Page 307 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 8 Original Research

Effects of HIV and non-communicable disease

comorbidity on healthcare costs and health experiences

in people living with HIV in Zimbabwe

Authors: Background: The effects of HIV and non-communicable disease (NCD) comorbidities on
Laston Gonah healthcare costs and health experiences have been documented in most high-income countries.
1
Indres Moodley 1
Khumbulani Hlongwana 1 However, little similar data are available for Zimbabwe and most countries in sub-Saharan
Africa. Untreated or under-treated NCDs can potentially negate the gains achieved from the
Affiliation: control of HIV.
1 Health Outcomes Research
Unit, Discipline of Public Objectives: The study sought to determine the effects of HIV-NCD comorbidity on healthcare
Health Medicine, School of costs, health experiences and treatment options for people living with HIV (PLWH) in
Nursing and Public Health, Zimbabwe.
College of Health Sciences,
University of KwaZulu-Natal, Methods: A repeated-measures, quantitative study was conducted at six antiretroviral therapy
Durban, South Africa
(ART) sites in the Gweru District of Zimbabwe. Simple random sampling was used to enrol
Corresponding author: 100 PLWH concurrently diagnosed with hypertension and/or diabetes mellitus (cases). Cases
Laston Gonah, were matched by age, sex and viral load to an equal number of PLWH without hypertension
[email protected] and/or diabetes mellitus (controls). Quantitative data were collected using an interviewer-
Dates: administered questionnaire at monthly intervals for 6 months. The questionnaire survey
Received: 04 May 2020 sought to compare healthcare costs, health-related experiences and treatment options between
Accepted: 23 June 2020 cases and controls. Data were analysed using Stata Version 13.1®. A logistic model was used
Published: 04 Sept. 2020 to examine other factors such as demographic, clinical and behavioural data that were assumed

How to cite this article: to be unchanged over the study period. A random-effects model, including costs and other
Gonah L, Moodley I, covariates, was used to compare groups in the final analysis.
Hlongwana K. Effects of HIV
and non-communicable Results: Non-communicable disease status was associated with the length of time on ART.
disease comorbidity on Cases spent significantly more on transport (p = 0.0001) and medication (adjusted odds ratio
healthcare costs and health [AOR] = 4.4, 95% confidence interval [CI]: 3.2–7.3); spent more days without doing usual daily
experiences in people living activities because of sickness (AOR = 4.2, 95% CI: 3.3–7.6) and were more likely to use alternative
with HIV in Zimbabwe. S Afr J
HIV Med. 2020;21(1), a1102. medication (AOR = 3.4, 95% CI: 2.3–4.6) when compared with controls. Unemployment, female
https://doi.org/10.4102/ gender, age of 60 years and above, and living in rural areas were associated with failure to
sajhivmed.v21i1.1102 purchase prescribed medication.
Copyright: Conclusions: HIV-NCD comorbidity causes an additional burden to PLWH because of
© 2020. The Authors. increased transport costs, NCD prescribed medication expenses and more productive days
Licensee: AOSIS. This
work is licensed under lost due to illness. The success of HIV programmes does not only rely on improving access to
the Creative Commons the diagnosis and treatment of HIV. Addressing the complications of HIV-related NCDs, and
Attribution License. the long-term costs of ART and its occasional potential for harm will be essential if health
outcomes in Zimbabweans living with HIV are to be optimised.
Keywords: human immunodeficiency virus; non-communicable disease; Zimbabwe;
antiretroviral therapy; unemployment; diagnosis and treatment of HIV; ART.

Introduction

Unprecedented donor and government funding to address the HIV and AIDS pandemic resulted in
more than 20 million people receiving antiretroviral therapy (ART) by mid-2017, against a total of 36.7
million people living with HIV (PLWH) worldwide. Whilst ART has markedly increased survival,
1
PLWH have been found to be at greater risk of developing non-communicable diseases (NCDs).
2
Read online:
Read online:
Scan this QR People living with HIV have a threefold increased risk of developing NCDs because of three main
Scan this QR
code with your
code with your reasons: (1) inflammatory and infectious sequelae of HIV infection, (2) the effects of ART treatment
smart phone or
smart phone or
mobile device
mobile device itself and (3) finally, the increased risk associated with ageing. Successful ART roll-out has
3
to read online.
to read online.
resulted in most PLWH living longer, possibly driving the onset of NCDs, because of long-term
http://www.sajhivmed.org.za 299 Open Access