Abstract
BackgroundThere are marked inconsistencies in prevalence data for human immunodeficiency virus and non-communicable disease (HIV-NCD) comorbidity in Zimbabwe.ObjectivesTo explain these discrepancies, we investigated the capacity of antiretroviral therapy (ART) sites in managing hypertension (HTN) and diabetes mellitus (DM) in people living with HIV (PLWH) in Gweru district, Zimbabwe.MethodThis was a qualitative research design in which key informant interviews were conducted with eight health managers, and 12 focus group discussions (FGDs) were conducted with 72 PLWH concurrently diagnosed with HTN and/or DM. Thematic data analysis was performed in NVivo version 12®.ResultsRoutine screening for HTN and targeted screening for DM were often interrupted by dysfunctional machines and intermittent supply of necessary consumables, impacting negatively on the capacity of the sites to monitor and screen for the NCDs. Erratic hypertensive and diabetic medication availability at study sites were also reported, forcing patients to turn to other treatment options (medication rationing or overdose or sharing, use of home remedies and traditional medicines, and reliance on faith and traditional healers).ConclusionFindings demonstrate that the quality of observed incidence and prevalence data for HTN and DM in LMICs is a function of the capacity of health centres to screen for NCDs. Given the ageing population of PLWH in sub-Saharan Africa, coupled with increasing trends in the prevalence of NCDs in HIV-infected people, HIV programmes have not evolved with the changing needs of PLWH. Attention to the holistic management of PLWH is long overdue.
Highlights
Unprecedented global improvement in enabling access to antiretroviral therapy (ART) by people living with human immunodeficiency virus (PLWH), contributing to increased viral suppression and increased survival in PLWH, is well documented.[1]
By the end of 2018, more than 61% of the 37.9 million PLWH, globally, were accessing ART, which is a substantial increase from 45% in 2010.1 Over the same period, acquired immunodeficiency syndrome (AIDS)-related deaths decreased by about 45%,1 thereby demonstrating the significant contribution of ART to increased survival in PLWH
While there is empirical evidence showing the positive contribution of ART to improved survival in PLWH, new threats associated with non-communicable diseases (NCDs) co-existing with human immunodeficiency virus (HIV) in PLWH have emerged.[2]
Summary
Unprecedented global improvement in enabling access to antiretroviral therapy (ART) by people living with human immunodeficiency virus (PLWH), contributing to increased viral suppression and increased survival in PLWH, is well documented.[1]. While there is empirical evidence showing the positive contribution of ART to improved survival in PLWH, new threats associated with non-communicable diseases (NCDs) co-existing with human immunodeficiency virus (HIV) in PLWH have emerged.[2] This co-existence is likely to impact negatively on the gains already achieved in controlling HIV, especially in many low- to middle-income countries (LMICs) where the majority of PLWH on ART live and where health care systems are known to be fragile.[2] The real effects of NCDs co-existence with HIV in PLWH in many settings may be undermined by the lack of accurate data to understand this phenomenon fully. There are marked inconsistencies in prevalence data for human immunodeficiency virus and non-communicable disease (HIV-NCD) comorbidity in Zimbabwe
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