhwanazi, Sibusiso ; Steto, Mpumelelo ; Mhlongo, Sibusiso ; Vellem, Velile ; Kwinda, Jabu ; Mthombeni, Skhumbuzo ; Mthembu, Sphiwe Clement ; Cousins, Jade ; Zondi, Thabile ; Padayachi, Nagavelli ; Ntshangase, Simphiwe ; Ngcobo, Sithembile ; Ndlela, Sizwe ; Ngema, Nomfundo ; Ntshakala, Nokukhanya ; Singh, Anupa ; Singh, Rochelle ; Pillay, Logan ; Govender, Asthentha ; Mabaso, Nondumiso ; Perumal, Kimeshree ; Zitha, Nondumiso ; Gqaleni, Nceba ; Ngcobo, Phumla ; Criticos, Costa ; Zondo, Raynold ; Kalyan, Dilip ; Ramnanan, Anand ; Harilall, Sashin</creator><creatorcontrib>Moosa, Yumna ; Zulu, Thando ; Gunda, Resign ; Surujdeen, Ashmika ; Gareta, Dickman ; Munatsi, Day ; Modise, Tshwaraganang H ; Dreyer, Jaco ; Nxumalo, Siyabonga ; Smit, Theresa K ; Ordering-Jespersen, Greg ; Mpofana, Innocentia B ; Moodley, Sashen ; Shen, Yen-Ju ; Bucibo, Sanah ; Baisley, Kathy J ; Herbst, Kobus ; Seeley, Janet ; Wong, Emily B. ; Olivier, Stephen ; Gunda, Resign ; Gareta, Dickman ; Munatsi, Day ; Dreyer, Jaco ; Nxumalo, Siyabonga ; Smit, Theresa K. ; Ording-Jespersen, Greg ; Khan, Khadija ; Sikhosana, Zizile E.L. ; Moodley, Sashen ; Khoza, Thandeka ; Mhlongo, Ngcebo ; Bucibo, Sana ; Nyamande, Kennedy ; Baisley, Kathy J. ; Cuadros, Diego ; Tanser, Frank ; Grant, Alison D. ; Hanekom, Willem A. ; Ndung'u, Thumbi ; Suleman, Mosa ; Jackpersad, Ramesh ; Mfolo, Boitsholo ; Buthelezi, Nompilo ; Ngubane, Hloniphile ; Ntuli, Sphiwe ; Zondi, Nombuyiselo ; Nene, Siboniso ; Ndlovu, Bongumenzi ; Ntimbane, Talente ; Mbuyisa, Mbali ; Sibiya, Melusi ; Ntombela, Ntombiyenkosi ; Dlamini, Mandisi ; Chonco, Hlobisile ; Mzimela, Nonhlahla ; Mthembu, Zinhle ; Bhengu, Thokozani ; Mbatha, Zamashandu ; Mthembu, Welcome Petros ; Sikhali, Mandlakayise ; Mkhwanazi, Ntombiyenhlahla ; Myeni, Rose ; Mfeka, Fezeka ; Mfeka, Nonceba ; Zungu, Ayanda ; Mfekayi, Nonhlahla ; Buthelezi, Mzamo ; Mkhwanazi, Senzeni ; Madolo, Tumi ; Nkosi, Thengokwakhe ; Mkhwanazi, Sibusiso ; Steto, Mpumelelo ; Mhlongo, Sibusiso ; Vellem, Velile ; Kwinda, Jabu ; Mthombeni, Skhumbuzo ; Mthembu, Sphiwe Clement ; Cousins, Jade ; Zondi, Thabile ; Padayachi, Nagavelli ; Ntshangase, Simphiwe ; Ngcobo, Sithembile ; Ndlela, Sizwe ; Ngema, Nomfundo ; Ntshakala, Nokukhanya ; Singh, Anupa ; Singh, Rochelle ; Pillay, Logan ; Govender, Asthentha ; Mabaso, Nondumiso ; Perumal, Kimeshree ; Zitha, Nondumiso ; Gqaleni, Nceba ; Ngcobo, Phumla ; Criticos, Costa ; Zondo, Raynold ; Kalyan, Dilip ; Ramnanan, Anand ; Harilall, Sashin ; Vukuzazi team</creatorcontrib><description>The convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health needs for individuals living with infectious and non-communicable diseases.
