. 2023 Sep;11(9):e1372-e1382.

doi: 10.1016/S2214-109X(23)00239-5.

The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey

Urisha Singh¹, Stephen Olivier², Diego Cuadros³, Alison Castle⁴, Yumna Moosa², Thando Zulu², Jonathan Alex Edwards⁵, Hae-Young Kim⁶, Resign Gunda⁷, Olivier Koole⁸, Ashmika Surujdeen², Dickman Gareta², Day Munatsi², Tshwaraganang H Modise², Jaco Dreyer², Siyabonga Nxumalo², Theresa K Smit², Greg Ordering-Jespersen², Innocentia B Mpofana², Khadija Khan², Zinzile E L Sikhosana², Sashen Moodley², Yen-Ju Shen², Thandeka Khoza², Ngcebo Mhlongo², Sanah Bucibo², Kennedy Nyamande⁹, Kathy J Baisley⁸, Alison D Grant¹⁰, Kobus Herbst¹¹, Janet Seeley¹², Deenan Pillay¹³, Willem Hanekom¹³, Thumbi Ndung'u¹⁴, Mark J Siedner¹⁵, Frank Tanser¹⁶, Emily B Wong¹⁷; Vukuzazi team

Collaborators, Affiliations

Collaborators

Vukuzazi team:
Emily B Wong, Stephen Olivier, Resign Gunda, Olivier Koole, Ashmika Surujdeen, Dickman Gareta, Day Munatsi, Tswaraganang H Modise, Jaco Dreyer, Siyabonga Nxumalo, Theresa K Smit, Greg Ording-Jespersen, Innocentia B Mpofana, Khadija Khan, Zizile E L Sikhosana, Sashen Moodley, Yen-Ju Shen, Thandeka Khoza, Ngcebo Mhlongo, Sana Bucibo, Kennedy Nyamande, Kathy J Baisley, Diego Cuadros, Frank Tanser, Alison D Grant, Kobus Herbst, Janet Seeley, Willem A Hanekom, Thumbi Ndung'u, Mark J Siedner, Deenan Pillay, Mosa Suleman, Jaikrishna Kalideen, Ramesh Jackpersad, Kgaugelo Moropane, Boitsholo Mfolo, Khabonina Malomane, Hlolisile Khumalo, Nompilo Buthelezi, Nozipho Mbonambi, Hloniphile Ngubane, Thokozani Simelane, Khanyisani Buthelezi, Sphiwe Ntuli, Nombuyiselo Zondi, Siboniso Nene, Bongumenzi Ndlovu, Talente Ntimbane, Mbali Mbuyisa, Xolani Mkhize, Melusi Sibiya, Ntombiyenkosi Ntombela, Mandisi Dlamini, Hlobisile Chonco, Hlengiwe Dlamini, Doctar Mlambo, Nonhlahla Mzimela, Zinhle Buthelezi, Zinhle Mthembu, Thokozani Bhengu, Sandile Mtehmbu, Phumelele Mthethwa, Zamashandu Mbatha, Welcome Petros Mthembu, Anele Mkhwanazi, Mandlakayise Sikhali, Phakamani Mkhwanazi, Ntombiyenhlahla Mkhwanazi, Rose Myeni, Fezeka Mfeka, Hlobisile Gumede, Nonceba Mfeka, Ayanda Zungu, Hlobisile Gumede, Nonhlahla Mfekayi, Smangaliso Zulu, Mzamo Buthelezi, Senzeni Mkhwanazi, Mlungisi Dube, Philippa Matthews, Siphephelo Dlamini, Hosea Kambonde, Lindani Mthembu, Seneme Mchunu, Sibahle Gumbi, Tumi Madolo, Thengokwakhe Nkosi, Sibusiso Mkhwanazi, Simbusio Nsibande, Mpumelelo Steto, Sibusiso Mhlongo, Velile Vellem, Pfarelo Tshivase, Jabu Kwinda, Bongani Magwaza, Siyabonga Nsibande, Skhumbuzo Mthombeni, Sphiwe Clement Mthembu, Antony Rapulana, Jade Cousins, Thabile Zondi, Nagavelli Padayachi, Freddy Mabetlela, Simphiwe Ntshangase, Nomfundo Luthuli, Sithembile Ngcobo, Kayleen Brien, Sizwe Ndlela, Nomfundo Ngema, Nokukhanya Ntshakala, Anupa Singh, Rochelle Singh, Logan Pillay, Kandaseelan Chetty, Asthentha Govender, Pamela Ramkalawon, Nondumiso Mabaso, Kimeshree Perumal, Senamile Makhari, Nondumiso Khuluse, Nondumiso Zitha, Hlengiwe Khati, Mbuti Mofokeng, Nomathamsanqa Majozi, Nceba Gqaleni, Hannah Keal, Phumla Ngcobo, Costa Criticos, Raynold Zondo, Dilip Kalyan, Clive Mavimbela, Anand Ramnanan, Sashin Harilall

