Epidemiological And Health Systems Implications Of Evolving HIV And Hypertension In South Africa And Kenya

Abstract

Health systems in sub-Saharan Africa are facing an ongoing HIV epidemic and increasing burden of noncommunicable disease. With the focus shifting to the development of comprehensive primary health care and chronic disease treatment, multidisease modeling is integral to estimating future health care needs. We extended an established agent-based model of HIV transmission to include hypertension in two rural settings: KwaZulu-Natal, South Africa, and western Kenya. We estimated that from 2018 to 2028 hypertension prevalence would increase from 40 percent to 46 percent in KwaZulu-Natal and from 29 percent to 35 percent in western Kenya, while HIV prevalence is stabilizing and predicted to decrease. As the health system burden in sub-Saharan Africa is changing, innovative chronic disease treatment and the broadening of successful programs, such as integrated HIV and noncommunicable disease care, are necessary to reach universal health care coverage.

EXHIBIT 1. Projected percent of people in KwaZulu-Natal, South Africa, with hypertension, HIV, or both, 2018–28

SOURCE Authors’ analysis of data from an STDSIM simulation. NOTE The shaded areas represent 95% uncertainty intervals.

EXHIBIT 2. Projected percent of people in western Kenya with hypertension, HIV, or both, 2018–28

SOURCE Authors’ analysis of data from an STDSIM simulation. NOTE The shaded areas represent 95% uncertainty intervals.

EXHIBIT 4. Hypertension treatment scenarios for KwaZulu-Natal, South Africa, and western Kenya in 2028

SOURCE Authors’ analysis of data from an STDSIM simulation; Shisana O, et al. The South African National Health and Nutrition Examination Survey, 2012 (note 37 in text); and Kenya Ministry of Health. Kenya STEPwise Survey for Non Communicable Diseases Risk Factors 2015 report (note 26 in text). NOTE The treatment target is for 50 percent of people with hypertension to receive care for it.