Prevalence, healthcare costs and management of non-communicable diseases in people living with human immunodeficiency virus: A scoping review.

Laston Gonah,Khumbulani Hlongwana,Indres Moodley

doi:10.4102/phcfm.v12i1.2474

Abstract

BackgroundCoexistence of human immunodeficiency virus (HIV) and non-communicable diseases (NCDs) is an important public health issue of increasing concern. However, the prevalence, healthcare costs and management protocols for NCDs in people living with HIV (PLHIV) remain unclear in most settings.AimTo scope evidence on prevalence, healthcare costs and disease management protocols associated with NCDs in PLHIV from studies published before July 2019.MethodsElectronic databases were searched for published articles, and reference lists were checked for relevant studies. Key terms included were HIV/AIDS, co-morbidity or multi-morbidity, NCDs, healthcare costs, treatment protocols, diabetes mellitus, hypertension in various combinations.ResultsA total of 152 records were assessed, and thereafter 25 studies were included in the final review after all the elimination. Twelve of the 25 studies mostly reported prevalence of NCDs in PLHIV, 4 reported impact of HIV–NCD co-morbidity on healthcare costs and 1 reported management protocols and capacity of antiretroviral therapy (ART) sites to manage HIV–NCD co-morbidity.ConclusionsResults showed higher prevalence rates of diabetes mellitus and hypertension in PLHIV compared with HIV-negative people. However, there was inconsistency in NCD prevalence data from studies conducted in sub-Saharan African (SSA) countries, and limited research evidence on capacity of ART sites to manage NCDs in PLHIV. Low prevalence rates of NCDs reported in SSA countries could be an indication of limited capacity to screen for NCDs because of the influence of health system and/or patient-level factors. Most studies were generally limited to cross-sectional studies, with very few interventional, longitudinal studies.

Highlights

Unprecedented worldwide improvements in access to antiretroviral therapy (ART) have resulted in viral suppression and markedly increased survival for people living with human immunodeficiency virus (PLHIV)
The majority of the studies (12) were primarily aimed at assessing the prevalence of noncommunicable diseases (NCDs) and the associated risk factors or determinants, whilst the remaining were aimed at assessing the feasibility of integrated NCD–HIV management and outcomes (9), impact of co-morbidities on costs, utilities and health-related quality of life (HRQL) in PLHIV (4) and the capacity of HIV treatment facilities to provide care for people with NCDs (1)
The study made important observations relevant to the prevalence, healthcare costs and management of NCDs in PLHIV: (1) common NCDs in PLHIV were hypertension and diabetes mellitus, (2) consistently higher NCD prevalence rates in PLHIV compared with HIV-negative people, (3) consistently higher NCD prevalence rates from studies conducted outside Africa, with fewer studies and inconsistent NCD prevalence rates reported from sub-Saharan Africa (SSA) studies, (4) fewer longitudinal case–control and interventional studies to determine NCD prevalence and related determinants (5) integrated management of HIV–NCD co-morbidity might be more cost-effective than vertical HIV and NCD programmes and (6) fewer studies reporting the capacity of ART clinics to manage NCDs in PLHIV

Summary

Introduction

Unprecedented worldwide improvements in access to antiretroviral therapy (ART) have resulted in viral suppression and markedly increased survival for people living with human immunodeficiency virus (PLHIV). According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), the number of PLHIV globally increased from an estimated 34 million in 2010 to 37.9 million people in 2018, with a concomitant 15% increase (from 47% to 62%) in the proportion of PLHIV accessing ART.[1,2] As a result of increased access to ART since 2010, a 33% decline in acquired immune deficiency syndrome (AIDS)-related mortality globally was recorded by the end of 2018, demonstrating an increased survival in PLHIV as a result of ART. Whilst ART has markedly increased the survival of PLHIV, the coexistence of HIV and noncommunicable diseases (NCDs) has become an important public health concern. The prevalence, healthcare costs and management protocols for NCDs in people living with HIV (PLHIV) remain unclear in most settings

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