Affiliations

¹ Africa Health Research Institute, KwaZulu-Natal, South Africa; Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
² Africa Health Research Institute, KwaZulu-Natal, South Africa.
³ Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA.
⁴ Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
⁵ International Institute for Rural Health, University of Lincoln, Lincoln, UK; Department of Biostatistics and Bioinformatics, Rollins School of Public Health and Department of Biomedical Informatics, Emory University School of Medicine, Emory University, Atlanta, GA, USA.
⁶ Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, USA.
⁷ Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
⁸ Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, UK.
⁹ Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Hospital, Durban, South Africa.
¹⁰ Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, UK; School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
¹¹ Africa Health Research Institute, KwaZulu-Natal, South Africa; Department of Science and Innovation, Medical Research Council, South African Population Research Infrastructure, Durban, South Africa.
¹² Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; London School of Hygiene and Tropical Medicine, London, UK.
¹³ Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infection and Immunity, University College London, London, UK.
¹⁴ Africa Health Research Institute, KwaZulu-Natal, South Africa; Ragon Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Division of Infection and Immunity, University College London, London, UK; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Durban, South Africa.
¹⁵ Africa Health Research Institute, KwaZulu-Natal, South Africa; Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
¹⁶ Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; College of Health Sciences, and Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa; International Institute for Rural Health, University of Lincoln, Lincoln, UK; School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa.
¹⁷ Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: emily.wong@ahri.org.

PMID: 37591585
PMCID: PMC10447220
DOI: 10.1016/S2214-109X(23)00239-5

The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey

Urisha Singh et al. Lancet Glob Health. 2023 Sep.

. 2023 Sep;11(9):e1372-e1382.

doi: 10.1016/S2214-109X(23)00239-5.

