Research Article: Comorbidities of HIV infection and health care seeking behavior among HIV infected patients attending public sector healthcare facilities in KwaZulu-Natal: A cross sectional study

Date Published: February 2, 2017

Publisher: Public Library of Science

Author(s): Manimbulu Nlooto, Wenhui Hu.

http://doi.org/10.1371/journal.pone.0170983

Abstract

HIV-infected people may present with co-infections, comorbidities, and side effects associated with antiretroviral therapy. This study explored the prevalence of comorbid health problems and determined the extent of the use of traditional medicine for treatment of co-infections, comorbidities of HIV infection and side effects.

A cross sectional study, using researcher-administered questionnaires, was carried out among HIV-infected patients in eight public sector healthcare facilities in KwaZulu-Natal between April and October 1024. Self-reports of comorbidities, co-infections and side effects were analyzed with respect to factors such as age, gender, race, and health care seeking behavior including the use of traditional medicine. Cross-tabulations were conducted to test the association between factors and the use of traditional medicine, using Pearson chi-squared (χ2) test. Simple and multiple logistic regression models tested the association of the use of traditional medicine with age, gender, race, side effects and comorbidities. Odds ratios with 95% confidence intervals were estimated. Missing values were handled, defined and treated as missing values in the final analysis.

Overall, 29.5% (n = 516) of the survey participants reported having other comorbidities and or co-infections besides their HIV condition. Same participants reported two or more comorbidities. Almost forty percent of participants (208/531, 39.17%) reported having hypertension as the most noninfectious comorbidity while 21.65% of participants (115/531) had tuberculosis accounting for the most infectious comorbidity. Almost eight percent of participants (142/1748, 8.12%) reported using traditional medicine after starting with cART. Sixty out of 142 participants (60/142, 42.25%) on cART resorted to the use of traditional medicine for the management of comorbidities and or co-infections of their HIV infection. Overall, 311 out of 1748 participants (17.80%) complained of ARVs related side-effects. Forty-five percent of those with side-effects (141/311, 45.34%) reported taking various types of medicines for treating side-effects, with 90.07% of them (127/141) using medicines prescribed by biomedically trained doctors or by pharmacy personnel as over-the -counter medicines, p <0. 001. Very few participants (14/141, 9.93%) resorted to the use of traditional medicine for treating side effects associated with antiretroviral therapy with no significant difference (p=0.293). In a multiple logistic regression, after adjusting for age, gender, race and side-effects due to antiretroviral therapy, odds for using traditional medicine were almost two times higher [odds ratio = 1.884, 95% Confidence Interval 1.317–2.695] with those participants having comorbidities and co-infections, with a significant difference p-value< 0.001. Comorbidities, co-infections and side effects are prevalent among HIV-infected patients attending public sector healthcare facilities. Odds of using traditional medicine were almost two times higher and significantly associated with the presence of comorbidities and co-infections than for other factors. The presence of such comorbid health problems does not explain the increased use of traditional medicine among HIV-infected patients on antiretroviral therapy. Findings from this study should be interpreted cautiously as they cannot be generalized to the entire population of HIV-infected patients in KwaZulu-Natal. Studies on safety and efficacy of herbal traditional medicines are needed for beneficiation of the minority of patients who still resort to them for co-treatment with combination antiretroviral therapy.

Partial Text

The burden of human immunodeficiency virus (HIV) infection is high in sub-Saharan Africa. In 2014, there were an estimated 25.8 million people living with HIV infection in the region [1]. South Africa has the largest HIV epidemic in the world with 6.8 million people living with HIV and an estimated prevalence rate of 18.9% among adults aged 15 to 49 years [2]. The KwaZulu-Natal province had the highest prevalence rate in South Africa with 16.9% [3]. Worldwide many people have taken or are currently taking complementary and alternative medicine (CAM) in combination with prescribed antiretroviral medicines [4]. Traditional medical practices can include the use of animal, mineral-based medicines, massages, spiritual therapies and a variety of other techniques unique to different regions and cultures [5]. African traditional health practitioners and those practicing other forms of traditional medicine (TM) not indigenous to African communities are an important point of access to health care for many Africans; they provide information, counselling and treatment options to members of the community [6].

This study found a high burden of comorbidities such as hypertension and diabetes; co-infections with tuberculosis and side effects due to cART among HIV infected people attending public sector healthcare facilities in KwaZulu-Natal. The observed prevalence of comorbidities in this study is consistent with the report on the rate of comorbidities of HIV infection in sub-Saharan Africa [12]. A similar study conducted in Canada showed that comorbidities are prevalent among HIV infected individuals on cART [22]. This study found that comorbidities were mainly chronic diseases affecting the cardiovascular (hypertension, heart disease) and endocrine (diabetes) systems. This finding is in agreement with the premature age-related comorbidities in a cohort of HIV patients in Italy [10]. Comorbidity of HIV infection in sub-Saharan Africa has been associated with negative physical functioning among patients receiving antiretroviral therapy [23]. HIV infected people with fewer comorbid health problems were reported to have better physical functioning in KwaZulu-Natal, South Africa [24]. We found that a few participants had more than two comorbidities and co-infections. This is in agreement with a study conducted in Tanzania where the presence of two or more opportunistic infections were reported among HIV infected people [25].

This study found that comorbidities, coinfections and side effects are prevalent among HIV infected attending public sector healthcare facilities. A few participants on cART still resorted to the use of traditional medicine for the management of comorbidities and coinfections of HIV infection, and side effects due to antiretroviral therapy. Odds of using traditional medicine were almost two times higher and significantly associated with the presence of comorbidities and co-infections than for other factors.

 

Source:

http://doi.org/10.1371/journal.pone.0170983