The ART Advantage: Health Care Utilization for Diabetes and Hypertension in Rural South Africa

Manne‐Goehler, Jennifer; Montana, Livia; Gómez‐Olivé, Francesc Xavier; Rohr, Julia; Harling, Guy; Wagner, Ryan G.; Wade, Alisha; Kabudula, Chodziwadziwa Whiteson; Geldsetzer, Pascal; Kahn, Kathleen; Tollman, Stephen; Berkman, Lisa F.; Bärnighausen, Till; Gaziano, Thomas A.

doi:10.1097/qai.0000000000001445

Cited by 83 publications

(87 citation statements)

References 30 publications

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“…This linkage to care is encouraging and may be important for both future prevention and also older persons’ health and well-being [ 42 , 43 ]. It could result from an ‘ART advantage’ [ 28 ]; these results and other research suggest that linkage to HIV care is associated with diagnosis and treatment of NCDs and other conditions [ 23 , 26 , 28 , 29 , 44 ].…”

Section: Discussionmentioning

confidence: 87%

“…Sometimes called an antiretroviral therapy (ART)-advantage, the attachment to health services due to HIV may explain why OPLWH are more likely to know if they have additional chronic conditions and to have it treated, compared to those without HIV [ 25 , 26 ]. Chronic communicable disease, including HIV, has been found to be an important positive predictor of older persons’ healthcare usage and having HIV and being on ART was a positive predictor of being cared for another NCD in two rural South Africa studies [ 27 , 28 ]. OPLWH in rural Uganda had visited a clinic more recently that those who were HIV-negative; these visits were for both HIV and NCD care [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

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“I attend at Vanguard and I attend here as well”: barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases

Knight

Schatz

Mukumbang

2018

Int J Equity Health

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BackgroundHIV and non-communicable disease (NCD) are syndemic within sub-Saharan Africa especially among older persons. The two epidemics interact with one another within a context of poverty, inequality and inequitable access to healthcare resulting in an increase in those aged 50 and older living with HIV and experiencing an NCD co-morbidity. We explore the challenges of navigating healthcare for older persons living with HIV and NCD co-morbidity.MethodsIn-depth semi-structured interviews were conducted with a small sample of older persons living with HIV (OPLWH). The perspectives of key informants were also sought to triangulate the evidence of OPLWH. The research took place in two communities on the outskirts of Cape Town, South Africa. All interviews were conducted by a trained interviewer and transcribed and translated for analysis. Thematic content analysis guided data analysis.ResultsOPLWH experienced an HIV-NCD syndemic. Our respondents sought care and accessed treatment for both HIV and other chronic (and acute) conditions, though these services were provided at different health facilities or by different health providers. Through the syndemic theory, it is possible to observe that OPLWH and NCDs face a number of physical and structural barriers to accessing the healthcare system. These barriers are compounded by separate appointments and spaces for each condition. These difficulties can exacerbate the impact of their ill-health and perpetuate structural vulnerabilities. Despite policy changes towards integrated care, this is not the experience of OPLWH in these communities.ConclusionsThe population living with HIV is aging increasing the likelihood that those living with HIV will also be living with other chronic conditions including NCDs. Thus, it is essential that health policy address this basic need to integrate HIV and NCD care.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

“I attend at Vanguard and I attend here as well”: barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases

Knight

Schatz

Mukumbang

2018

Int J Equity Health

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“…Surprisingly, HIV status was not associated with return for study visits although previous evidence suggests that HIV status is associated with increased contact with various healthcare providers. 38 , 45 Nevertheless, there are different demands for dual protection from an HIV-positive versus HIV-negative population. Although HIV-positive women had higher likelihood of condom use –in line with recommended preventative actions– HIV status did not affect dual protection.…”

Section: Discussionmentioning

confidence: 99%

TheEmpower Nudgelottery to increase dual protection use: a proof-of-concept randomised pilot trial in South Africa

