Page 312 - HIVMED_v21_i1.indb

Page 6 of 8 Original Research

Cases, whether diagnosed with DM, HTN or both, were more on medication among cases was $12 compared with $1
likely to be hospitalised compared with controls (AOR = 2.4, among controls, considering only those who were able to
95% CI: 1.2–3.3). The average number of hospitalisation days purchase all the prescribed medication.
in cases was 5 days compared with 1 day in controls.
Assessment of usual diet
Days spent without usual daily tasks or activities
because of illness There was no significant difference in usual diet between
cases and controls, using the 24-hour food recall method. The
To assess the effect of NCDs on productivity, average monthly usual diet for both cases and controls was carbohydrate
number of days spent without doing usual daily activities staples and green leafy vegetables, with less protein sources
because of illness was compared between cases and controls. of food. Employment status was significantly associated with
Cases were more likely to spend more days without doing consuming a balanced diet, rich in all the required nutrients,
usual daily activities compared with controls (AOR = 4.2, in both cases and controls (p = 0.0003). Consumption of a
95% CI: 3.3–7.6, p = 0.0000). balanced diet was not associated with other demographic
characteristics and NCD status.
Days spent without doing usual daily tasks or activities were
associated with female gender, inability to purchase Discussion
medication and unemployment status. Women spent more
days without usual daily activities when compared with men The study compared healthcare costs, health experiences and
in both cases and controls (p = 0.0031). Again, the inability to care-related outcomes in PLWH diagnosed with HTN and/
purchase prescribed medication was associated with more or DM with a matched control group of PLWH without
days spent without doing usual daily activities because of NCDs. This study observed numerous important findings of
illness in both cases and controls (p = 0.0023). Unemployed relevance to PLWH in Africa (Zimbabwe) who are on ART
participants spent more days without doing ‘usual’ daily and virally suppressed:
activities as compared with formally employed and • The concurrent presence of comorbid disease is a function
informally employed participants (p = 0.001). Subgroup of time on ART.
analysis of cases showed that cases with more than two • HIV-NCD comorbidity undermines the goals of HIV
NCDs spent more days without doing usual daily activities treatment, which is to control the virus (HIV) and promote
(AOR = 2.1, 95% CI: 1.3–4.4).
wellness: (1) expenses increase, for example, medication
Ability to purchase non-communicable disease and travel costs; (2) impaired management of comorbid
conditions, where over 68% of the case group were unable
medication to afford DM or HTN medication, which were not
Not all patients could afford their prescribed medication. supplied free-of-charge; (3) increasing vulnerability to
Therefore, simply estimating costs on the basis of monthly non-evidence-based health options and (4) HIV-NCD
prescriptions would not have represented the actual situation comorbidity results in greater risk of morbidity and
on the ground. Participants – cases and controls – were asked mortality.
to indicate monthly medication expenses and to record for • Women bear the greater burden of comorbid disease, and
the duration of the study, which medicines had not been experience greater ‘disability’ – unable to do usual daily
purchased each month. This inability to purchase prescribed tasks.
medication was used in this study as an adjunctive measure • Rural citizens and the elderly appear to experience a
of the effect of NCDs on healthcare costs in PLWH. greater negative impact of economic hardship from
comorbid conditions.
Cases were less likely than controls to be able to purchase
medication for ill health. Inability to purchase medication In general, controls, namely, virally suppressed PLWH
was associated with having an NCD (AOR = 4.4, 95% CI: without HTN, DM or both, were associated with lower
3.2–7.3). Among the cases, the inability to purchase NCD average monthly expenses on prescription medication and
medication was associated with the number of NCDs per spent fewer number of days without carrying out usual daily
patient, sex, age and employment status. Cases with two or activities or tasks because of illness, compared with virally
more NCDs were more unlikely to purchase medication suppressed PLWH with HTN and/or DM. In Zimbabwe,
compared with those with one NCD (p = 0.000). Female most PLWH access ART free-of-charge in public health
participants were less likely than male cases to afford facilities. However, medication for the NCDs is usually not
9
monthly medication requirements (p = 0.0011). Participants available free-of-charge. These patients have to access
living in rural areas and those in the age categories 60–69 medication largely through out-of-pocket expenses. Ability
years and ≥70 years were similarly less likely to afford to pay for NCD medication, therefore, becomes a major
medications, than urban participants and those aged <60 determinant for access to medication, which results in poor
years (p = 0.0031, 0.0001 and 0.0000, respectively). Formal management of the NCDs and the generally observed higher
employment was significantly associated with the ability to number of productive days lost because of illness. This has
purchase medication, after adjusting for potential potential to impact negatively on the gains achieved so far in
confounders (p = 0.000). Estimated average monthly expense controlling HIV through ART.

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