November 15, 2023

The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey

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Emily Wong, M.D.Emily Wong, M.D.Emily Wong, M.D., assistant professor of Medicine in the Division of Infectious Diseases, is the latest winner of the Heersink School of Medicine's Featured Discovery. This initiative celebrates important research from Heersink faculty members.

Her study, "The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey,” was recently published in The Lancet Global Health.

The research utilized data from the Vukuzazi survey, a broad community-based multi-disease study conducted in rural KwaZulu-Natal between 2018 and 2020. Within this research, 18,041 adolescents and adults underwent detailed health screening for HIV, hypertension, and diabetes.

“The results indicated that half of the participants had one of these three conditions. However, the level of health system support varied significantly depending on the specific disease,” says Wong. “A substantial majority of individuals living with HIV received optimal healthcare from the system. Conversely, most individuals with the two non-communicable diseases did not have their health needs adequately addressed by the system."

The Heersink communications staff sat with Dr. Wong to gain insight into her study, UAB, and the science community.

Q: What compelled you to pursue this research?

I am an infectious disease physician and have been living and working in South Africa for most of my career. The province where I live, which is where we conducted this study, has one of the world's highest rates of people living with HIV and also has a very large public-sector antiretroviral therapy program to provide free treatment for people living with HIV.

We conducted the Vukuzazi study to understand the most important diseases in the community 15 years after antiretroviral therapy became available in South Africa. In our first major analyses from Vukuzazi, we found that members of the community were highly affected by both infectious and non-communicable diseases. Here, we wanted to understand what the people living with these chronic conditions needed from the health system to get to optimal health.

Q: What was your most unexpected finding?

We were surprised to find that HIV and non-communicable diseases had such different patterns of met vs. unmet health needs. Even in the face of such a large HIV burden, the health system in our area of rural KwaZulu-Natal optimally met the health needs of nearly 80% of people living with HIV. In contrast, over half of the people with hypertension and 90% of the people with diabetes had unmet health needs.

Q: How do you feel your research will impact the science community?

My research team and I hope that these findings will contribute to a larger conversation about broadening the use of the tremendous infrastructure that has been set up to treat HIV around the world to address the other health conditions that impact HIV-affected communities. Vertical health programs focusing on one disease are attractive for funders and implementers because they are streamlined. However, we need to expand the scope of such programs to address all the health needs of people with HIV and their communities.

We also hope that the novel health needs scale introduced in this manuscript may be useful to the broader community working on multimorbidity. In designing this scale, we tried to make it simple and universally applicable so that it could be used to analyze the health needs of people with diverse problems ranging from HIV to cancer or mental health conditions.

Q: What is your research’s relevance to human disease (if applicable)?

The Vukuzazi study has ambitious goals to understand the biological, social, environmental, and microbiological determinants of health and disease in our community in rural KwaZulu-Natal. Here, in this particular analysis, we focus on how particular diseases impact the health needs of individuals and the health system.

Q: What made you come to UAB?

One of the reasons I came to UAB is that there is a true commitment to global health and global health research here. I am one of three faculty members in the Division of Infectious Diseases who live in Southern Africa and are embedded in partner institutions. UAB's commitment to global health partnerships and its aspiration to make these partnerships equitable were highlighted earlier this year at the first annual UAB Global Health Symposium, co-hosted by the Mary Heersink Institute for Global Health. Commitment to global health training, care, and research at the highest levels of the university is critical to the success of projects like this one and is one of the reasons I love being at UAB.