Convergence of HIV and non-communicable disease epidemics: Geospatial mapping of the unmet health needs in a HIV Hyperendemic South African community.

Autor:	Cuadros DF; Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA., Devi C; Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA., Singh U; Africa Health Research Institute, KwaZulu-Natal, South Africa.; Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa., Olivier S; Africa Health Research Institute, KwaZulu-Natal, South Africa., Castle A; Africa Health Research Institute, KwaZulu-Natal, South Africa.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Moosa Y; Harvard Medical School, Boston, MA, USA., Edwards JA; International Institute for Rural Health, University of Lincoln, Lincolnshire, UK.; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.; Department of Biomedical Informatics, Emory University School of Medicine, Emory University, Atlanta, GA, USA., Kim HY; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA., Siedner MJ; Africa Health Research Institute, KwaZulu-Natal, South Africa.; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa., Wong EB; Africa Health Research Institute, KwaZulu-Natal, South Africa.; Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, USA., Tanser F; Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa.; School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2023 Mar 29. Date of Electronic Publication: 2023 Mar 29.
DOI:	10.1101/2023.03.27.23287807
Abstrakt:	Background: As people living with HIV (PLHIV) are experiencing longer survival, the co-occurrence of HIV and non-communicable diseases has become a public health priority. In response to this emerging challenge, we aimed to characterize the spatial structure of convergence of chronic health conditions in a HIV hyperendemic community in KwaZulu-Natal, South Africa. Methods: We utilized data from a comprehensive population-based disease survey conducted in KwaZulu-Natal, South Africa, which collected data on HIV, diabetes, and hypertension. We implemented a novel health needs scale to categorize participants as: diagnosed and well-controlled (Needs Score 1), diagnosed and sub-optimally controlled (Score 2), diagnosed but not engaged in care (Score 3), or undiagnosed and uncontrolled (Score 4). Scores 2-4 were indicative of unmet health needs. We explored the geospatial structure of unmet health needs using different spatial clustering methods. Findings: The analytical sample comprised of 18,041 individuals. We observed a similar spatial structure for HIV among those with a combined needs Score 2-3 (diagnosed but uncontrolled) and Score 4 (undiagnosed and uncontrolled), with most PLHIV with unmet needs clustered in the southern peri-urban area, which was relatively densely populated within the surveillance area. Multivariate clustering analysis revealed a significant overlap of all three diseases in individuals with undiagnosed and uncontrolled diseases (unmet needs Score 4) in the southern part of the catchment area. Interpretation: In a HIV hyperendemic community in South Africa, areas with the highest needs for PLHIV with undiagnosed and uncontrolled disease are also areas with the highest burden of unmet needs for other chronic health conditions, such as diabetes and hypertension. The identification and prioritization of geographically clustered vulnerable communities with unmet health needs for both HIV and non-communicable diseases provide a basis for policy and implementation strategies to target communities with the highest health needs. Funding: Research reported in this publication was supported by the Fogarty International Center (R21 TW011687; D43 TW010543), the National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases (K24 HL166024; T32 AI007433) of the National Institutes of Health, and Heart Lung and Blood Institute (K24 HL166024, T32 AI007433). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the funders. Competing Interests: Declaration of interest: The authors have no conflicts of interest to declare.
Databáze:	MEDLINE
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