Non-communicable diseases among people living with HIV at Chitungwiza central hospital in Zimbabwe.

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.