Secure The Future – South Africa – Gauteng Province

Lead by the Bristol-Myers Squib Foundation, the SECURE THE FUTURE® initiative works with their partners in Africa to provide care and support for communities affected by HIV. 

Sub-Saharan Africa (SSA) has endemic HIV prevalence (>15%) and the highest (>70%) global HIV- Tuberculosis (TB) co-infection rate, primarily affecting socioeconomically disadvantaged urban and rural populations, the majority of whom are black.

Patients in Gauteng Province are referred to the 3 participating hospitals. The WITS Healthcare complex serves two thirds of the Gauteng population of 13 million people, which includes 3 million people from Soweto and more than a million migrants. The population has a high HIV, TB and smoking prevalence particularly among males. Because of their vulnerable status, patients experience significant morbidity and mortality. Of particular concern is the increasing incidence of lung cancer among black women, associated with increased smoking and potentially indoor air pollution from coal stoves.

Latest 2011 SA National Cancer Registry (NCR) age standardized incidence rates for lung cancer are under-reported at 11/100,000 population, as the NCR is pathology-based relying on lung tissue biopsy specimens. The most important cause of lung cancer is tobacco smoking. Large numbers of lung cancers related to asbestos and other occupational exposures (from mining), indoor biomass-fuel exposure and chronic inflammatory lung diseases – in particular tuberculosis also occur.

With the successful scale-up of antiretroviral therapy (ART), SA is facing an epidemic of non-communicable diseases (NCD’s) among aging people living with HIV/AIDS (APLWH). This population group is expected to triple by 2040 and the burden of COPD and lung cancer will increase, highlighting the need for health system planning and for burden of disease research to inform health system responses.

Lung cancer is the most common non-AIDS defining cancer among HIV-positive individuals with an incidence two to four fold higher than in HIV-negative patients, caused mainly by high prevalence of cigarette smoking among the HIV population.

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