Non-communicable diseases among people living with HIV at Chitungwiza central hospital in Zimbabwe.
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Date
2022
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Abstract
Background
The incidence of non-communicable diseases (NCDs) has been reported to be on the rise in the years
preceding 2010. Over the years, NCDs have become a global public health burden and a leading cause
of premature death, mainly in low to middle-income countries (LMICs). Additionally, sub-Saharan
Africa has shown a rise in morbidity and mortality due to NCDs. In Zimbabwe, only a few studies have
been conducted to examine the incidence of NCDs in people living with HIV (PLHIV). The study
objectives included determining the incidence of NCDs in PLHIV on ART over a ten-year period and
the associated risk factors. Furthermore, the study explored physicians’ perceptions on the availability
and quality of clinical care for the management of NCDs, in addition to evaluating the knowledge and
perceptions of PLHIV towards NCDs.
Methods
The study encompassed a mixed methods approach using both quantitative and qualitative methods. The
thesis is based on three different articles each built from a different study design. Reliability of the
questionnaire and the data collection sheet were determined by calculating the Cronbach alpha which
exceeded 0.8 in both cases. In addition validity of the tools went through a panel of experts before being
approved and also pilot studies were conducted to validate the tools before actual data collection.
The title of the first article was: Incidence of non-communicable diseases (NCDs) in HIV patients on
ART in a developing country: Case of Zimbabwe’s Chitungwiza Central Hospital—A retrospective
cohort study (2010–2019) and it addresses the first two objectives of the thesis. This was a retrospective
analysis of data from ongoing longitudinal population-based cohorts from Chitungwiza Central Hospital
(CCH) in Zimbabwe, focusing on PLHIV receiving antiretroviral therapy (ART) at the opportunistic
infections clinic (OIC) housed at CCH, covering the period 2010-2019. This was crucial for long-term
follow-ups and determining the associated risk factors. The intention was to first establish the incidence
of NCDs in PLHIV, as well as the association of the incidence with several factors such as age,
geographic location of residence of the study participants and their gender. The incidences of NCDs
namely cancers, cardiovascular diseases, diabetes mellitus and hypertension were determined and
generalized estimating equations (GEE) were used to estimate the association between NCDs and the
selected risk factors. Article 2 which addresses objective 3 was published in the Globalization and Health Journal and was entitled: A qualitative exploratory study of selected physicians’ perceptions of the
management of non-communicable diseases at a referral hospital in Zimbabwe. This was a qualitative
exploratory study meant to obtain expert perceptions of care delivery for NCDs in one Zimbabwean
referral hospital setting. Data was collected from participants who consented. A four-point Likert scale
was used to categorize different levels of perceived satisfaction and analysis was done using Stata version
13. The third article making up the thesis and addresses objective 4 is entitled: Knowledge and
Perceptions about Non-Communicable Diseases by people living with HIV: A descriptive cross-sectional
study from Chitungwiza Central Hospital Zimbabwe. The article has been accepted by the African Health
Sciences Journal and is pending publication. This was a cross-sectional explanatory study using a mixed
methods approach to describe-the participants’ responses. The study explores and descriptively
documents the perceptions and knowledge of PLHIV on their exposure to the NCDs burden.
Results
Data collected at the study’s baseline (2010) showed that the most prevalent NCD was hypertension,
found in 8.9% (18/203) of the study participants, followed by diabetes (6.9%), then cardiovascular
diseases (CVD) (3.9%). The least common NCD was cancer (1.9%). Incidences of all of these NCDs
showed an increasing trend as the time of follow-up progressed. The associated risk factors found to be
significantly associated with the development of NCDs were gender, with females being 2 times more
likely than males to develop NCD (p = 0.002) and follow-up time (p<0.001). Moreover, geographical
location was a significant risk factor as urban patients were more likely to develop hypertension as
compared to peri-urban patients (p = 0.001). Nineteen of the doctors were general practitioners, whilst
four were specialists. The findings indicated that both general and specialists perceived some shortfalls
in clinical care for NCDs. Moreover, the perceptions of general practitioners and specialists were not
significantly different. Doctors perceived cancer care to be lagging far behind the other three NCDs
under study. Care for cardiovascular diseases (CVDs) and diabetes showed mixed perceptions amongst
participants, with positive perceptions almost equalling negative perceptions. Furthermore,
hypertension was perceived to be clinically cared for better than the other NCDs under study. Reasons
for the gaps in NCD clinical care were attributed by 33% of the participants to financial challenges; a
further 27% to patient behavioural challenges; and 21% to communication challenges. The study also
found a moderately good level of knowledge (65%) and very high levels of positive perceptions (81%)
on NCDs. Participants <40 years of age were more knowledgeable (p=0.003) and a history of NCD in the family had a positive influence on knowledge (p=0.001). Females showed a more positive
perception (p=0.043), whilst both increasing age and low education negatively impacted perceptions
(p<0.001) as well as knowledge (p=0.020).
Conclusion
The study concluded that NCDs and HIV comorbidity is common with women, who are more likely than
men to develop NCDs as they advance in age. There is need to devise targeted intervention approaches
to the respective NCDs and risk factors since they diversely affect people with different demographic
characteristics. Moreover, the care delivery for the selected NCDs under study at CCH need to be
improved. It is crucial to diagnose NCDs before patients show clinical symptoms. This helps disease
prognosis to yield better care results. The evaluation of doctors’ perceptions indicates the need to improve
NCD care at CCH in order to control NCD co-morbidities that may increase mortality. Patients’
knowledge and perceptions were moderately high but reduced with decreasing levels of education and
increasing age. The study recommends educational campaigns to disseminate information about NCDs
in PLHIV, targeting the least educated population groups and those older than 40 years of age.
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.