01 December 2017

The double whammy of HIV and NCDs

Around 10% of Delft Community Health Centre's HIV positive patients are simultaneously being treated for NCDs.

Delft Community Health Centre sees around 35 000 patients a month from Cape Town’s northern areas, and every morning the corridors and waiting areas are clogged with people.

Infectious diseases – especially tuberculosis and HIV – are the main focus of the centre, but the incidence of non-communicable diseases (NCDs) is steadily rising, particularly hypertension and diabetes.

Seven pills per day

Delft’s head of clinical services, Dr Sheron Forgus, says that around 10% of the centre’s HIV positive patients are also being treated for NCDs.

One of these is Elizabeth Meyer, who was first diagnosed with HIV in 2002. She has managed to keep the virus in check for many years and only started ARV treatment a couple of months ago. That part is easy for her. She finds her diabetes and hypertension far more difficult to manage.

“Two years ago I was diagnosed with diabetes. My mouth was dry, I had painful burning under my feet,” says the soft-spoken 43-year-old mother.

Meyer now has to take seven pills every day. In the morning, she takes a “big thick” diabetes pill, a blood pressure pill and a cholesterol tablet. She repeats this at night, but adds her daily ARV, which is a three-in-one pill.

“In the beginning, it was hard and I wanted to vomit. I was drowsy and very nauseous but I am getting used to it,” says Meyer. She is also trying hard to cut sugar, salt and fizzy drinks from her diet and watch her weight, which is a constant battle.

Over 6 000 HIV positive patients have started on ARVs at the centre, and around 2 200 are stable with undetectable levels of the virus, says Sister Tresia Nontshinga, the operational manager for infectious diseases.

A patient every 12 minutes

These stable patients are organised into “clubs” of up to 25 people with similar disease profiles. Grouping the diabetic HIV positive patients together, for example, both creates a support system and makes it easier for nurses to address similar problems at the same time.

Forgus says that health workers working in infectious diseases have become much more aware of NCDs in the past few years, and are dedicated to screening their HIV positive patients. But it is complicated and time-consuming.

Stable HIV positive patients get to see a doctor once a year and these check-ups now take a long time as doctors need to test for NCDs too – which means that they test their “eyes, feet, do blood tests for their sugar levels, cholesterol tests, test their kidneys”, says Forgus.

Each Delft doctor currently see 40 patients a day – that’s a patient every 12 minutes if you work for eight hours flat out without any breaks.

In addition, the different medicines bring their own interactions. A class of ARVs called protease inhibitors (PI) can cause diabetes, in part because the medicine interferes with the body’s absorption of glucose.

Luckily, these are “second line” ARVs, taken by people who have become resistant to normal treatment, and the health department recently introduced a new ARV called dolutegravir, which doesn’t impact on glucose.

Litres and litres of fizzy drinks

But dolutegravir interferes with a diabetes medicine called metformin. The blood-thinning medicine, warfarin, for people in danger of clots, interferes with TB medication.

There is also very little time to educate patients about healthy habits, particularly related to diet.

“Our patients drink litres and litres and litres of fizzy drinks,” says Forgus. “But the consultations are short and we have to address everything in one visit. To encourage behaviour change, you need at least 30 minutes with each patient.”

One of the centre’s busy doctors, Dr Marcia Vermeulen adds: “Most of our patients are suffer from poor diet and inactivity. But they are unemployed and looking for a job, not going to the gym. There are no gyms here.”

By 2025, around 12,3-million South Africans will be on long-term medication for HIV and various NCDs, according to the Department of Health.  This is going to put massive strain on the health system.- Health-e News.

Image credit: iStock