We analysed data collected between May 25, 2018, and March 13, 2020, from participants of a large, community-based, cross-sectional multimorbidity survey (Vukuzazi) that offered community-based HIV, hypertension, and diabetes screening to all residents aged 15 years or older in a surveillance area in the uMkhanyakude district in KwaZulu-Natal, South Africa. Data from the Vukuzazi survey were linked with data from demographic and health surveillance surveys with a unique identifier common to both studies. Questionnaires were used to assess the diagnosed health conditions, treatment history, general health, and sociodemographic characteristics of an individual. For each condition (ie, HIV, hypertension, and diabetes), individuals were defined as having no health needs (absence of condition), met health needs (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimisation). We analysed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution.
Of 18 041 participants who completed the survey (12 229 [67·8%] were female and 5812 [32·2%] were male), 9898 (54·9%) had at least one of the three chronic diseases measured. 4942 (49·9%) of these 9898 individuals had at least one unmet health need (1802 [18·2%] of 9898 needed treatment optimisation, 1282 [13·0%] needed engagement in care, and 1858 [18·8%] needed a diagnosis). Unmet health needs varied by disease; 1617 (93·1%) of 1737 people who screened positive for diabetes, 2681 (58·2%) of 4603 people who screened positive for hypertension, and 1321 (21·7%) of 6096 people who screened positive for HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed and unmet health needs for all three conditions had specific sites of concentration; all three conditions had an overlapping geographical pattern for the need for diagnosis.
Although people living with HIV predominantly have a well controlled condition, there is a high burden of unmet health needs for people living with hypertension and diabetes. In South Africa, adapting current, widely available HIV care services to integrate non-communicable disease care is of high priority.
Fogarty International Center and the National Institutes of Health, the Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, the South African Medical Research Council, the South African Population Research Infrastructure Network, and the Wellcome Trust.
For the isiZulu translation of the abstract see Supplementary Materials section.</description><identifier>ISSN: 2214-109X</identifier><identifier>EISSN: 2214-109X</identifier><identifier>DOI: 10.1016/S2214-109X(23)00239-5</identifier><identifier>PMID: 37591585</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Cross-Sectional Studies ; Diabetes Mellitus - epidemiology ; Female ; HIV Infections - epidemiology ; Humans ; Hypertension - epidemiology ; Male ; Multimorbidity ; Noncommunicable Diseases ; South Africa - epidemiology ; United States</subject><ispartof>The Lancet global health, 2023-09, Vol.11 (9), p.e1372-e1382</ispartof><rights>2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license</rights><rights>Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.</rights><rights>2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c468t-21c309c6cf460c9bb6cc30fc7550cd0439433fc4119a20f44988b2d8a60e50a73</citedby><cites>FETCH-LOGICAL-c468t-21c309c6cf460c9bb6cc30fc7550cd0439433fc4119a20f44988b2d8a60e50a73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,860,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37591585$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moosa, Yumna</creatorcontrib><creatorcontrib>Zulu, Thando</creatorcontrib><creatorcontrib>Gunda, Resign</creatorcontrib><creatorcontrib>Surujdeen, Ashmika</creatorcontrib><creatorcontrib>Gareta, Dickman</creatorcontrib><creatorcontrib>Munatsi, Day</creatorcontrib><creatorcontrib>Modise, Tshwaraganang H</creatorcontrib><creatorcontrib>Dreyer, Jaco</creatorcontrib><creatorcontrib>Nxumalo, Siyabonga</creatorcontrib><creatorcontrib>Smit, Theresa K</creatorcontrib><creatorcontrib>Ordering-Jespersen, Greg</creatorcontrib><creatorcontrib>Mpofana, Innocentia B</creatorcontrib><creatorcontrib>Moodley, Sashen</creatorcontrib><creatorcontrib>Shen, Yen-Ju</creatorcontrib><creatorcontrib>Bucibo, Sanah</creatorcontrib><creatorcontrib>Baisley, Kathy J</creatorcontrib><creatorcontrib>Herbst, Kobus</creatorcontrib><creatorcontrib>Seeley, Janet</creatorcontrib><creatorcontrib>Wong, Emily B.