Philosophical perspectives on community based Non-communicable disease services and the quality of life of people living with HIV in Uganda

Abstract

The review paper traces and expounds the philosophical thinking on the history of the community based Non Communicable Disease(NCD) Services as a measure to improve the Quality of Life (QoL) of people with NCDs living with HIV. It explores how the historical trends, the contributions and the key contributors to the events for the advancement of the community based NCD services as key intervention for the improvement of QoL for people living with HIV. The historical and philosophical aspects of the paper guides the readers and writers on NCDs and HIV to gain a deep understanding of the trends of community NCD services and the quality of life of people with NCDs living with HIV and AIDS. It explored how people with HIV and on Anti-Retroviral Therapy (ART) become susceptible to Hypertension(HT) and Diabetes Mellitus(DM). In absence of the community based NCD services, the physical health, environmental wellbeing and social relationship QoL domains will remain poor for all the patients receiving HIV services in communities. Consequently, the coburden of NCDs and HIV will increase in case the Journal of Environmental Science and Public Health 409 J Environ Sci Public Health 2020; 4 (4): 409-430 DOI: 10.26502/jesph.96120110 prevention strategies are not implemented, the susceptibility to NCDs among the patients will increase and compromise their quality of life. The philosophical and theoretical aspects of the paper guides institutions on the development and implementation of the community based NCD services to mitigate on the effects of NCDs and improve the QoL among HIV patients on ART receiving services in communities. The philosophical and theoretical aspects of the paper guides policy development and evaluates implementation strategies to mitigate the NCD effects among people living with HIV. Good health and good QoL are fundamental human rights that have existed since the birth of medicine by the early philosophers that was supported by the modern understanding of the concept of health as noted by the constitution of the World Health Organization (WHO). Keywords: Community; Non Communicable Diseases; Services; Quality of Life; HIV; People Living with HIV; Uganda; Theories; Philosophies 1. Introduction 1.1 Global Perspective of HIV and Non Communicable Diseases The Non-communicable chronic diseases (NCDs) are diseases or conditions that affect individuals over an extensive period of time and for which there are no known causative agents that are transmitted from one affected individual to another [1]. The co-morbidities related to hypertension and Diabetes Mellitus (DM) as common NCDs in HIV patients on Anti-Retroviral Therapy (ART) causes reduction in the physical health, environmental health and social relationship quality of life. The prevalence of Diabetes Mellitus (DM) and hypertension among PLHIV makes these noncommunicable diseases of concern. DM prevalence in HIV infected people was approximately 14% [2, 3]. The co-occurrence of DM and hypertension in HIV was a threat to public health, especially in developing countries [ 4, 3]. These findings support that DM and hypertension are emerging NCDs in HIV infection and demand attention from countries with high prevalence rates of HIV infection. The intensification of DM and hypertension in HIV infection contributes to the transition of HIV from being an acute condition to a chronic condition [3]. The co-existence of the two diseases needed integrated community services to address the barriers associated with non-integration of HIV and NCD screening and co-management in the communities to improve the environmental, social relationships and physical health domains of quality of life (QoL).