Abstract

BackgroundThe effects of HIV and non-communicable disease (NCD) comorbidities on healthcare costs and health experiences have been documented in most high-income countries. However, little similar data are available for Zimbabwe and most countries in sub-Saharan Africa. Untreated or under-treated NCDs can potentially negate the gains achieved from the control of HIV.ObjectivesThe study sought to determine the effects of HIV-NCD comorbidity on healthcare costs, health experiences and treatment options for people living with HIV (PLWH) in Zimbabwe.MethodsA repeated-measures, quantitative study was conducted at six antiretroviral therapy (ART) sites in the Gweru District of Zimbabwe. Simple random sampling was used to enrol 100 PLWH concurrently diagnosed with hypertension and/or diabetes mellitus (cases). Cases were matched by age, sex and viral load to an equal number of PLWH without hypertension and/or diabetes mellitus (controls). Quantitative data were collected using an interviewer-administered questionnaire at monthly intervals for 6 months. The questionnaire survey sought to compare healthcare costs, health-related experiences and treatment options between cases and controls. Data were analysed using Stata Version 13.1®. A logistic model was used to examine other factors such as demographic, clinical and behavioural data that were assumed to be unchanged over the study period. A random-effects model, including costs and other covariates, was used to compare groups in the final analysis.ResultsNon-communicable disease status was associated with the length of time on ART. Cases spent significantly more on transport (p = 0.0001) and medication (adjusted odds ratio [AOR] = 4.4, 95% confidence interval [CI]: 3.2–7.3); spent more days without doing usual daily activities because of sickness (AOR = 4.2, 95% CI: 3.3–7.6) and were more likely to use alternative medication (AOR = 3.4, 95% CI: 2.3–4.6) when compared with controls. Unemployment, female gender, age of 60 years and above, and living in rural areas were associated with failure to purchase prescribed medication.ConclusionsHIV-NCD comorbidity causes an additional burden to PLWH because of increased transport costs, NCD prescribed medication expenses and more productive days lost due to illness. The success of HIV programmes does not only rely on improving access to the diagnosis and treatment of HIV. Addressing the complications of HIV-related NCDs, and the long-term costs of ART and its occasional potential for harm will be essential if health outcomes in Zimbabweans living with HIV are to be optimised.

Highlights

  • Unprecedented donor and government funding to address the HIV and AIDS pandemic resulted in more than 20 million people receiving antiretroviral therapy (ART) by mid-2017, against a total of 36.7 million people living with HIV (PLWH) worldwide.[1]

  • People living with HIV have a threefold increased risk of developing non-communicable diseases (NCDs) because of three main reasons: (1) inflammatory and infectious sequelae of HIV infection, (2) the effects of ART treatment itself and (3) the increased risk associated with ageing.[3]

  • The study compared healthcare costs, health experiences and care-related outcomes in PLWH diagnosed with HTN and/ or diabetes mellitus (DM) with a matched control group of PLWH without NCDs

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Summary

Introduction

Unprecedented donor and government funding to address the HIV and AIDS pandemic resulted in more than 20 million people receiving antiretroviral therapy (ART) by mid-2017, against a total of 36.7 million people living with HIV (PLWH) worldwide.[1] Whilst ART has markedly increased survival, PLWH have been found to be at greater risk of developing non-communicable diseases (NCDs).[2]. HIV-NCD comorbidity could have implications for healthcare costs, health experiences and survival compared with HIV alone. The effects of HIV-NCD comorbidity on healthcare costs, health experiences and treatment options have previously been documented, especially in high-income countries, this is not true for most sub-Saharan African countries, including Zimbabwe.[2] Conducting such studies provides valuable information so that targeted intervention strategies can be developed. The effects of HIV and non-communicable disease (NCD) comorbidities on healthcare costs and health experiences have been documented in most high-income countries. Untreated or under-treated NCDs can potentially negate the gains achieved from the control of HIV

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