Diabetes health care specific services readiness and availability in Kenya: Implications for Universal Health Coverage

Non-communicable diseases and resistant tuberculosis, a growing burden among people living with HIV in Eastern Kenya

Human Immunodeficiency Virus (HIV) and tuberculosis (TB) continue to pose a significant health burden in Kenya. Countries with the highest rates of people living with HIV (PLWH) also have a high prevalence of non-communicable diseases (NCDs), including type 2 diabetes (T2D) and hypertension (HPT). This study evaluated the burden and factors associated with T2D, HPT, and TB, including resistant strains among PLWH receiving antiretroviral therapy (ART) in Eastern Kenya. Blood and sputum samples, and baseline information were collected from 280 consenting PLWH. The participants' blood pressure (BP), glycated hemoglobin (HbA1c), CD4 cell counts, HIV viral load, full blood count, blood chemistry, and Rifampicin resistance were assessed. The mean (SD) age of the participants was 35.6 (±9.8) years, and a median (IQR) duration of living with HIV of 7 (4 -8) years. Most participants, 179 (63.9%), were HIV mono-infected, with 58 (20.7%) HIV/TB, 42 (15%) HIV/T2D, and 33 (11.8%) HIV/HPT dual comorbidities reported. Triple comorbidities reported included 18 (6.4%) HIV/T2D/HPT, 9 (3.2%) HIV/TB/T2D, and 9 (3.2%) HIV/TB/HPT, with 4 (1.4%) HIV/TB/T2D/HPT quadruple comorbidity reported. Six (2.1%) multidrug-resistant TB coinfections were detected. In multivariate analyses, being on ARV only (aOR 0.5; 95% CI 0.4 - 0.6, p = 0.0001) and achieving virological suppression (aOR 0.8; 95% CI 0.6 - 0.9, p = 0.017) were protective against HIV/TB coinfection. Previous hospital admission (aOR 1.2; 95% CI 1.1 - 1.4, p = 0.049) and previous TB infection (aOR 1.6; 95% CI 1.0 - 3.0, p = 0.034) were associated with HIV/TB coinfection. The PLWH in Eastern Kenya continues to experience a syndemic of NCDs and TB, including resistant strains. Consistent adherence to ART is crucial for achieving viral suppression; these are protective against NCDs and TB among PLWH. The findings highlight the necessity of integrating NCD management with HIV and TB treatment programs in Kenya.

A Readiness Level Assessment of Healthcare Facilities in the Democratic Republic of Congo for the Management of Cardiovascular Disease and Diabetes

Introduction: Sub-Saharan Africa in general, and the Democratic Republic of the Congo (DRC) in particular, is undergoing an epidemiological transition characterized by a more rapid increase in the number of non-communicable diseases (NCDs). However, the level of readiness of the DRC's healthcare facilities (HFs) to manage these diseases is unknown. Thus, our study aimed to assess these HFs' level of readiness to manage cardiovascular disease (CVD) and diabetes. Methodology: This cross-sectional study involved 1412 HFs in the DRC, selected by stratified random sampling. They are representative of the country's 26 provinces. The World Health Organization (WHO) Service Availability and Readiness Survey (SARA) was used. The "readiness" outcome was a composite measure of the capacity of HFs to manage CVD and diabetes. The readiness indicator comprised four domains, and a score of ≥70% indicated "readiness" to manage CVD and diabetes. Informed consent was obtained from the stakeholders, and the ethics committee held a positive opinion. Statistical analyses were performed using STATA 17 software. Results: The average readiness scores of the DRC's HFs to manage CVD and diabetes are less than 50%, being 38.3% (37.3-39.3) and 39.8% (38.7-40.9), respectively. These scores were less than 40% for CVD and diabetes in rural HFs. They were less than 30% for CVD and diabetes in primary-level HF. No province possesses over 50% of health facilities equipped to address cardiovascular illnesses, and only four provinces (Haut Uele, Kinshasa, Nord Kivu, and Sud Kivu) possess over 50% of health facilities equipped to address diabetes. The provinces with health facilities exhibiting the least preparedness in managing cardiovascular illnesses and diabetes are Nord Ubangi and Sankuru. Only 0.07% (0.01-0.5) of HFs obtained a score ≥ 70% for CVD management, and 5.9% (4.8-7.3) obtained this score for diabetes management. Conclusions: Significant deficiencies must be rectified to enhance service delivery in the management of cardiovascular disease (CVD) and diabetes. Most primary-level and rural facilities demonstrated inadequate preparedness for CVD and diabetes screening and management, exhibiting low readiness scores and limited-service availability in the assessed domains. While secondary-level services are relatively accessible, critical gaps persist that must be addressed to improve readiness for CVD and diabetes care. Healthcare facilities should possess the capacity to deliver recommended services across various tiers, ensuring both service readiness and availability.