Mkhwanazi Thandiwe Wendy, Modjadji Perpetua, Mokgalaboni Kabelo, Madiba Sphiwe, Roomaney Rifqah Abeeda
Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa.
Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa.
Diseases. 2023 Sep 26;11(4):129. doi: 10.3390/diseases11040129.
The growing burden of non-communicable diseases amidst the largest burden of HIV in South Africa leads to disease combinations of multimorbidity with the complexity of care. We conducted a cross-sectional study to assess multimorbidity, medication adherence, and associated factors among out-patients with chronic diseases in primary health care (PHC) facilities in Tshwane, South Africa. A structured questionnaire was used to collect data on comorbidities and medication adherence, along with socio-demographic and lifestyle factors. Logistic regression models were used to analyse the determinants of multimorbidity and medication adherence. In all 400 patients with chronic diseases (mean age: 47 ± 12 years) living in poor environments, common chronic conditions were hypertension (62%), diabetes (45%), HIV (44%), TB (33%), hypercholesterolemia (18%), and gout (13%). The proportion of concordant comorbidity (i.e., diseases with similar risk profiles and management) was 72%, more than 28% of discordant comorbidity (i.e., diseases not related in pathogenesis or management). Most patients had two coexisting chronic conditions (75%), while few had more than two chronic conditions (23%) and single-occurring conditions (2%). Prevalence rates for common multimorbidity patterns were 25% (HIV and TB), 17% (hypertension and diabetes), 9% (hypertension, diabetes, and hypercholesterolemia), and 2% (hypertension diabetes and HIV), while medication adherence was estimated at 74%. In multivariate analysis, multimorbidity was associated with an older age and lower socio-economic status, while medication non-adherence was associated with a younger age and socio-economic factors. The study highlights the presence of multimorbidity among primary care patients attributed to hypertension, diabetes, HIV, and TB in South Africa with non-adherence to medication in one-third of patients. Policies are needed for education on multimorbidity with a need to optimize lifestyle modifications, perhaps proactive outreach or nursing contact with high-risk patients with public-health-sensitive conditions, such as HIV and/or TB, as well as patients with a history of non-adherence to medications. Considerations should be given to the development of a medication adherence scale for multiple chronic conditions beyond assessing adherence to a single index medication.
在南非艾滋病负担最为沉重的情况下，非传染性疾病的负担日益加重，导致了多种疾病并存的复杂病情以及护理的复杂性。我们开展了一项横断面研究，以评估南非茨瓦内初级卫生保健（PHC）机构中慢性病门诊患者的多种疾病并存情况、药物依从性及相关因素。我们使用一份结构化问卷来收集有关合并症和药物依从性的数据，以及社会人口学和生活方式因素。我们使用逻辑回归模型来分析多种疾病并存和药物依从性的决定因素。共有400名生活在贫困环境中的慢性病患者（平均年龄：47±12岁）参与研究，常见慢性病包括高血压（62%）、糖尿病（45%）、艾滋病（44%）、结核病（33%）、高胆固醇血症（18%）和痛风（13%）。一致性合并症（即具有相似风险特征和管理方式的疾病）的比例为72%，不一致性合并症（即发病机制或管理方面不相关的疾病）的比例超过28%。大多数患者有两种并存的慢性病（75%），少数患者有两种以上慢性病（23%），单一疾病患者占2%。常见多种疾病并存模式的患病率分别为25%（艾滋病和结核病）、17%（高血压和糖尿病）、9%（高血压、糖尿病和高胆固醇血症）以及2%（高血压、糖尿病和艾滋病），而药物依从性估计为74%。在多变量分析中，多种疾病并存与年龄较大和社会经济地位较低有关，而药物不依从与年龄较小和社会经济因素有关。该研究凸显了南非初级保健患者中存在由高血压、糖尿病、艾滋病和结核病导致的多种疾病并存情况，且三分之一的患者存在药物不依从问题。需要制定有关多种疾病并存情况的教育政策，优化生活方式改变，或许可对具有公共卫生敏感状况（如艾滋病和/或结核病）的高危患者以及有药物不依从病史的患者进行积极外展或护理联系。除了评估对单一指标药物的依从性外，还应考虑制定针对多种慢性病的药物依从性量表。