</creatorcontrib><creatorcontrib>Olivier, Stephen</creatorcontrib><creatorcontrib>Gunda, Resign</creatorcontrib><creatorcontrib>Gareta, Dickman</creatorcontrib><creatorcontrib>Munatsi, Day</creatorcontrib><creatorcontrib>Dreyer, Jaco</creatorcontrib><creatorcontrib>Nxumalo, Siyabonga</creatorcontrib><creatorcontrib>Smit, Theresa K.</creatorcontrib><creatorcontrib>Ording-Jespersen, Greg</creatorcontrib><creatorcontrib>Khan, Khadija</creatorcontrib><creatorcontrib>Sikhosana, Zizile E.L.</creatorcontrib><creatorcontrib>Moodley, Sashen</creatorcontrib><creatorcontrib>Khoza, Thandeka</creatorcontrib><creatorcontrib>Mhlongo, Ngcebo</creatorcontrib><creatorcontrib>Bucibo, Sana</creatorcontrib><creatorcontrib>Nyamande, Kennedy</creatorcontrib><creatorcontrib>Baisley, Kathy J.</creatorcontrib><creatorcontrib>Cuadros, Diego</creatorcontrib><creatorcontrib>Tanser, Frank</creatorcontrib><creatorcontrib>Grant, Alison D.</creatorcontrib><creatorcontrib>Hanekom, Willem A.</creatorcontrib><creatorcontrib>Ndung'u, Thumbi</creatorcontrib><creatorcontrib>Suleman, Mosa</creatorcontrib><creatorcontrib>Jackpersad, Ramesh</creatorcontrib><creatorcontrib>Mfolo, Boitsholo</creatorcontrib><creatorcontrib>Buthelezi, Nompilo</creatorcontrib><creatorcontrib>Ngubane, Hloniphile</creatorcontrib><creatorcontrib>Ntuli, Sphiwe</creatorcontrib><creatorcontrib>Zondi, Nombuyiselo</creatorcontrib><creatorcontrib>Nene, Siboniso</creatorcontrib><creatorcontrib>Ndlovu, Bongumenzi</creatorcontrib><creatorcontrib>Ntimbane, Talente</creatorcontrib><creatorcontrib>Mbuyisa, Mbali</creatorcontrib><creatorcontrib>Sibiya, Melusi</creatorcontrib><creatorcontrib>Ntombela, Ntombiyenkosi</creatorcontrib><creatorcontrib>Dlamini, Mandisi</creatorcontrib><creatorcontrib>Chonco, Hlobisile</creatorcontrib><creatorcontrib>Mzimela, Nonhlahla</creatorcontrib><creatorcontrib>Mthembu, Zinhle</creatorcontrib><creatorcontrib>Bhengu, Thokozani</creatorcontrib><creatorcontrib>Mbatha, Zamashandu</creatorcontrib><creatorcontrib>Mthembu, Welcome Petros</creatorcontrib><creatorcontrib>Sikhali, Mandlakayise</creatorcontrib><creatorcontrib>Mkhwanazi, Ntombiyenhlahla</creatorcontrib><creatorcontrib>Myeni, Rose</creatorcontrib><creatorcontrib>Mfeka, Fezeka</creatorcontrib><creatorcontrib>Mfeka, Nonceba</creatorcontrib><creatorcontrib>Zungu, Ayanda</creatorcontrib><creatorcontrib>Mfekayi, Nonhlahla</creatorcontrib><creatorcontrib>Buthelezi, Mzamo</creatorcontrib><creatorcontrib>Mkhwanazi, Senzeni</creatorcontrib><creatorcontrib>Madolo, Tumi</creatorcontrib><creatorcontrib>Nkosi, Thengokwakhe</creatorcontrib><creatorcontrib>Mkhwanazi, Sibusiso</creatorcontrib><creatorcontrib>Steto, Mpumelelo</creatorcontrib><creatorcontrib>Mhlongo, Sibusiso</creatorcontrib><creatorcontrib>Vellem, Velile</creatorcontrib><creatorcontrib>Kwinda, Jabu</creatorcontrib><creatorcontrib>Mthombeni, Skhumbuzo</creatorcontrib><creatorcontrib>Mthembu, Sphiwe Clement</creatorcontrib><creatorcontrib>Cousins, Jade</creatorcontrib><creatorcontrib>Zondi, Thabile</creatorcontrib><creatorcontrib>Padayachi, Nagavelli</creatorcontrib><creatorcontrib>Ntshangase, Simphiwe</creatorcontrib><creatorcontrib>Ngcobo, Sithembile</creatorcontrib><creatorcontrib>Ndlela, Sizwe</creatorcontrib><creatorcontrib>Ngema, Nomfundo</creatorcontrib><creatorcontrib>Ntshakala, Nokukhanya</creatorcontrib><creatorcontrib>Singh, Anupa</creatorcontrib><creatorcontrib>Singh, Rochelle</creatorcontrib><creatorcontrib>Pillay, Logan</creatorcontrib><creatorcontrib>Govender, Asthentha</creatorcontrib><creatorcontrib>Mabaso, Nondumiso</creatorcontrib><creatorcontrib>Perumal, Kimeshree</creatorcontrib><creatorcontrib>Zitha, Nondumiso</creatorcontrib><creatorcontrib>Gqaleni, Nceba</creatorcontrib><creatorcontrib>Ngcobo, Phumla</creatorcontrib><creatorcontrib>Criticos, Costa</creatorcontrib><creatorcontrib>Zondo, Raynold</creatorcontrib><creatorcontrib>Kalyan, Dilip</creatorcontrib><creatorcontrib>Ramnanan, Anand</creatorcontrib><creatorcontrib>Harilall, Sashin</creatorcontrib><creatorcontrib>Vukuzazi team</creatorcontrib><title>The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey</title><title>The Lancet global health</title><addtitle>Lancet Glob Health</addtitle><description>The convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health needs for individuals living with infectious and non-communicable diseases.
