Singh Urisha, Olivier Stephen, Cuadros Diego, Castle Alison, Moosa Yumna, Edwards Jonathan Alex, Kim Hae-Young, Siedner Mark J, Tanser Frank, Wong Emily B
Africa Health Research Institute, KwaZulu-Natal, South Africa.
Nelson R Mandela School of Medicine; University of KwaZulu-Natal, Durban, SA.
Res Sq. 2023 Mar 21:rs.3.rs-2702048. doi: 10.21203/rs.3.rs-2702048/v1.
The convergence of infectious and non-communicable diseases (NCDs) in South Africa poses a challenge to health systems. Here we establish a framework to quantify met and unmet health needs for individuals living with infectious and NCDs. In this study, we screened adult residents >15 years of age within the uMkhanyakude district in KwaZulu- Natal, South Africa for HIV, hypertension (HPTN) and diabetes mellitus (DM). For each condition, individuals were defined as having no unmet health needs (absence of condition), met health need (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimization). We analyzed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution. We found that of 18,041 participants, 9,898 (55%) had at least one chronic condition. 4,942 (50%) of these individuals had at least one unmet health need (18% needed treatment optimization, 13% needed engagement in care, and 19% needed diagnosis). Unmet health needs varied by disease: 93% of people with DM, 58% of people with HPTN and 21% of people with HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed, unmet health needs had specific sites of concentration whilst the need for diagnosis for all three conditions was co-located. Whilst people living with HIV are predominantly well-controlled, there is a high burden of unmet health needs for people living with HPTN and DM. Adaptation of HIV models of care to integrate HIV and NCD services is of high priority.
在南非，传染病与非传染性疾病（NCDs）的交汇给卫生系统带来了挑战。在此，我们建立了一个框架，以量化感染性疾病和非传染性疾病患者已满足和未满足的健康需求。在本研究中，我们对南非夸祖鲁 - 纳塔尔省乌姆哈尼亚库德区15岁以上的成年居民进行了艾滋病毒、高血压（HPTN）和糖尿病（DM）筛查。对于每种疾病，个体被定义为没有未满足的健康需求（无疾病状况）、满足健康需求（疾病得到良好控制）或有一个或多个未满足的健康需求（包括诊断、接受治疗或优化治疗）。我们分析了个体和合并疾病状况下已满足和未满足的健康需求，并调查了它们的地理空间分布。我们发现，在18,041名参与者中，9,898人（55%）至少患有一种慢性病。其中，4,942人（50%）至少有一项未满足的健康需求（18%需要优化治疗，13%需要接受治疗，19%需要诊断）。未满足的健康需求因疾病而异：93%的糖尿病患者、58%的高血压患者和21%的艾滋病毒感染者有未满足的健康需求。在地理空间上，艾滋病毒的已满足健康需求分布广泛，未满足的健康需求有特定的集中地点，而所有三种疾病的诊断需求则集中在同一地点。虽然艾滋病毒感染者大多病情得到良好控制，但高血压和糖尿病患者未满足的健康需求负担很重。将艾滋病毒护理模式调整为整合艾滋病毒和非传染性疾病服务是当务之急。
