Abstract
BackgroundEpidemiological transition in high HIV-burden settings is resulting in a rise in HIV/NCD multimorbidity. The majority of NCD risk behaviours start during adolescence, making this an important target group for NCD prevention and multimorbidity prevention in adolescents with a chronic condition such as HIV. However, there is data paucity on NCD risk and prevention in adolescents with HIV in high HIV-burden settings. The aim of this study was to investigate the extent to which NCD comorbidity (prevention, diagnosis, and management) is incorporated within existing adolescent HIV primary healthcare services in Cape Town, South Africa.MethodsWe reviewed medical records of 491 adolescents and youth living with HIV (AYLHIV) aged 10–24 years across nine primary care facilities in Cape Town from November 2018–March 2019. Folders were systematically sampled from a master list of all AYLHIV per facility and information on HIV management and care, NCDs, NCD risk and NCD-related health promotion extracted.ResultsThe median age was 20 years (IQR: 14–23); median age at ART initiation 18 years (IQR: 6–21) and median duration on ART 3 years (IQR: 1.1–8.9). Fifty five percent of participants had a documented comorbidity, of which 11% had an NCD diagnosis with chronic respiratory diseases (60%) and mental disorders (37%) most common. Of those with documented anthropometrics (62%), 48% were overweight or obese. Fifty nine percent of participants had a documented blood pressure, of which 27% were abnormal. Twenty-six percent had a documented health promoting intervention, 42% of which were NCD-related; ranging from alcohol or substance abuse (13%); smoking (9%); healthy weight or diet (9%) and mental health counselling (10%).ConclusionsOur study demonstrates limited NCD screening and health promotion in AYLHIV accessing healthcare services. Where documented, our data demonstrates existing NCD comorbidity and NCD risk factors highlighting a missed opportunity for multimorbidity prevention through NCD screening and health promotion. Addressing this missed opportunity requires an integrated health system and intersectoral action on upstream NCD determinants to turn the tide on the rising NCD and multimorbidity epidemic.
Highlights
Epidemiological transition in high HIV-burden settings is resulting in a rise in HIV/Non-communicable disease (NCD) multimorbidity
The burden of NCDs is increasing most rapidly in low- and middle-income countries (LMIC) with NCDs projected to account for nearly half of the burden of disease in low-income countries by 2030 and a four-fold higher probability of NCD-related premature deaths compared to high-income countries [2]
This study describes documentation of NCD and NCD risk screening and health promotion in HIVinfected adolescents and youth receiving antiretroviral therapy (ART) in an urban setting in South Africa
Summary
Epidemiological transition in high HIV-burden settings is resulting in a rise in HIV/NCD multimorbidity. The estimated overall cost of diabetes in sub-Saharan Africa was US$19·45 billion or 1·2% of cumulative gross domestic product in 2015 [9] with health systems unable to provide adequate management for diabetes and its associated risk factors and sequelae [9] This growing cost of NCDs is of particular concern as LMICs are grappling with higher levels of NCD at earlier stages of economic development, with fewer resources, and with less time to respond effectively [10]. This highlights the importance of a focus on prevention of NCDs through early identification of modifiable risk factors at the primary care level across the lifecourse as the most feasible and cost- effective approach to maintaining population health [11]
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