title: Patterns of HIV, TB, and non-communicable disease multi-morbidity in peri-urban South Africa- a cross sectional study.
abstract: 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.
authors.affiliation: Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Room 2.24, Entrance 5, Falmouth building Anzio road, Observatory 7925, Cape Town, South Africa. tolullah.oni@uct.ac.za.|Health Impact Assessment Directorate, Western Cape Department of Health, Cape Town, South Africa. tolullah.oni@uct.ac.za.|Centre for Infectious Disease Epidemiology Research, Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. tolullah.oni@uct.ac.za.
authors.forename: Tolu
authors.initials: T
authors.lastname: Oni
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa. Liz.Youngblood@westerncape.gov.za.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Youngblood
authors.affiliation: Health Impact Assessment Directorate, Western Cape Department of Health, Cape Town, South Africa. Andrew.boulle@uct.ac.za.|Centre for Infectious Disease Epidemiology Research, Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. Andrew.boulle@uct.ac.za.
authors.forename: Andrew
authors.initials: A
authors.lastname: Boulle
authors.affiliation: Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK. n.mcgrath@soton.ac.uk.|Africa Centre for Health and Population Studies, University of Kwazulu Natal, Durban, South Africa. n.mcgrath@soton.ac.uk.
authors.forename: Nuala
authors.initials: N
authors.lastname: McGrath
authors.affiliation: Health Impact Assessment Directorate, Western Cape Department of Health, Cape Town, South Africa. r.j.wilkinson@imperial.ac.uk.|Department of Medicine, University of Cape Town, Cape Town, South Africa. r.j.wilkinson@imperial.ac.uk.|Department of Medicine, Imperial College, London, W2 1PG, UK. r.j.wilkinson@imperial.ac.uk.|Medical Research Council National Institute of Medical Research, London, NW7 1AA, UK. r.j.wilkinson@imperial.ac.uk.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wilkinson
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa. Naomi.levitt@uct.ac.za.|Chronic Disease Initiative for Africa, Cape Town, South Africa. Naomi.levitt@uct.ac.za.
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Levitt
mesh_terms: D000293:Adolescent; D000328:Adult; D003141:Communicable Diseases / Q000150:complications / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology*; D014505:Urban Population; D055815:Young Adult