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. 2021 Oct 14;18(1):72.
doi: 10.1186/s12981-021-00387-3.

Treatment outcomes among adults with HIV/non-communicable disease multimorbidity attending integrated care clubs in Cape Town, South Africa

Blessings Gausi  1 , Natacha Berkowitz  2 , Nisha Jacob  2 , Tolu Oni  2   3
Affiliations

Treatment outcomes among adults with HIV/non-communicable disease multimorbidity attending integrated care clubs in Cape Town, South Africa

Blessings Gausi et al. AIDS Res Ther. .

Abstract

Background: The growing burden of the HIV and non-communicable disease (NCD) syndemic in Sub- Saharan Africa has necessitated introduction of integrated models of care in order to leverage existing HIV care infrastructure for NCDs. However, there is paucity of literature on treatment outcomes for multimorbid patients attending integrated care. We describe 12-month treatment outcomes among multimorbid patients attending integrated antiretroviral treatment (ART) and NCD clubs in Cape Town, South Africa.

Methods: As part of an integrated clubs (IC) model pilot implemented in 2016 by the local government at two primary health care clinics in Cape Town, we identified all multimorbid patients who were enrolled for IC for at least 12 months by August 2017. Mean adherence percentages (using proxy of medication collection and attendance of club visits) and optimal disease control (defined as the proportion of participants achieving optimal blood pressure, glycosylated haemoglobin control and HIV viral load suppression where appropriate) were calculated at 12 months before, at the point of IC enrolment and 12 months after IC enrolment. Predictors of NCD control 12 months post IC enrolment were investigated using multivariable logistic regression.

Results: As of 31 August 2017, 247 HIV-infected patients in total had been enrolled into IC for at least 12 months. Of these, 221 (89.5%) had hypertension, 4 (1.6%) had diabetes mellitus and 22 (8.9%) had both diseases. Adherence was maintained before and after IC enrolment with mean adherence percentages of 92.2% and 94.2% respectively. HIV viral suppression rates were 98.6%, 99.5% and 99.4% at the three time points respectively. Retention in care was high with 6.9% lost to follow up at 12 months post IC enrolment. Across the 3 time-points, optimal blood pressure control was achieved in 43.1%, 58.9% and 49.4% of participants while optimal glycaemic control was achieved in 47.4%, 87.5% and 53.3% of participants with diabetes respectively. Multivariable logistic analyses showed no independent variables significantly associated with NCD control.

Conclusion: Multimorbid adults living with HIV achieved high levels of HIV control in integrated HIV and NCD clubs. However, intensified interventions are needed to maintain NCD control in the long term.

Keywords: Adherence clubs; Diabetes mellitus; HIV/AIDS; Hypertension; Integrated care; Multimorbidity; Non-communicable diseases; South Africa.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Available records for viral loads (VL), blood pressure (BP) and glycosylated heamoglobin (HbA1c) at three time points in the study. HbA1c measured in patients with DM
Fig. 2
Fig. 2
Mean systolic blood pressure at three time points: 12 months before, at entry and 12 months after entry to integrated club
Fig. 3
Fig. 3
Mean diastolic blood pressure at three time points: 12 months before, at entry and 12 months after entry to integrated club
Fig. 4
Fig. 4
Mean glycosylated heamoglobin (HbA1c) at three time points: 12 months before, at entry and 12 months after entry to integrated club
Fig. 5
Fig. 5
Proportion of participants with controlled Blood Pressure (BP) at three time points
See this image and copyright information in PMC

References

    1. Statistics South Africa (Institution). Mid-year population estimates 2016. Johanesburg; 2016. https://www.statssa.gov.za/publications/P0302/P03022016.pdf.
    1. GHO | By category | Antiretroviral therapy coverage—data and estimates by country. WHO.; http://apps.who.int/gho/data/node.main.626?lang=en. Accessed 23 Mar 2019.
    1. Department of Health. South African National Department of Health. Annual Report. 2015/2016 2016; 2015. https://www.gov.za/documents/department-health-annual-report-20152016-22.... Accessed 23 Mar 2019.
    1. Marcus JL, Chao CR, Leyden WA, Xu L, Quesenberry CP, Klein DB, et al. Narrowing the gap in life expectancy between HIV-infected and HIV-uninfected individuals with access to care. JAIDS J Acquir Immune Defic Syndr. 2016;73(1):39–46. doi: 10.1097/QAI.0000000000001014. - DOI - PMC - PubMed
    1. Dillon DG, Gurdasani D, Riha J, Ekoru K, Asiki G, Mayanja BN, et al. Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis. Int J Epidemiol. 2013;42(6):1754–1771. doi: 10.1093/ije/dyt198. - DOI - PMC - PubMed

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