title: Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings--insights from South Africa.
abstract: Sub-Saharan Africa is experiencing a multiple disease burden. Noncommunicable diseases (NCDs) are emerging, and their risk factors are becoming more common as lifestyles change and rates of urbanization increase. Simultaneously, epidemics of infectious diseases persist, and HIV/AIDS has taken hold in the region, although recent data indicate a decrease in new HIV infection rates. With the use of diabetes as a marker for NCDs, it was estimated that the number of people with diabetes would rise between 2000 and 2010 despite the HIV/AIDS epidemic, largely because of the aging of the population and the increase in risk factors for diabetes in South Africa. These numbers are likely to increase further, given the declining HIV/AIDS mortality rates and longer life expectancy due to the up-scaling of antiretroviral therapy (ART), with its concomitant metabolic complications. Given that treated HIV/AIDS has become a chronic disease, and the health care needs of people on ART resemble those of people with NCDs, and given that vertical programs are difficult to sustain when health systems are underresourced and strained, there is a powerful argument to integrate the primary level care for people with chronic diseases, whether they be NCDs or infectious diseases. Pilot studies are required to test the feasibility of an integrated service that extends from health facilities into the community in a reciprocal manner based on the WHO Innovative Care for Chronic Conditions model of care. These will begin to provide the evidence that policy makers need to change the mode of health care delivery.
authors.affiliation: Division of Endocrinology and Diabetes, Department of Medicine, University of Cape Town, South Africa. naomi.levitt@uct.ac.za
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Levitt
authors.forename: Krisela
authors.initials: K
authors.lastname: Steyn
authors.forename: Joel
authors.initials: J
authors.lastname: Dave
authors.forename: Debbie
authors.initials: D
authors.lastname: Bradshaw
mesh_terms: D000163:Acquired Immunodeficiency Syndrome; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease / Q000453:epidemiology* / Q000401:mortality; D003695:Delivery of Health Care; D003920:Diabetes Mellitus / Q000453:epidemiology; D058872:Epidemics; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006295:Health Resources; D006801:Humans; D008017:Life Expectancy; D011203:Poverty; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents
references.citation: N Engl J Med. 2007 Apr 26;356(17):1723-35
references.pmid: 17460226
references.citation: Curationis. 1999 Jun;22(2):27-31
references.pmid: 11040616
references.citation: Br J Gen Pract. 2005 Apr;55(513):305-12
references.pmid: 15826439
references.citation: J Clin Psychol Med Settings. 2009 Mar;16(1):87-93
references.pmid: 19253016
references.citation: Obes Rev. 2008 Jul;9(4):297-311
references.pmid: 18179616
references.citation: Clin Infect Dis. 2007 Jan 15;44(2):295-300
references.pmid: 17173234
references.citation: Prim Care Diabetes. 2009 Aug;3(3):181-8
references.pmid: 19748331
references.citation: S Afr Med J. 2003 Sep;93(9):682-8
references.pmid: 14635557
references.citation: Heart. 2008 Nov;94(11):1376-82
references.pmid: 18519551
references.citation: N Engl J Med. 2003 Nov 20;349(21):1993-2003
references.pmid: 14627784
references.citation: Diabet Med. 1997 Dec;14(12):1073-7
references.pmid: 9455936
references.citation: J Antimicrob Chemother. 2008 Feb;61(2):238-45
references.pmid: 18070830
references.citation: Curr HIV/AIDS Rep. 2008 Aug;5(3):132-9
references.pmid: 18627662
references.citation: Diabet Med. 2008 May;25(5):606-11
references.pmid: 18445175
references.citation: Lipids. 2010 Jan;45(1):73-80
references.pmid: 19916038
references.citation: S Afr Med J. 2008 Aug;98(8):618-22
references.pmid: 18928041
references.citation: Eur Heart J. 2011 Apr;32(8):945-51
references.pmid: 21228007
references.citation: Diabetes Obes Metab. 2008 Jun;10(6):441-50
references.pmid: 17825081
references.citation: Lancet. 2011 Feb 12;377(9765):568-77
references.pmid: 21295844
references.citation: J Acquir Immune Defic Syndr. 2009 Jan 1;50(1):37-43
references.pmid: 19295333
references.citation: J Hum Hypertens. 2008 Mar;22(3):236-9
references.pmid: 18046436
references.citation: AIDS Res Hum Retroviruses. 2009 Aug;25(8):771-81
references.pmid: 19619010
references.citation: Hum Resour Health. 2010 Mar 31;8:8
references.pmid: 20356363
references.citation: Ethn Dis. 2010 Winter;20(1):29-34
references.pmid: 20178179
references.citation: Antivir Ther. 2009;14(3):371-80
references.pmid: 19474471
references.citation: Bull World Health Organ. 2007 Nov;85(11):880-5
references.pmid: 18038079
references.citation: Pan Afr Med J. 2009 Oct 24;3:10
references.pmid: 21532719
references.citation: J Clin Hypertens (Greenwich). 2009 Oct;11(10):564-72
references.pmid: 19817937
references.citation: Diabetes Care. 2007 May;30(5):1081-7
references.pmid: 17337504
references.citation: AIDS. 2003 May 2;17(7):971-9
references.pmid: 12700446
references.citation: Diabetes Care. 1993 Apr;16(4):601-7
references.pmid: 8462387
references.citation: S Afr Med J. 2007 Dec;97(12):1284-8
references.pmid: 18264611
references.citation: Diabet Med. 2006 Jan;23(1):103-4
references.pmid: 16409575
references.citation: J Acquir Immune Defic Syndr. 2007 Dec 1;46(4):451-5
references.pmid: 18077834
references.citation: J Clin Endocrinol Metab. 2007 Jul;92(7):2506-12
references.pmid: 17456578
references.citation: S Afr Med J. 2007 Aug;97(8 Pt 2):637-41
references.pmid: 17952221
references.citation: S Afr Med J. 2007 Aug;97(8 Pt 2):700-6
references.pmid: 17952227