Neighborhood-level determinants of HIV and chronic disease comorbidity in a South African urban informal settlement Public Deposited

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  • March 20, 2019
Creator
  • Huber, Amy
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • INTRODUCTION The prevalence of chronic disease and HIV comorbidity is increasing in South Africa and prevention strategies for this context are needed. In order to maintain the health of people living with HIV, it is necessary to move beyond the individual level and consider the characteristics of the neighborhoods and contexts to which the individual belongs. METHODS Using cross-sectional data from a randomized community survey conducted in Diepsloot, South Africa, we examined the distribution of HIV, hypertension, diabetes, and obesity, four highly prevalent chronic diseases at the neighborhood level. We mapped the distribution of each level of the HIV care cascade and each chronic disease using the Spatial Scan Statistic to identify hotspot areas. We then conducted a log binomial regression analysis to assess factors associated with 1) living in an area of higher than expected HIV infectiousness; and 2) prevalent chronic disease among those with and without HIV. RESULTS Sixteen percent of the study population were living with HIV, 3% (n=42) were diabetic, 29% (n=359) were hypertensive, and nearly 50% (n= 576) of the population was either overweight or obese, with women having a higher prevalence than men (66% vs. 26%). Overall, 9% of the sample was living with HIV and at least one other chronic disease. Overlapping hotspots of hypertension, diabetes, and obesity prevalence were present and differed from the areas of high HIV prevalence. Individuals residing in a HIV infectiousness hotspot were more likely to be of higher education level (at least secondary school) (Prevalence Ratio=1.43, 95%CI: 1.14-1.78) and unemployed without government grant assistance (PR=1.21, 95%CI: 1.00-1.46). Controlling for other factors, HIV positive participants with a chronic condition were more likely to live less than 300 meters from the nearest supermarket (PR=1.21, 95% Confidence Interval(CI): 0.97-1.51). CONCLUSIONS Within a poor urban informal settlement in South Africa, we observed variation between neighborhoods in engagement in the HIV care cascade, level of HIV infectiousness, and chronic disease prevalence suggesting that these conditions have different drivers. Our findings support targeted interventions at the neighborhood level such as HIV testing programs and chronic disease screening as an efficient way to reach those in need of health outreach.
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  • In Copyright
Advisor
  • Miller, William
  • Pettifor, Audrey
  • Emch, Michael
  • Van Rie, Annelies
  • Aiello, Allison
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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