Patterns of HIV, TB, and non-communicable disease multi-morbidity in peri-urban South Africa- a cross sectional study

Tolu Oni, Elizabeth Youngblood, Andrew Boulle, Nuala McGrath, Robert J Wilkinson, Naomi S Levitt, Tolu Oni, Elizabeth Youngblood, Andrew Boulle, Nuala McGrath, Robert J Wilkinson, Naomi S Levitt

Abstract

Background: Many low and middle-income countries are experiencing colliding epidemics of chronic infectious (ID) and non-communicable diseases (NCD). As a result, the prevalence of multiple morbidities (MM) is rising.

Methods: We conducted a study to describe the epidemiology of MM in a primary care clinic in Khayelitsha. Adults with at least one of HIV, tuberculosis (TB), diabetes (DM), and hypertension (HPT) were identified between Sept 2012-May 2013 on electronic databases. Using unique patient identifiers, drugs prescribed across all facilities in the province were linked to each patient and each drug class assigned a condition.

Results: These 4 diseases accounted for 45% of all prescription visits. Among 14364 chronic disease patients, HPT was the most common morbidity (65%). 22.6% of patients had MM, with an increasing prevalence with age; and a high prevalence among younger antiretroviral therapy (ART) patients (26% and 30% in 18-35 yr and 36-45 year age groups respectively). Among these younger ART patients with MM, HPT and DM prevalence was higher than in those not on ART.

Conclusions: We highlight the co-existence of multiple ID and NCD. This presents both challenges (increasing complexity and the impact on health services, providers and patients), and opportunities for chronic diseases screening in a population linked to care. It also necessitates re-thinking of models of health care delivery and requires policy interventions to integrate and coordinate management of co-morbid chronic diseases.

Figures

Figure 1
Figure 1
Distribution of HPT, DM, HIV/ART, and TB, stratified by gender across age groups among patients with prescriptions for at least one of HPT, DM, HIV/ART, and TB. Key: HPT Hypertension; DM Diabetes; ART Antiretroviral therapy; TB Tuberculosis; MM Multimorbidity.
Figure 2
Figure 2
Patterns and distribution of single, double and triple morbidities.
Figure 3
Figure 3
Proportion of patients with multimorbidity among 32 474 patients who attended the clinic and received any prescription; and the distribution of morbidities among patients with prescriptions for at least one of HPT, DM, HIV/ART, and TB. Key: HPT Hypertension; DM Diabetes; HIV/ART HIV infected patients on antiretroviral therapy; TB Tuberculosis; MM Multimorbidity.
Figure 4
Figure 4
Distribution of non-HIV morbidities among MM patients (n = 3246), stratified by sex and HIV/ART groups. Error bars show 95% confidence intervals.
Figure 5
Figure 5
Distribution of HPT and DM across age groups comparing HIV/ART MM patients to MM patients not on ART (HIV status unknown). Error bars show 95% confidence intervals.

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