Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study.
Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study.
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DOI：
10.1016/s2214-109x(21)00176-5
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发表时间：
2021-07
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影响因子：
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通讯作者：
Vukuzazi Team
中科院分区：
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作者：
Wong EB;Olivier S;Gunda R;Koole O;Surujdeen A;Gareta D;Munatsi D;Modise TH;Dreyer J;Nxumalo S;Smit TK;Ording-Jespersen G;Mpofana IB;Khan K;Sikhosana ZEL;Moodley S;Shen YJ;Khoza T;Mhlongo N;Bucibo S;Nyamande K;Baisley KJ;Cuadros D;Tanser F;Grant AD;Herbst K;Seeley J;Hanekom WA;Ndung'u T;Siedner MJ;Pillay D;Vukuzazi Team
整个撒哈拉以南非洲在治疗艾滋病毒方面取得了显著进展，但关于艾滋病毒流行人群中其他主要病因的流行率和重叠情况的数据很少。我们的目的是确定传染性和非传染性疾病在南非农村这类人群中的流行程度和重叠程度。我们对来自南非夸祖鲁-纳塔尔省uMkhanyakude地区非洲卫生研究所人口监测区的符合条件的青少年和成年人进行了横断面研究。15岁以上的参与者被邀请参加一个流动保健营。通过问卷调查确定HIV、肺结核、高血压和糖尿病的病史。通过测量血压、胸部x光以及血液和痰化验来估计艾滋病毒、活动性和终生结核病、血糖升高、血压升高以及这些因素的组合的人口患病率和地理空间分布。2018年5月25日至2019年11月28日，招募了17118名青少年和成年人进行评估。总体而言，52.1% （95% CI 53.1 - 52.9）患者至少有一种活动性疾病。34.2%（33.5 ~ 34.9）有HIV， 1.4%（1.2 ~ 1.6）有活动性结核，21.8%（21.2 ~ 22.4）有终生结核，8.5%（8.1 ~ 8.9）有血糖升高，23.0%（22.4 ~ 23.6）有血压升高。适当的治疗和最佳的疾病控制在艾滋病毒中最高（78.1%），在血压升高（42.5%）、活动性肺结核（29.6%）和血糖升高（7.1%）中较低。疾病流行率在性别、年龄组和地理空间上存在显著差异：男性的活动性和终身结核病流行率较高，而女性在30-49岁期间的艾滋病毒流行率相当高，50岁以上的多种和控制不良的非传染性疾病流行率上升。我们在南非农村人口中发现了传染病和非传染性疾病流行的趋同，相对于所有其他疾病，艾滋病得到了很好的治疗，但结核病、高血糖和高血压的诊断和治疗却很差。需要采取一项公共卫生对策，扩大艾滋病毒检测和治疗方案的成功，为特定人群提供针对多种疾病的护理，以优化撒哈拉以南非洲这些环境中的健康状况。惠康信托基金、比尔和梅林达·盖茨基金会、南非科学与创新部、南非医学研究理事会和南非人口研究基础设施网络。有关摘要的isiZulu翻译，请参阅补充资料部分。
There has been remarkable progress in the treatment of HIV throughout sub-Saharan Africa, but there are few data on the prevalence and overlap of other significant causes of disease in HIV endemic populations. Our aim was to identify the prevalence and overlap of infectious and non-communicable diseases in such a population in rural South Africa. We did a cross-sectional study of eligible adolescents and adults from the Africa Health Research Institute demographic surveillance area in the uMkhanyakude district of KwaZulu-Natal, South Africa. The participants, who were 15 years or older, were invited to participate at a mobile health camp. Medical history for HIV, tuberculosis, hypertension, and diabetes was established through a questionnaire. Blood pressure measurements, chest x-rays, and tests of blood and sputum were taken to estimate the population prevalence and geospatial distribution of HIV, active and lifetime tuberculosis, elevated blood glucose, elevated blood pressure, and combinations of these. 17 118 adolescents and adults were recruited from May 25, 2018, to Nov 28, 2019, and assessed. Overall, 52·1% (95% CI 51·3–52·9) had at least one active disease. 34·2% (33·5–34·9) had HIV, 1·4% (1·2–1·6) had active tuberculosis, 21·8% (21·2–22·4) had lifetime tuberculosis, 8·5% (8·1–8·9) had elevated blood glucose, and 23·0% (22·4–23·6) had elevated blood pressure. Appropriate treatment and optimal disease control was highest for HIV (78·1%), and lower for elevated blood pressure (42·5%), active tuberculosis (29·6%), and elevated blood glucose (7·1%). Disease prevalence differed notably by sex, across age groups, and geospatially: men had a higher prevalence of active and lifetime tuberculosis, whereas women had a substantially high prevalence of HIV at 30–49 years and an increasing prevalence of multiple and poorly controlled non-communicable diseases when older than 50 years. We found a convergence of infectious and non-communicable disease epidemics in a rural South African population, with HIV well treated relative to all other diseases, but tuberculosis, elevated blood glucose, and elevated blood pressure poorly diagnosed and treated. A public health response that expands the successes of the HIV testing and treatment programme to provide multidisease care targeted to specific populations is required to optimise health in such settings in sub-Saharan Africa. Wellcome Trust, Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, South African Medical Research Council, and South African Population Research Infrastructure Network. For the isiZulu translation of the abstract see Supplementary Materials section.