Linkage to HIV care and hypertension and diabetes control in rural South Africa: Results from the population-based Vukuzazi Study.
Linkage to HIV care and hypertension and diabetes control in rural South Africa: Results from the population-based Vukuzazi Study.
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DOI：
10.1371/journal.pgph.0001221
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发表时间：
2022
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非传染性疾病(NCDs)占南非所有死亡人数的一半，这在一定程度上反映了非传染性疾病的医疗需求未得到满足。利用现有的艾滋病毒基础设施被吹捧为缓解这一长期护理缺口的一种战略。我们评估了艾滋病毒护理平台是否与改善非传染性疾病护理有关。我们对夸祖鲁-纳塔尔农村的成年人进行了基于社区的筛查，收集了BP、HbA1c和卫生服务利用数据。高血压和糖尿病的护理级联指标被定义为：1)知道，如果以前被诊断，2)如果在过去6个月内看医生，3)接受治疗，如果在过去2周内报告用药情况，4)控制，如果BP<；140/90 mmHg或HbA1c<；6.5%。我们建立了多变量调整后的Logistic回归模型，用来比较病毒抑制的HIV感染者和HIV阴性对照患者的高血压和糖尿病护理级联中每一步的成功完成。采用逆概率抽样加权得到总体水平的估计值。分析样本包括4933人[平均年龄58.4岁；77%是女性]。与HIV阴性相比，抑制HIV与较低的糖尿病调整患病率(知晓(-6.0%[95%CI：-11.0，-1.1%])、护理(-5.7%[-10.6，-0.8%])和治疗(-4.8%[-9.7，0.1%])相关；但控制糖尿病的调整患病率较高(3.2%[0.2-6.2%])。相比之下，抑制艾滋病毒与高血压的调整后患病率较高相关，包括知晓(7.4%[5.3-9.6%])、护理(8.0%[5.9-10.2%])、治疗(8.4%[6.1-10.6%])和控制(9.0%[6.2-11.8%])。总体而言，高血压和糖尿病患者的疾病控制率分别为40.0%(38.6-40.8%)和6.8%(5.9-7.8%)。夸祖鲁-纳塔尔农村参与艾滋病毒护理通常与较差的糖尿病护理和改善的高血压护理有关。虽然进一步的工作应该探索如何将艾滋病毒方案的成功转化为非传染性疾病的护理，但也需要加强初级卫生保健，以应对日益增长的非传染性疾病流行。
Non-communicable diseases (NCDs) account for half of all deaths in South Africa, partly reflecting unmet NCDs healthcare needs. Leveraging existing HIV infrastructure is touted as a strategy to alleviate this chronic care gap. We evaluated whether HIV care platforms are associated with improved NCDs care. We conducted a community-based screening of adults in rural KwaZulu-Natal, collecting BP, HbA1c, and health services utilization data. Care cascade indicators for hypertension and diabetes mellitus were defined as: 1) aware, if previously diagnosed, 2) in care, if seeing a provider within last 6 months; 3) treated, if reporting medication use within preceding 2 weeks; and 4) controlled, if BP<140/90mmHg or HbA1c<6.5%. We fit multivariable adjusted logistic regression models to compare successful completion of each step of the care cascade for hypertension and diabetes between people with virally suppressed HIV and HIV-negative comparators. Inverse probability sampling weights were applied to derive population-level estimates. The analytic sample included 4,933 individuals [mean age 58.4 years; 77% female]. Compared to being HIV-negative, having suppressed HIV was associated with lower adjusted prevalence of being aware (-6.0% [95% CI: -11.0, -1.1%]), in care (-5.7% [-10.6, -0.8%]), and in treatment (-4.8% [-9.7, 0.1%]) for diabetes; but higher adjusted prevalence of controlled diabetes (3.2% [0.2–6.2%]). In contrast, having suppressed HIV was associated with higher adjusted prevalence of being aware (7.4% [5.3–9.6%]), in care (8.0% [5.9–10.2%]), in treatment (8.4% [6.1–10.6%]) and controlled (9.0% [6.2–11.8%]), for hypertension. Overall, disease control was achieved for 40.0% (38.6–40.8%) and 6.8% (5.9–7.8%) of individuals with hypertension and diabetes, respectively. Engagement in HIV care in rural KwaZulu-Natal was generally associated with worse diabetes care and improved hypertension care. While further work should explore how success of HIV programs can be translated to NCD care, strengthening of primary healthcare will also be needed to respond to the growing NCDs epidemic.