Patterns of HIV, TB, and non-communicable disease multi-morbidity in peri-urban South Africa- a cross sectional study

BMC Infect Dis. 2015 Jan 17;15:20. doi: 10.1186/s12879-015-0750-1.


Background: Many low and middle-income countries are experiencing colliding epidemics of chronic infectious (ID) and non-communicable diseases (NCD). As a result, the prevalence of multiple morbidities (MM) is rising.

Methods: We conducted a study to describe the epidemiology of MM in a primary care clinic in Khayelitsha. Adults with at least one of HIV, tuberculosis (TB), diabetes (DM), and hypertension (HPT) were identified between Sept 2012-May 2013 on electronic databases. Using unique patient identifiers, drugs prescribed across all facilities in the province were linked to each patient and each drug class assigned a condition.

Results: These 4 diseases accounted for 45% of all prescription visits. Among 14364 chronic disease patients, HPT was the most common morbidity (65%). 22.6% of patients had MM, with an increasing prevalence with age; and a high prevalence among younger antiretroviral therapy (ART) patients (26% and 30% in 18-35 yr and 36-45 year age groups respectively). Among these younger ART patients with MM, HPT and DM prevalence was higher than in those not on ART.

Conclusions: We highlight the co-existence of multiple ID and NCD. This presents both challenges (increasing complexity and the impact on health services, providers and patients), and opportunities for chronic diseases screening in a population linked to care. It also necessitates re-thinking of models of health care delivery and requires policy interventions to integrate and coordinate management of co-morbid chronic diseases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Communicable Diseases / complications
  • Communicable Diseases / epidemiology*
  • Comorbidity
  • Cross-Sectional Studies
  • Delivery of Health Care
  • Female
  • HIV Infections / complications
  • HIV Infections / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • South Africa / epidemiology
  • Tuberculosis, Pulmonary / complications
  • Tuberculosis, Pulmonary / epidemiology*
  • Urban Population
  • Young Adult