Galárraga

Harries

Maughan-Brown

et al. 2018

Reproductive Health Matters

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The objective of this study is to measure the preliminary efficacy of a pilot intervention, grounded in behavioural economics, increasing adherence of dual protection (simultaneous use of effective modern contraception and a barrier method, such as a condom) to protect against HIV, other sexually transmitted infections, and unintended pregnancy. Between 2015 and 2016, 100 women aged 18–40 years, seeking post-abortion care in Cape Town, South Africa were recruited to Empower Nudge, a randomised controlled trial to test a lottery incentive intervention designed to increase dual protection. At baseline, the mean age of participants was 27 years; 82% of them were from South Africa; 58% self-identified as Black African; average education completed was 11.7 years. At three months, assignment to the lottery intervention was associated with higher odds of returning for study visits (OR: 6.0; 95%CI: 2.45 to 14.7, p < 0.01), higher condom use (OR: 4.5; 95%CI: 1.43 to 14.1; p < 0.05), and higher use of dual protection (OR: 3.16; 95%CI: 1.01 to 9.9; p < 0.05). Only 60% of the study population returned after three months and only 38% returned after six months. Women who receive post-abortion care represent a neglected population with an urgent need for HIV and pregnancy prevention. Dual protection is a critically important strategy for this population. Lottery-based behavioural economics strategies may offer possible ways to increase dual protection use in this population. Further research with larger samples, longer exposure time, and more sites is needed to establish fully powered efficacy of lottery incentives for dual protection; using objective verification for monitoring.

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“…Our results showed similar HIV infection numbers in individuals with and without myocardial infarction and stroke, and an even lower percentage of HIV infected subjects with angina (18.6%) when compared to those without angina (22.9%). These findings might be explained by previous findings from the same cohort that showed that HIV-positive patients are more likely to receive healthcare services for diabetes and hypertension 38 , which ultimately can lead to fewer cardiovascular events.…”

Section: Discussionmentioning

confidence: 82%

Disparities in Management of Cardiovascular Disease in Rural South Africa

Jardim¹,

Reiger²,

Abrahams‐Gessel³

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background Optimal secondary prevention is critical for the reduction of repeated cardiovascular events and the control of cardiovascular risk factors in this context is essential. Data on secondary prevention of cardiovascular disease (CVD) in sub-Saharan Africa are needed to inform intervention strategies, with a particular focus on local disparities. The aim of this study was to assess CVD management in a rural community in northeast South Africa. Methods and Results We recruited adults aged ≥ 40 years residing in the Agincourt sub-district of Mpumalanga province. Data collection included socioeconomic and clinical data, anthropometric measures, blood pressure, HIV status and point-of-care glucose and lipid levels. CVD was defined as self-report of myocardial infarction and stroke, or angina diagnosed by Rose Criteria. A linear regression model was built to identify variables independently associated with the number of cardiovascular risk factors controlled. Out of 5,059 subjects, 592 (11.7%) met CVD diagnostic criteria. Angina was reported in 77.0% of these subjects, stroke in 25.2% and myocardial infarction in 3.7%. Percent controlled of the five individual risk factors assessed were as follows: tobacco 92.9%; blood pressure 51.2%; BMI 33.8%; LDL 31.4%; and waist-to-hip ratio 29.7%. Only 4.4% had all five risk factors controlled and 42.4% had three or more risk factors controlled. Male sex (β-coefficient=0.44; 95%CI 0.25–0.63; p<0.001), absence of physical disability (β-coefficient=0.40; 95%CI 0.16–0.65; p=0.001) and socioeconomic status (SES) (β-coefficient=0.10; 95%CI 0.01–0.19; p=0.035) were directly associated with the number of risk factors controlled. Conclusions Currently, CVD is not being optimally managed in this rural area of South Africa. There are significant disparities in control of CVD risk factors by sex, SES, and level of disability. Efforts to improve secondary prevention in this population should be focused on females, subjects from lower SES, and those with physical disabilities.

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The ART Advantage: Health Care Utilization for Diabetes and Hypertension in Rural South Africa

Cited by 83 publications

References 30 publications

“I attend at Vanguard and I attend here as well”: barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases

“I attend at Vanguard and I attend here as well”: barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases

TheEmpower Nudgelottery to increase dual protection use: a proof-of-concept randomised pilot trial in South Africa

Disparities in Management of Cardiovascular Disease in Rural South Africa

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