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. 2011 Dec;94(6):1690S-1696S.
doi: 10.3945/ajcn.111.019075. Epub 2011 Nov 16.

Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings--insights from South Africa

Naomi S Levitt  1 , Krisela Steyn, Joel Dave, Debbie Bradshaw
Affiliations

Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings--insights from South Africa

Naomi S Levitt et al. Am J Clin Nutr. 2011 Dec.

Abstract

Sub-Saharan Africa is experiencing a multiple disease burden. Noncommunicable diseases (NCDs) are emerging, and their risk factors are becoming more common as lifestyles change and rates of urbanization increase. Simultaneously, epidemics of infectious diseases persist, and HIV/AIDS has taken hold in the region, although recent data indicate a decrease in new HIV infection rates. With the use of diabetes as a marker for NCDs, it was estimated that the number of people with diabetes would rise between 2000 and 2010 despite the HIV/AIDS epidemic, largely because of the aging of the population and the increase in risk factors for diabetes in South Africa. These numbers are likely to increase further, given the declining HIV/AIDS mortality rates and longer life expectancy due to the up-scaling of antiretroviral therapy (ART), with its concomitant metabolic complications. Given that treated HIV/AIDS has become a chronic disease, and the health care needs of people on ART resemble those of people with NCDs, and given that vertical programs are difficult to sustain when health systems are underresourced and strained, there is a powerful argument to integrate the primary level care for people with chronic diseases, whether they be NCDs or infectious diseases. Pilot studies are required to test the feasibility of an integrated service that extends from health facilities into the community in a reciprocal manner based on the WHO Innovative Care for Chronic Conditions model of care. These will begin to provide the evidence that policy makers need to change the mode of health care delivery.

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Figures

FIGURE 1.
FIGURE 1.
Estimated disability-adjusted life years by cause, South Africa, 2000.
FIGURE 2.
FIGURE 2.
Estimated age-standardized mortality rates by broad cause group and province, South Africa, 2000.
FIGURE 3.
FIGURE 3.
Estimated increase in the numbers of people with diabetes from 1995 to 2010 in both the presence and absence of the HIV epidemic, based on assumptions of no increase, a 50% increase, and a 100% increase in age-specific prevalence.
FIGURE 4.
FIGURE 4.
WHO Innovative Care for Chronic Conditions framework.
See this image and copyright information in PMC

References

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