We analysed data collected between May 25, 2018, and March 13, 2020, from participants of a large, community-based, cross-sectional multimorbidity survey (Vukuzazi) that offered community-based HIV, hypertension, and diabetes screening to all residents aged 15 years or older in a surveillance area in the uMkhanyakude district in KwaZulu-Natal, South Africa. Data from the Vukuzazi survey were linked with data from demographic and health surveillance surveys with a unique identifier common to both studies. Questionnaires were used to assess the diagnosed health conditions, treatment history, general health, and sociodemographic characteristics of an individual. For each condition (ie, HIV, hypertension, and diabetes), individuals were defined as having no health needs (absence of condition), met health needs (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimisation). We analysed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution.
Of 18 041 participants who completed the survey (12 229 [67·8%] were female and 5812 [32·2%] were male), 9898 (54·9%) had at least one of the three chronic diseases measured. 4942 (49·9%) of these 9898 individuals had at least one unmet health need (1802 [18·2%] of 9898 needed treatment optimisation, 1282 [13·0%] needed engagement in care, and 1858 [18·8%] needed a diagnosis). Unmet health needs varied by disease; 1617 (93·1%) of 1737 people who screened positive for diabetes, 2681 (58·2%) of 4603 people who screened positive for hypertension, and 1321 (21·7%) of 6096 people who screened positive for HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed and unmet health needs for all three conditions had specific sites of concentration; all three conditions had an overlapping geographical pattern for the need for diagnosis.
Although people living with HIV predominantly have a well controlled condition, there is a high burden of unmet health needs for people living with hypertension and diabetes. In South Africa, adapting current, widely available HIV care services to integrate non-communicable disease care is of high priority.
Fogarty International Center and the National Institutes of Health, the Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, the South African Medical Research Council, the South African Population Research Infrastructure Network, and the Wellcome Trust.
