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The growing burden of non-communicable disease among persons living with HIV in Zimbabwe

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Title: The growing burden of non-communicable disease among persons living with HIV in Zimbabwe
Authors: Smit, M
Olney, J
Ford, NP
Vitoria, M
Gregson, S
Vassall, A
Hallett, TB
Item Type: Journal Article
Abstract: Objectives: We aim to characterize the future noncommunicable disease (NCD) burden in Zimbabwe to identify future health system priorities. Methods: We developed an individual-based multidisease model for Zimbabwe, simulating births, deaths, infection with HIV and progression and key NCD [asthma, chronic kidney disease (CKD), depression, diabetes, hypertension, stroke, breast, cervical, colorectal, liver, oesophageal, prostate and all other cancers]. The model was parameterized using national and regional surveillance and epidemiological data. Demographic and NCD burden projections were generated for 2015 to 2035. Results: The model predicts that mean age of PLHIV will increase from 31 to 45 years between 2015 and 2035 (compared with 20 –26 in uninfected individuals). Conse- quently, the proportion suffering from at least one key NCD in 2035 will increase by 26% in PLHIV and 6% in uninfected. Adult PLHIV will be twice as likely to suffer from at least one key NCD in 2035 compared with uninfected adults; with 15.2% of all key NCDs diagnosed in adult PLHIV, whereas contributing only 5% of the Zimbabwean population. The most prevalent NCDs will be hypertension, CKD, depression and cancers. This demographic and disease shift in PLHIV is mainly because of reductions in incidence and the success of ART scale-up leading to longer life expectancy, and to a lesser extent, the cumulative exposure to HIV and ART. Conclusion: NCD services will need to be expanded in Zimbabwe. They will need to be integrated into HIV care programmes, although the growing NCD burden amongst uninfected individuals presenting opportunities for additional services developed within HIV care to benefit HIV-negative persons.
Issue Date: 27-Mar-2018
Date of Acceptance: 4-Jan-2018
URI: http://hdl.handle.net/10044/1/55713
DOI: https;//dx.doi.org/10.1097/QAD.0000000000001754
ISSN: 0269-9370
Publisher: Lippincott, Williams & Wilkins
Start Page: 773
End Page: 782
Journal / Book Title: AIDS
Volume: 32
Copyright Statement: Q 2018 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Sponsor/Funder: Medical Research Council (MRC)
Bill & Melinda Gates Foundation
Civilian Research & Development Foundation Golbal
Funder's Grant Number: MR/K010174/1B
Keywords: 06 Biological Sciences
11 Medical And Health Sciences
17 Psychology And Cognitive Sciences
Publication Status: Published
Appears in Collections:Imperial College Business School
School of Public Health