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 Lancet. Global Health
Abstract Methods Results Supplementary Materials References Associated Data Supplementary Materials Data Availability Statement Summary Background 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. Methods 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. Findings 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. Interpretation 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. Funding 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. Translation For the isiZulu translation of the abstract see Supplementary Materials section.
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Urisha Singh, Stephen Olivier, Diego Cuadros et al.. 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 Lancet. Global Health. (2023). https://doi.org/10.1016/S2214-109X(23)00239-5 Urisha Singh, Stephen Olivier, Diego Cuadros, Alison Castle, Yumna Moosa, Thando Zulu, Jonathan Alex Edwards, Hae-Young Kim, Resign Gunda, Olivier Koole, Ashmika Surujdeen, Dickman Gareta, Day Munatsi, Tshwaraganang H Modise, Jaco Dreyer, Siyabonga Nxumalo, Theresa K Smit, Greg Ordering-Jespersen, Innocentia B Mpofana, Khadija Khan, Zinzile E L Sikhosana, Sashen Moodley, Yen-Ju Shen, Thandeka Khoza, Ngcebo Mhlongo, Sanah Bucibo, Kennedy Nyamande, Kathy J Baisley, Alison D Grant, Kobus Herbst, Janet Seeley, Deenan Pillay, Willem Hanekom, Thumbi Ndung’u, Mark J Siedner, Frank Tanser, Emily B Wong
aAfrica Health Research Institute, KwaZulu-Natal, South Africa bNelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa cSchool of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa dSchool of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa eCollege of Health Sciences, and Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa fDigital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA gDivision of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA hRagon Institute, Massachusetts General Hospital, Boston, MA, USA iHarvard Medical School, Harvard University, Boston, MA, USA jInternational Institute for Rural Health, University of Lincoln, Lincoln, UK kDepartment of Biostatistics and Bioinformatics, Rollins School of Public Health and Department of Biomedical Informatics, Emory University School of Medicine, Emory University, Atlanta, GA, USA lDepartment of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, USA mLondon School of Hygiene and Tropical Medicine, London, UK nDepartment of Pulmonology and Critical Care, Inkosi Albert Luthuli Hospital, Durban, South Africa oSchool of Public Health, University of Witwatersrand, Johannesburg, South Africa pDepartment of Science and Innovation, Medical Research Council, South African Population Research Infrastructure, Durban, South Africa qDivision of Infection and Immunity, University College London, London, UK rHIV Pathogenesis Programme, Doris Duke Medical Research Institute, Durban, South Africa sSchool of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa tDivision of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA 