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Daultrey H, Oliver NS, Wright J, Levett TJ, Chakera AJ. What Is the Influence of HIV Serostatus on HbA1c? A Prospective Analysis Using Continuous Glucose Monitoring. Diabetes Care 2024; 47:1379-1385. [PMID: 38805493 DOI: 10.2337/dc24-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/01/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Type 2 diabetes (T2D) is reported to be more common in people living with HIV (PLWH). Clinical guidelines recommend screening for diabetes in PLWH, but there is no agreed method due to studies reporting HbA1c is falsely low in PLWH. These studies were performed in the early HIV era when participants were taking older preparations of antiretroviral therapy that are rarely used today. We aimed to investigate whether HIV serostatus influences HbA1c. RESEARCH DESIGNS AND METHODS We conducted a prospective cohort study of PLWH and age- and sex-matched HIV-negative participants who were purposely recruited from clinics in Brighton, U.K. Each participant wore a Dexcom G6 continuous glucose monitor (CGM) for up to 10 days, had glucose measured during an oral glucose tolerance test, and fructosamine and paired HbA1c were measured. We performed regression analysis to assess the influence of HIV on HbA1c and used a separate model for CGM glucose, venous glucose, and fructosamine. In addition, we included predictor variables used in previous studies that explored HbA1c discrepancy. RESULTS We recruited 60 PLWH (90% men, 50% with T2D, mean ± SD age 57 ± 10.7 years, 100% undetectable viral load) and 48 people without HIV (92% men, 30% with T2D, mean age 57.7 ± 8.9 years). We found that HIV serostatus did not have a significant influence on HbA1c within the regression models. CONCLUSIONS We performed a comprehensive assessment of glycemia to assess whether HIV serostatus influences HbA1c. We did not find any strong evidence that HIV serostatus influenced HbA1c. The results of our study support incorporating HbA1c into routine clinical blood work in PLWH.
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Affiliation(s)
| | - Nick S Oliver
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, U.K
| | | | - Tom J Levett
- Brighton and Sussex Medical School, Brighton, East Sussex, U.K
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Mulindwa F, Schwarz JM, Brusselaers N, Nabwana M, Bollinger R, Buzibye A, Amutuhaire W, Yendewa G, Odongpiny ELA, Kiguba R, Castelnuovo B. Blood glucose outcomes of anti-retroviral therapy naïve Ugandan people with HIV with pre-diabetes mellitus initiated on dolutegravir for 48 weeks. BMC Infect Dis 2024; 24:746. [PMID: 39075383 DOI: 10.1186/s12879-024-09655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The Uganda ministry of Health recommends frequent blood glucose monitoring for the first six months on dolutegravir, in people with HIV (PWH) having pre-diabetes mellitus (pre-DM). We sought to determine if indeed PWH with pre-diabetes started on dolutegravir had worse blood glucose outcomes at 48 weeks compared to those with normal blood glucose. METHODS In this matched cohort study, we compared 44 PWH with pre-DM and 88 PWH with normal blood glucose at baseline. The primary outcome was change in mean fasting blood glucose (FBG) from baseline to week 48 and 2-hour blood glucose (2hBG) from baseline to week 36 compared between the two groups. RESULTS There was significant increase in FBG in PWH with normal blood glucose (mean change in FBG(FBG): 3.9 mg/dl, 95% confidence interval (95% CI): (2.2, 5.7), p value (p) = < 0.0001) and decrease in those with pre-DM (FBG: -6.1 mg/dl, 95%CI (-9.1, -3.2), p = < 0.0001) at 48 weeks. 2hBG was significantly lower than at baseline in both groups with the magnitude of reduction larger in those with pre-DM at 12 weeks (adjusted differences in mean drop in 2hBG (a2hBG): -19.69 mg/dl, 95%CI (-30.19, -9.19), p = < 0.0001) and 36 weeks (a2hBG: -19.97 mg/dl, 95%CI (-30.56, -9.39), p = < 0.0001). CONCLUSION We demonstrated that Ugandan ART naïve PWH with pre-diabetes at enrollment have consistent improvement in both fasting blood glucose and glucose tolerance over 48 weeks on dolutegravir. Intensified blood glucose monitoring of these patients in the first six months of dolutegravir may be unnecessary.
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Affiliation(s)
- Frank Mulindwa
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda.
- Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, USA
- Department of Basic Sciences, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Nele Brusselaers
- Global Health Institute, Antwerp University, Antwerp, Belgium
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska University, Stockholm, Sweden
| | - Martin Nabwana
- Makerere University Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Allan Buzibye
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Willington Amutuhaire
- Department of Internal Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - George Yendewa
- Department of Internal Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Ronald Kiguba
- Department of Pharmacology and Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
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Ibro SA, Kasim AZ, Seid SS, Abdusemed KA, Senbiro IA, Waga SS, Abamecha F, Azalework HG, Soboka M, Gebresilassie A, Tesfaye S, Abafogi AA, Merga H, Husen A, Beyene DT. Mapping the evidence on integrated service delivery for non-communicable and infectious disease comorbidity in sub-Saharan Africa: protocol for a scoping review. BMJ Open 2024; 14:e084740. [PMID: 38904125 PMCID: PMC11191815 DOI: 10.1136/bmjopen-2024-084740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION The concurrent occurrence of infectious diseases (IDs) and non-communicable diseases (NCDs) presents complex healthcare challenges in sub-Saharan Africa (SSA), where healthcare systems often grapple with limited resources. While an integrated care approach has been advocated to address these complex challenges, there is a recognised gap in comprehensive evidence regarding the various models of integrated care, their components and the feasibility of their implementation. This scoping review aims to bridge this gap by examining the breadth and nature of evidence on integrated care models for NCDs and IDs within SSA, thereby updating the current evidence base in the domain. METHODS AND ANALYSIS Based on the Joanna Briggs Institute (JBI) framework for scoping reviews, this study will include peer-reviewed and grey literature reporting on integrated care models for NCD-ID comorbidities in SSA. A comprehensive search of published sources in electronic databases (PubMed, Scopus, Embase, the Cochrane Library, Health System Evidence and Research4Life) and grey literature (Google Scholar, EBSCO Open Dissertations and relevant organisational websites) will be conducted to identify sources of information reported in English from 2018 onwards. The review will consider sources of evidence reporting on integrated care model for NCDs such as diabetes; chronic cardiovascular, respiratory and kidney diseases; cancers; epilepsy; and mental illness, and comorbid IDs such as HIV, tuberculosis and malaria. All sources of evidence will be considered irrespective of the study designs or methods used. The review will exclude sources that solely focus on the differentiated or patient-centred care delivery approach, and that focus on other conditions, populations or settings. The reviewers will independently screen the sources for eligibility and extract data using a JBI-adapted data tool on the Parsifal review platform. Data will be analysed using descriptive and thematic analyses and results will be presented in tables, figures, diagrams and a narrative summary. ETHICS AND DISSEMINATION Ethical approval is not required for this review as it will synthesise published data and does not involve human participants. The final report will be submitted for publication in a peer-reviewed journal. The findings will be used to inform future research. STUDY REGISTRATION OSF: https://doi.org/10.17605/OSF.IO/KFVEY.
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Affiliation(s)
| | | | | | | | | | | | - Fira Abamecha
- Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | | | | | | | | | | | - Hailu Merga
- Epidemiology, Jimma University, Jimma, Ethiopia
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Wang L, Zhao J, Schank M, Hill AC, Banik P, Zhang Y, Wu XY, Lightner JW, Ning S, El Gazzar M, Moorman JP, Yao ZQ. Circulating GDF-15: a biomarker for metabolic dysregulation and aging in people living with HIV. FRONTIERS IN AGING 2024; 5:1414866. [PMID: 38895099 PMCID: PMC11183798 DOI: 10.3389/fragi.2024.1414866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024]
Abstract
Despite effective control of HIV replication by antiretroviral therapy (ART), a significant number of people living with HIV (PLWH) fail to achieve complete immune reconstitution and thus are deemed immune non-responders (INRs). Compared with immune responders (IRs) who have restored their CD4 T cell numbers and functions, CD4 T cells from these INRs exhibit prominent mitochondrial dysfunction and premature aging, which play a major role in increasing the incidence of non-AIDS, non-communicable diseases (NCDs). To date, there are no reliable biomarkers that can be used to typify and manage PLWH, especially INRs with non-AIDS NCDs. Growth differential factor-15 (GDF-15) is a transforming growth factor-β (TGF-β) family member known to regulate several biological processes involved in cell aging and stress responses. Since PLWH exhibit premature aging and metabolic dysregulation, here we measured the plasma levels of GDF-15 by ELISA and metabolic proteins by proteomic array and correlated the results with clinical parameters in ART-controlled PLWH (including INRs and IRs) and healthy subjects (HS). We found that GDF-15 levels were significantly elevated in PLWH compared to HS. GDF-15 levels were positively correlated with age and negatively associated with body mass and LDL cholesterol levels in the study subjects. Also, elevated GDF-15 levels were correlated with differential dysregulation of multiple metabolic proteins in PLWH. These results suggest that GDF-15 protein may serve as a biomarker of metabolic dysregulation and aging, and this biomarker will be useful in clinical trials targeting aging and metabolic disorders in ART-treated PLWH.
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Affiliation(s)
- Ling Wang
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Juan Zhao
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Madison Schank
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Addison C. Hill
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Puja Banik
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Yi Zhang
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Xiao Y. Wu
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Janet W. Lightner
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Shunbin Ning
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Mohamed El Gazzar
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
| | - Jonathan P. Moorman
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Hepatitis (HBV/HCV/HIV) Program, James H. Quillen VA Medical Center, Department of Veterans Affairs, Johnson City, TN, United States
| | - Zhi Q. Yao
- Center of Excellence for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
- Hepatitis (HBV/HCV/HIV) Program, James H. Quillen VA Medical Center, Department of Veterans Affairs, Johnson City, TN, United States
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Flack KA, Rainey ES, Urasa SJ, Koipapi S, Kalaria RN, Howlett WP, Mukaetova-Ladinska EB, Dekker MCJ, Gray WK, Walker RW, Dotchin CL, Mtwaile H, Lewis TCD, Stone LG, McNally RJQ, Makupa PC, Paddick SM. Lack of Association of Vascular Risk Factors with HIV-Associated Neurocognitive Disorders in cART-Treated Adults Aged ≥ 50 Years in Tanzania. Viruses 2024; 16:819. [PMID: 38932112 PMCID: PMC11209468 DOI: 10.3390/v16060819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024] Open
Abstract
HIV-associated neurocognitive disorders (HAND) are highly prevalent in those ageing with HIV. High-income country data suggest that vascular risk factors (VRFs) may be stronger predictors of HAND than HIV-disease severity, but data from sub-Saharan Africa are lacking. We evaluated relationships of VRFs, vascular end-organ damage and HAND in individuals aged ≥ 50 in Tanzania. c-ART-treated individuals were assessed for HAND using consensus criteria. The prevalence of VRFs and end organ damage markers were measured. The independent associations of VRFs, end organ damage and HAND were examined using multivariable logistic regression. Data were available for 153 individuals (median age 56, 67.3% female). HAND was highly prevalent (66.7%, 25.5% symptomatic) despite well-managed HIV (70.5% virally suppressed). Vascular risk factors included hypertension (34%), obesity (10.5%), hypercholesterolemia (33.3%), diabetes (5.3%) and current smoking (4.6%). End organ damage prevalence ranged from 1.3% (prior myocardial infarction) to 12.5% (left ventricular hypertrophy). Measured VRFs and end organ damage were not independently associated with HAND. The only significant association was lower diastolic BP (p 0.030, OR 0.969 (0.943-0.997). Our results suggest that vascular risk factors are not major drivers of HAND in this setting. Further studies should explore alternative aetiologies such as chronic inflammation.
