Undiagnosed and untreated disease identified in rural South Africa

PICTURE: Emily Wong, MD view After

Credit: African Institute for Health Research

BIRMINGHAM, Alabama – A comprehensive health screening program in rural northern KwaZulu-Natal, South Africa has found a high burden of undiagnosed or poorly controlled noncommunicable diseases, according to a study published in The Lancet Global Health.

Researchers found that four in five women over the age of 30 lived with a chronic health problem, and that the HIV-negative population and the elderly – especially those over the age of 50 – carried the heaviest burden of non-infectious diseases. diagnosed or poorly controlled. communicable diseases such as diabetes and hypertension.

The study was co-led by Emily Wong, MD, resident faculty member at the Africa Health Research Institute, or AHRI, in Durban, KwaZulu-Natal, South Africa. Wong is also an assistant professor in the Division of Infectious Diseases at the University of Alabama in the Birmingham Department of Medicine and an associate scientist at the UAB AIDS Research Center.

“The data will give researchers at AHRI and the Department of Health critical indicators for where the most urgent interventions are needed,” Wong said. “The research was done before COVID-19, but it has highlighted the urgency of diagnosing and treating people with noncommunicable diseases – given that people with uncontrolled diabetes and hypertension are at risk. higher to get very sick with COVID. “

Durban is the global epicenter of tuberculosis infections associated with HIV. Wong is working there to understand the impact of infection with HIV – the virus that causes AIDS – on the pathogenesis, immunity and epidemiology of tuberculosis. She works closely with another UAB researcher who also works at AHRI, Andries “Adrie” Steyn, Ph.D., professor in the department of microbiology at UAB.

“We are working hard to strengthen the links and collaborations between the two institutions and to create a UAB-AHRI tuberculosis center that further facilitates multidisciplinary collaborations,” said Wong. Wong joined UAB last year and she will spend around 80% of her time at AHRI and 20% at UAB when travel resumes after her COVID-19 hiatus.

As a backdrop to the study, 15 years of intense public health efforts that improved access to antiretroviral therapy in sub-Saharan Africa have beneficially reduced AIDS mortality and increased life expectancy. As a result, tackling other causes of disease, including tuberculosis and noncommunicable diseases, is increasingly a priority.

Within 18 months Lancet Global Health In the study, health workers screened 17,118 people aged 15 and over through mobile camps within one kilometer of each participant’s home in uMkhanyakude district. They found high and overlapping burdens of HIV, tuberculosis, diabetes and hypertension in men and women.

While HIV cases were, for the most part, well diagnosed and treated, certain demographic groups, including men in their 20s and 30s, still had high rates of undiagnosed and untreated HIV. The majority of people with tuberculosis, diabetes or high blood pressure were not diagnosed or were not well controlled. Tuberculosis remains one of the leading causes of death in South Africa, and the high rates of undiagnosed and asymptomatic tuberculosis seen by health workers are cause for concern.

“Our results suggest that the massive efforts of the past 15 years to test and treat HIV have worked very well for this disease,” Wong said. “But in this process we may have overlooked some of the other important diseases that are very prevalent.”

The mobile camps screened for diabetes, high blood pressure, nutritional status (obesity and malnutrition), tobacco and alcohol consumption, as well as HIV and tuberculosis. The TB screening component included high-quality digital chest x-rays and sputum tests for people who reported symptoms or abnormal x-rays. The clinical information was overlaid over 20 years of demographic data from AHRI’s Demographic and Health Surveillance research. Using a sophisticated data system and the use of artificial intelligence to interpret chest x-rays, the AHRI clinical team examined real-time information and referred people to the public health system at need.

The researchers found that:

  • Half of people 15 years of age or older had at least one active disease and 12 percent had two or more diseases. The incidences of diabetes and high blood pressure were 8.5 percent and 23 percent, respectively.
  • One third of people were living with HIV, but most of it was well diagnosed and treated. Women bear a particularly high burden of HIV, high blood pressure and diabetes.
  • For tuberculosis, 1.4 percent of people had active disease and 22 percent had lifelong disease. About 80 percent of undiagnosed TB cases were asymptomatic, and men had higher rates of active TB.

Researchers also identified several types of disease by geographic location – for example, the highest HIV burden was seen near major roads, while higher rates of tuberculosis and noncommunicable diseases were seen in more areas. remote.


Wong is the corresponding author of the study “Convergence of Infectious and Noncommunicable Disease Outbreaks in Rural South Africa: A Cross-sectional Population-Based Multimorbidity Study,” and there are 30 co-authors.

Support came from the Wellcome Trust grant 201433 / Z / 16 / Z, the Bill & Melinda Gates Foundation grant OPP1175182, the South African Department of Science and Innovation, the South African Medical Research Council and the South African Population Research Infrastructure Network. Support was also provided by grants AI118538 and TW011687 from the National Institutes of Health, the United Kingdom Medical Research Council, the United Kingdom Department for International Development, the South African Research Chairs Initiative, the Victor Daitz Foundation and the Sub-Saharan African Network for Tuberculosis and HIV Research.

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