For the isiZulu translation of the abstract see Supplementary Materials section.</description><subject>Cross-Sectional Studies</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Female</subject><subject>HIV Infections - epidemiology</subject><subject>Humans</subject><subject>Hypertension - epidemiology</subject><subject>Male</subject><subject>Multimorbidity</subject><subject>Noncommunicable Diseases</subject><subject>South Africa - epidemiology</subject><subject>United States</subject><issn>2214-109X</issn><issn>2214-109X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUctu1DAUjRCIVqWfAPKySBPwM4nZoKqCtqKCRQtCbCzHuSFGSTz4MSj_0o_FMy1DWeGNr-4959zHKYrnBL8imFSvryklvCRYfj2h7CXGlMlSPCoO9-nHD-KD4jiEHzg_KRmt66fFAauFJKIRh8XtzQBogoj03KE0b6MB9BgHNAN0AfXOo4vLLys0LGvwEeZg3bzaoTurW4gQkJ2RT16P6MMv_S2Nqfyoox5X6NqlrHPae2v0m0zR4xJsQK5HGhnvQigDmJj1MnVKY7ST863tbFxQSH4Dy7PiSa_HAMf3_1Hx-f27m7OL8urT-eXZ6VVpeNXEkhLDsDSV6XmFjWzbyuREb2ohsOkwZ5Iz1htOiNQU95zLpmlp1-gKg8C6ZkfF2zvddWon6AzMMa-j1t5O2i_Kaav-rcx2UN_dRhHMeU0pzgon9wre_UwQoppsMDCOegaXgqKNyFNgKbZQcQfdncBDv-9DsNq6q3buqq11ijK1c1eJzHvxcMg964-Xf7eAfKqNBa-CsTAb6KzPd1ads_9p8Rthjrd3</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Moosa, Yumna</creator><creator>Zulu, Thando</creator><creator>Gunda, Resign</creator><creator>Surujdeen, Ashmika</creator><creator>Gareta, Dickman</creator><creator>Munatsi, Day</creator><creator>Modise, Tshwaraganang H</creator><creator>Dreyer, Jaco</creator><creator>Nxumalo, Siyabonga</creator><creator>Smit, Theresa K</creator><creator>Ordering-Jespersen, Greg</creator><creator>Mpofana, Innocentia B</creator><creator>Moodley, Sashen</creator><creator>Shen, Yen-Ju</creator><creator>Bucibo, Sanah</creator><creator>Baisley, Kathy J</creator><creator>Herbst, Kobus</creator><creator>Seeley, Janet</creator><creator>Wong, Emily B.</creator><creator>Olivier, Stephen</creator><creator>Gunda, Resign</creator><creator>Gareta, Dickman</creator><creator>Munatsi, Day</creator><creator>Dreyer, Jaco</creator><creator>Nxumalo, Siyabonga</creator><creator>Smit, Theresa K.</creator><creator>Ording-Jespersen, Greg</creator><creator>Khan, Khadija</creator><creator>Sikhosana, Zizile E.L.</creator><creator>Moodley, Sashen</creator><creator>Khoza, Thandeka</creator><creator>Mhlongo, Ngcebo</creator><creator>Bucibo, 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(Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Lancet global health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moosa, Yumna</au><au>Zulu, Thando</au><au>Gunda, Resign</au><au>Surujdeen, Ashmika</au><au>Gareta, Dickman</au><au>Munatsi, Day</au><au>Modise, Tshwaraganang H</au><au>Dreyer, Jaco</au><au>Nxumalo, Siyabonga</au><au>Smit, Theresa K</au><au>Ordering-Jespersen, Greg</au><au>Mpofana, Innocentia B</au><au>Moodley, Sashen</au><au>Shen, Yen-Ju</au><au>Bucibo, Sanah</au><au>Baisley, Kathy J</au><au>Herbst, Kobus</au><au>Seeley, Janet</au><au>Wong, Emily B.</au><au>Olivier, Stephen</au><au>Gunda, Resign</au><au>Gareta, Dickman</au><au>Munatsi, Day</au><au>Dreyer, Jaco</au><au>Nxumalo, Siyabonga</au><au>Smit, Theresa K.</au><au>Ording-Jespersen, Greg</au><au>Khan, Khadija</au><au>Sikhosana, Zizile E.L.</au><au>Moodley, Sashen</au><au>Khoza, Thandeka</au><au>Mhlongo, Ngcebo</au><au>Bucibo, Sana</au><au>Nyamande, Kennedy</au><au>Baisley, Kathy J.</au><au>Cuadros, Diego</au><au>Tanser, Frank</au><au>Grant, Alison D.</au><au>Hanekom, Willem A.</au><au>Ndung'u, Thumbi</au><au>Suleman, Mosa</au><au>Jackpersad, Ramesh</au><au>Mfolo, Boitsholo</au><au>Buthelezi, Nompilo</au><au>Ngubane, Hloniphile</au><au>Ntuli, Sphiwe</au><au>Zondi, Nombuyiselo</au><au>Nene, Siboniso</au><au>Ndlovu, Bongumenzi</au><au>Ntimbane, Talente</au><au>Mbuyisa, Mbali</au><au>Sibiya, Melusi</au><au>Ntombela, Ntombiyenkosi</au><au>Dlamini, Mandisi</au><au>Chonco, Hlobisile</au><au>Mzimela, Nonhlahla</au><au>Mthembu, Zinhle</au><au>Bhengu, Thokozani</au><au>Mbatha, Zamashandu</au><au>Mthembu, Welcome Petros</au><au>Sikhali, Mandlakayise</au><au>Mkhwanazi, Ntombiyenhlahla</au><au>Myeni, Rose</au><au>Mfeka, Fezeka</au><au>Mfeka, Nonceba</au><au>Zungu, Ayanda</au><au>Mfekayi, Nonhlahla</au><au>Buthelezi, Mzamo</au><au>Mkhwanazi, Senzeni</au><au>Madolo, Tumi</au><au>Nkosi, Thengokwakhe</au><au>Mkhwanazi, Sibusiso</au><au>Steto, Mpumelelo</au><au>Mhlongo, Sibusiso</au><au>Vellem, Velile</au><au>Kwinda, Jabu</au><au>Mthombeni, Skhumbuzo</au><au>Mthembu, Sphiwe