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The ART Advantage: Health Care Utilization for Diabetes and Hypertension in Rural South Africa

Manne-Goehler, Jennifer MD, ScD, MSc*,†; Montana, Livia ScD, MA; Gómez-Olivé, Francesc Xavier MD, PhD, MSc‡,§; Rohr, Julia PhD, MPH; Harling, Guy ScD†,‖,¶; Wagner, Ryan G. PhD, MSc§; Wade, Alisha MBBS, DPhil§,#; Kabudula, Chodziwadziwa W. PhD, MSc§,#; Geldsetzer, Pascal MBChB, MPH; Kahn, Kathleen MD, PhD, MPH§,#; Tollman, Stephen MD, PhD, MPH§,#; Berkman, Lisa F. PhD, MSc‡,§; Bärnighausen, Till W. MD, ScD, MSc†,‖,**; Gaziano, Thomas A. MD††,‡‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2017 - Volume 75 - Issue 5 - p 561–567
doi: 10.1097/QAI.0000000000001445
Clinical Science

Background: The prevalence of diabetes and hypertension has increased in HIV-positive populations, but there is limited understanding of the role that antiretroviral therapy (ART) programs play in the delivery of services for these conditions. The aim of this study is to assess the relationship between ART use and utilization of health care services for diabetes and hypertension.

Methods: Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa is a cohort of 5059 adults. The baseline study collects biomarker-based data on HIV, ART, diabetes, and hypertension and self-reported data on health care utilization. We calculated differences in care utilization for diabetes and hypertension by HIV and ART status and used multivariable logistic regressions to estimate the relationship between ART use and utilization of services for these conditions, controlling for age, sex, body mass index, education, and household wealth quintile.

Results: Mean age, body mass index, hypertension, and diabetes prevalence were lower in the HIV-positive population (all P < 0.001). Multivariable logistic regression showed that ART use was significantly associated with greater odds of blood pressure measurement [adjusted odds ratio (aOR) 1.27, 95% confidence interval (CI): 1.04 to 1.55] and blood sugar measurement (aOR 1.26, 95% CI: 1.05 to 1.51), counseling regarding exercise (aOR 1.57, 95% CI: 1.11 to 2.22), awareness of hypertension diagnosis (aOR 1.52, 95% CI: 1.12 to 2.05), and treatment for hypertension (aOR 1.63, 95% CI: 1.21 to 2.19).

Conclusions: HIV-positive patients who use ART are more likely to have received health care services for diabetes and hypertension. This apparent ART advantage suggests that ART programs may be a vehicle for strengthening health systems for chronic care.

Supplemental Digital Content is Available in the Text.

*Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;

Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA;

Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA;

§Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa;

Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa;

Research Department of Infection and Population Health, University College London, London, United Kingdom;

#INDEPTH Network, Accra, Ghana;

**Institute of Public Health, University of Heidelberg, Heidelberg, Germany;

††Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and

‡‡Center for Health Decision Science, Harvard Medical School, Boston, MA.

Correspondence to: Jennifer Manne-Goehler, MD, DSc, MSc, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 (e-mail:

Supported by the National Institute of Aging at the National Institutes of Health (Grant Numbers 1P01AG041710-01A1, HAALSI—Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa and P30AG024409, for the Program on the Global Demography of Aging at Harvard University). T.W.B. was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the Federal Ministry of Education and Research; the Wellcome Trust; the European Commission; the Clinton Health Access Initiative; and from NICHD of NIH (R01-HD084233), NIAID of NIH (R01-AI124389 and R01-AI112339) as well as FIC of NIH (D43-TW009775).

The authors have no conflicts of interest to disclose.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The HAALSI study is nested within the Agincourt Health and Socio-Demographic Surveillance System site, funded by the University of the Witwatersrand and Medical Research Council, South Africa, and the Wellcome Trust, United Kingdom (058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z).

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Received December 23, 2016

Accepted April 12, 2017

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