Authors

Collaborators

Vukuzazi team:
Emily B Wong, Stephen Olivier, Resign Gunda, Olivier Koole, Ashmika Surujdeen, Dickman Gareta, Day Munatsi, Tswaraganang H Modise, Jaco Dreyer, Siyabonga Nxumalo, Theresa K Smit, Greg Ording-Jespersen, Innocentia B Mpofana, Khadija Khan, Zizile E L Sikhosana, Sashen Moodley, Yen-Ju Shen, Thandeka Khoza, Ngcebo Mhlongo, Sana Bucibo, Kennedy Nyamande, Kathy J Baisley, Diego Cuadros, Frank Tanser, Alison D Grant, Kobus Herbst, Janet Seeley, Willem A Hanekom, Thumbi Ndung'u, Mark J Siedner, Deenan Pillay, Mosa Suleman, Jaikrishna Kalideen, Ramesh Jackpersad, Kgaugelo Moropane, Boitsholo Mfolo, Khabonina Malomane, Hlolisile Khumalo, Nompilo Buthelezi, Nozipho Mbonambi, Hloniphile Ngubane, Thokozani Simelane, Khanyisani Buthelezi, Sphiwe Ntuli, Nombuyiselo Zondi, Siboniso Nene, Bongumenzi Ndlovu, Talente Ntimbane, Mbali Mbuyisa, Xolani Mkhize, Melusi Sibiya, Ntombiyenkosi Ntombela, Mandisi Dlamini, Hlobisile Chonco, Hlengiwe Dlamini, Doctar Mlambo, Nonhlahla Mzimela, Zinhle Buthelezi, Zinhle Mthembu, Thokozani Bhengu, Sandile Mtehmbu, Phumelele Mthethwa, Zamashandu Mbatha, Welcome Petros Mthembu, Anele Mkhwanazi, Mandlakayise Sikhali, Phakamani Mkhwanazi, Ntombiyenhlahla Mkhwanazi, Rose Myeni, Fezeka Mfeka, Hlobisile Gumede, Nonceba Mfeka, Ayanda Zungu, Hlobisile Gumede, Nonhlahla Mfekayi, Smangaliso Zulu, Mzamo Buthelezi, Senzeni Mkhwanazi, Mlungisi Dube, Philippa Matthews, Siphephelo Dlamini, Hosea Kambonde, Lindani Mthembu, Seneme Mchunu, Sibahle Gumbi, Tumi Madolo, Thengokwakhe Nkosi, Sibusiso Mkhwanazi, Simbusio Nsibande, Mpumelelo Steto, Sibusiso Mhlongo, Velile Vellem, Pfarelo Tshivase, Jabu Kwinda, Bongani Magwaza, Siyabonga Nsibande, Skhumbuzo Mthombeni, Sphiwe Clement Mthembu, Antony Rapulana, Jade Cousins, Thabile Zondi, Nagavelli Padayachi, Freddy Mabetlela, Simphiwe Ntshangase, Nomfundo Luthuli, Sithembile Ngcobo, Kayleen Brien, Sizwe Ndlela, Nomfundo Ngema, Nokukhanya Ntshakala, Anupa Singh, Rochelle Singh, Logan Pillay, Kandaseelan Chetty, Asthentha Govender, Pamela Ramkalawon, Nondumiso Mabaso, Kimeshree Perumal, Senamile Makhari, Nondumiso Khuluse, Nondumiso Zitha, Hlengiwe Khati, Mbuti Mofokeng, Nomathamsanqa Majozi, Nceba Gqaleni, Hannah Keal, Phumla Ngcobo, Costa Criticos, Raynold Zondo, Dilip Kalyan, Clive Mavimbela, Anand Ramnanan, Sashin Harilall

Affiliations

¹ Africa Health Research Institute, KwaZulu-Natal, South Africa; Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
² Africa Health Research Institute, KwaZulu-Natal, South Africa.
³ Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA.
⁴ Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
⁵ International Institute for Rural Health, University of Lincoln, Lincoln, UK; Department of Biostatistics and Bioinformatics, Rollins School of Public Health and Department of Biomedical Informatics, Emory University School of Medicine, Emory University, Atlanta, GA, USA.
⁶ Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, USA.
⁷ Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
⁸ Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, UK.
⁹ Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Hospital, Durban, South Africa.
¹⁰ Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, UK; School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
¹¹ Africa Health Research Institute, KwaZulu-Natal, South Africa; Department of Science and Innovation, Medical Research Council, South African Population Research Infrastructure, Durban, South Africa.
¹² Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; London School of Hygiene and Tropical Medicine, London, UK.
¹³ Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infection and Immunity, University College London, London, UK.
¹⁴ Africa Health Research Institute, KwaZulu-Natal, South Africa; Ragon Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Division of Infection and Immunity, University College London, London, UK; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Durban, South Africa.
¹⁵ Africa Health Research Institute, KwaZulu-Natal, South Africa; Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
¹⁶ Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; College of Health Sciences, and Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa; International Institute for Rural Health, University of Lincoln, Lincoln, UK; School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa.
¹⁷ Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: emily.wong@ahri.org.

PMID: 37591585
PMCID: PMC10447220
DOI: 10.1016/S2214-109X(23)00239-5

Abstract

Background: The convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health needs for individuals living with infectious and non-communicable diseases.