Clement</au><au>Cousins, Jade</au><au>Zondi, Thabile</au><au>Padayachi, Nagavelli</au><au>Ntshangase, Simphiwe</au><au>Ngcobo, Sithembile</au><au>Ndlela, Sizwe</au><au>Ngema, Nomfundo</au><au>Ntshakala, Nokukhanya</au><au>Singh, Anupa</au><au>Singh, Rochelle</au><au>Pillay, Logan</au><au>Govender, Asthentha</au><au>Mabaso, Nondumiso</au><au>Perumal, Kimeshree</au><au>Zitha, Nondumiso</au><au>Gqaleni, Nceba</au><au>Ngcobo, Phumla</au><au>Criticos, Costa</au><au>Zondo, Raynold</au><au>Kalyan, Dilip</au><au>Ramnanan, Anand</au><au>Harilall, Sashin</au><aucorp>Vukuzazi team</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey</atitle><jtitle>The Lancet global health</jtitle><addtitle>Lancet Glob Health</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>11</volume><issue>9</issue><spage>e1372</spage><epage>e1382</epage><pages>e1372-e1382</pages><issn>2214-109X</issn><eissn>2214-109X</eissn><abstract>The convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health needs for individuals living with infectious and non-communicable diseases.
We analysed data collected between May 25, 2018, and March 13, 2020, from participants of a large, community-based, cross-sectional multimorbidity survey (Vukuzazi) that offered community-based HIV, hypertension, and diabetes screening to all residents aged 15 years or older in a surveillance area in the uMkhanyakude district in KwaZulu-Natal, South Africa. Data from the Vukuzazi survey were linked with data from demographic and health surveillance surveys with a unique identifier common to both studies. Questionnaires were used to assess the diagnosed health conditions, treatment history, general health, and sociodemographic characteristics of an individual. For each condition (ie, HIV, hypertension, and diabetes), individuals were defined as having no health needs (absence of condition), met health needs (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimisation). We analysed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution.
Of 18 041 participants who completed the survey (12 229 [67·8%] were female and 5812 [32·2%] were male), 9898 (54·9%) had at least one of the three chronic diseases measured. 4942 (49·9%) of these 9898 individuals had at least one unmet health need (1802 [18·2%] of 9898 needed treatment optimisation, 1282 [13·0%] needed engagement in care, and 1858 [18·8%] needed a diagnosis). Unmet health needs varied by disease; 1617 (93·1%) of 1737 people who screened positive for diabetes, 2681 (58·2%) of 4603 people who screened positive for hypertension, and 1321 (21·7%) of 6096 people who screened positive for HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed and unmet health needs for all three conditions had specific sites of concentration; all three conditions had an overlapping geographical pattern for the need for diagnosis.
Although people living with HIV predominantly have a well controlled condition, there is a high burden of unmet health needs for people living with hypertension and diabetes. In South Africa, adapting current, widely available HIV care services to integrate non-communicable disease care is of high priority.
Fogarty International Center and the National Institutes of Health, the Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, the South African Medical Research Council, the South African Population Research Infrastructure Network, and the Wellcome Trust.
For the isiZulu translation of the abstract see Supplementary Materials section.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>37591585</pmid><doi>10.1016/S2214-109X(23)00239-5</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2214-109X |
| ispartof | The Lancet global health, 2023-09, Vol.11 (9), p.e1372-e1382 |
| issn | 2214-109X 2214-109X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10447220 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Cross-Sectional Studies Diabetes Mellitus - epidemiology Female HIV Infections - epidemiology Humans Hypertension - epidemiology Male Multimorbidity Noncommunicable Diseases South Africa - epidemiology United States |
| title | The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey |
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