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J Acquir Immune Defic Syndr. 2017 Aug 15;75(5):561-567. doi: 10.1097/QAI.0000000000001445.

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

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*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.



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.


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.


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).


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.

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