Journal
BMC INFECTIOUS DISEASES
Volume 15, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s12879-015-0750-1
Keywords
HIV; Tuberculosis; Hypertension; Diabetes; Multimorbidity
Categories
Funding
- Carnegie Corporation Postdoctoral Fellowship
- Harry Crossley Senior Clinical Fellowship
- Wellcome Trust
- Wellcome Trust fellowship [WT083495MA]
- Western Cape Department of Health
- Wellcome Trust [WT088316, 084323]
- MRC(UK) [U. 1175.02.002.00014.01]
- European and Developing Countries Clinical Trials Partnership [IP. 07.32080.02]
- European Union (FP7) [Health-F3-2012305578]
- Department of Health, Medical Research Council and National Research Foundation, South Africa
- The Francis Crick Institute [10219, 10218] Funding Source: researchfish
- Wellcome Trust [104803/Z/14/Z] Funding Source: researchfish
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Background: Many low and middle-income countries are experiencing colliding epidemics of chronic infectious (ID) and non-communicable diseases (NCD). As a result, the prevalence of multiple morbidities (MM) is rising. Methods: We conducted a study to describe the epidemiology of MM in a primary care clinic in Khayelitsha. Adults with at least one of HIV, tuberculosis (TB), diabetes (DM), and hypertension (HPT) were identified between Sept 2012-May 2013 on electronic databases. Using unique patient identifiers, drugs prescribed across all facilities in the province were linked to each patient and each drug class assigned a condition. Results: These 4 diseases accounted for 45% of all prescription visits. Among 14364 chronic disease patients, HPT was the most common morbidity (65%). 22.6% of patients had MM, with an increasing prevalence with age; and a high prevalence among younger antiretroviral therapy (ART) patients (26% and 30% in 18-35 yr and 36-45 year age groups respectively). Among these younger ART patients with MM, HPT and DM prevalence was higher than in those not on ART. Conclusions: We highlight the co-existence of multiple ID and NCD. This presents both challenges (increasing complexity and the impact on health services, providers and patients), and opportunities for chronic diseases screening in a population linked to care. It also necessitates re-thinking of models of health care delivery and requires policy interventions to integrate and coordinate management of co-morbid chronic diseases.
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