Quantifying met and unmet health needs for HIV, hypertension and diabetes in rural KwaZulu-Natal, South Africa

Abstract

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.

Figure 1

Health states with corresponding health needs, needs scores and needs groups.* dependent on confirmatory diagnostic testing.

Figure 2

Distribution of health needs for within the Vukuzazi cohort for participants with HIV, diabetes and/or hypertension. (2a) Total number of participants with no health needs identified (n=8143) and those with health needs identified (n=9898) in a cohort of 18041 participants. (2b) Disease distribution amongst individuals with health needs identified (n=9898), 61.7% of these participants had HIV whilst 17.6% and 45.6% of participants with health needs had diabetes or hypertension. (2c) Distribution of met and unmet health needs for individual chronic health states. (2d) Distribution of met and unmet health needs for all three diseases combined (i.e. HIV, diabetes and hypertension).

Figure 3

Geospatial distribution of health needs for HIV, hypertension and diabetes individually and for all three chronic conditions combined. Need score 1 reprsenets participants that are diagnosed and well controlled with a need for chronic medicaiton provision. Need score 2 represents participants who are diagnosed and suboptimally controlled with a need for treatment optomisation. Need score 3 represents participants who are diagnosed and not engaged in care with a need for engagement in care. Need score 4 represents participatns who are undiagnosed and uncontrolled with a need for diagnosis, engagement in care, optomisation of treatment and provision of chronic medication.