Methods: We analysed data collected between May 25, 2018, and March 13, 2020, from participants of a large, community-based, cross-sectional multimorbidity survey (Vukuzazi) that offered community-based HIV, hypertension, and diabetes screening to all residents aged 15 years or older in a surveillance area in the uMkhanyakude district in KwaZulu-Natal, South Africa. Data from the Vukuzazi survey were linked with data from demographic and health surveillance surveys with a unique identifier common to both studies. Questionnaires were used to assess the diagnosed health conditions, treatment history, general health, and sociodemographic characteristics of an individual. For each condition (ie, HIV, hypertension, and diabetes), individuals were defined as having no health needs (absence of condition), met health needs (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimisation). We analysed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution.

Findings: Of 18 041 participants who completed the survey (12 229 [67·8%] were female and 5812 [32·2%] were male), 9898 (54·9%) had at least one of the three chronic diseases measured. 4942 (49·9%) of these 9898 individuals had at least one unmet health need (1802 [18·2%] of 9898 needed treatment optimisation, 1282 [13·0%] needed engagement in care, and 1858 [18·8%] needed a diagnosis). Unmet health needs varied by disease; 1617 (93·1%) of 1737 people who screened positive for diabetes, 2681 (58·2%) of 4603 people who screened positive for hypertension, and 1321 (21·7%) of 6096 people who screened positive for HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed and unmet health needs for all three conditions had specific sites of concentration; all three conditions had an overlapping geographical pattern for the need for diagnosis.

Interpretation: Although people living with HIV predominantly have a well controlled condition, there is a high burden of unmet health needs for people living with hypertension and diabetes. In South Africa, adapting current, widely available HIV care services to integrate non-communicable disease care is of high priority.

Funding: Fogarty International Center and the National Institutes of Health, the Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, the South African Medical Research Council, the South African Population Research Infrastructure Network, and the Wellcome Trust.

Translation: For the isiZulu translation of the abstract see Supplementary Materials section.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests We declare no competing interests.

Figures

**Figure 1**
Framework for understanding the relationship between health states, health needs, needs scores, and needs groups

**Figure 2**
Distribution of health needs in the Vukuzazi cohort for participants with HIV, diabetes, or hypertension (A) Total number of participants with no health needs identified and with health needs identified. (B) Disease distribution among individuals with health needs identified. (C) Distribution of met and unmet health needs for individual chronic health states. (D) Distribution of met and unmet health needs for all three conditions combined (ie, HIV, diabetes, and hypertension). Green represents needs score 1 (ie, diagnosed with a well controlled condition), yellow represents needs score 2 (ie, diagnosed with a suboptimally controlled condition), light pink represents needs score 3 (ie, diagnosed but not engaged in care), and pink represents needs score 4 (ie, undiagnosed with an uncontrolled condition). Black error bars indicate 95% CIs.

**Figure 3**
Geospatial distribution of health needs for HIV, hypertension, and diabetes individually and for all three chronic conditions combined

See this image and copyright information in PMC

Update of

Quantifying met and unmet health needs for HIV, hypertension and diabetes in rural KwaZulu-Natal, South Africa.
Singh U, Olivier S, Cuadros D, Castle A, Moosa Y, Edwards JA, Kim HY, Siedner MJ, Tanser F, Wong EB. Singh U, et al. Res Sq [Preprint]. 2023 Mar 21:rs.3.rs-2702048. doi: 10.21203/rs.3.rs-2702048/v1. Res Sq. 2023. Update in: Lancet Glob Health. 2023 Sep;11(9):e1372-e1382. doi: 10.1016/S2214-109X(23)00239-5. PMID: 36993494 Free PMC article. Updated. Preprint.

Comment in

Access to comprehensive services for HIV and non-communicable diseases in sub-Saharan Africa.
Mfinanga SG. Mfinanga SG. Lancet Glob Health. 2023 Sep;11(9):e1317-e1318. doi: 10.1016/S2214-109X(23)00262-0. Lancet Glob Health. 2023. PMID: 37591570 No abstract available.

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The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey

Collaborators

Affiliations

The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

Update of

Comment in

References

Publication types

MeSH terms

Grants and funding

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Full Text Sources

Medical

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