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Affiliation(s)
- Katherine A. Flack
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Emma S. Rainey
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Sarah J. Urasa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Sengua Koipapi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Rajesh N. Kalaria
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - William P. Howlett
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Elizabeta B. Mukaetova-Ladinska
- Department of Neuroscience, Behaviour and Psychology, University of Leicester, Leicester LE1 7HA, UK
- The Evington Centre, Leicester General Hospital, Leicester LE5 4QF, UK
| | - Marieke C. J. Dekker
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - William K. Gray
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Richard W. Walker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Catherine L. Dotchin
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Himidi Mtwaile
- Department of Radiology, NSK Hospital, Arusha P.O. Box 3114, Tanzania
| | - Thomas C. D. Lewis
- Department of Old Age Psychiatry, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne NE4 6BE, UK
| | - Lydia G. Stone
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | | | - Philip C. Makupa
- HIV Care and Treatment Centre (CTC), Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro P.O Box 3054, Tanzania
| | - Stella-Maria Paddick
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Old Age Psychiatry, Gateshead Health NHS Foundation Trust, Gateshead NE8 4YL, UK
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Badacho AS, Woltamo DD, Demissie DB, Mahomed OH. Mapping evidence on barriers to and facilitators of diagnosing noncommunicable diseases among people living with human immunodeficiency virus in low- and middle-income countries in Africa: A scoping review. SAGE Open Med 2024; 12:20503121241253960. [PMID: 38784122 PMCID: PMC11113038 DOI: 10.1177/20503121241253960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Objectives To map the evidence on the barriers to and facilitators of diagnosing noncommunicable diseases among people living with HIV in low- and middle-income countries in Africa. Introduction Noncommunicable diseases are increasing among people living with HIV. Thus, strengthened and sustained diagnosis of noncommunicable diseases through integrated noncommunicable diseases and HIV care is needed to improve patient outcomes. However, there is paucity of evidence on the barriers and facilitators diagnosing noncommunicable diseases among people living with HIV in low- and middle-income countries. Methods The Arksey and O'Malley methodological framework was used. A comprehensive systematic search of academic databases (MEDLINE, Academic Search Complete, APA PsycInfo, CAB, and Health Source/Nursing) was performed via EBSCO search and PubMed. The articles were reviewed independently by three reviewers. The results were structured using Capability-Opportunity-Motivation-Behavior model and Theoretical Domains Framework. Results A total of 152 articles were retrieved for full-text review. Forty-one articles met the inclusion criteria. The identified barriers were relevant to all the Capability-Opportunity-Motivation-Behavior constructs and 14 Theoretical Domains Framework domains. A lack of knowledge and awareness of noncommunicable diseases, fear of stigma, financial problems and out-of-pocket payments were the most cited patient-level barriers. Healthcare providers (knowledge and awareness gaps, skill and competence deficiencies, unwillingness, burnout, low motivation, and apathy) were frequently cited. Lack of equipment, noncommunicable disease medications and supply chain challenges, lack of integrated noncommunicable disease and HIV care, and shortage of trained healthcare providers were identified as health-system-level barriers. Conclusion This scoping review is the first to identify barriers and facilitators using a theoretical framework. The most cited barriers include a lack of integrated HIV and noncommunicable disease care, equipment and logistics chain challenges for noncommunicable diseases, patients' and healthcare providers' lack of knowledge and awareness of noncommunicable diseases, and healthcare provider's skill and competency deficiencies. Addressing these issues is crucial for improving patient outcomes and reducing the burden on healthcare providers and health systems.
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Affiliation(s)
- Abebe Sorsa Badacho
- School of Nursing and Public Health, Public Health Medicine Discipline, University of KwaZulu-Natal, Durban, South Africa
- School Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Deginesh Dawit Woltamo
- School of Nursing and Public Health, Public Health Medicine Discipline, University of KwaZulu-Natal, Durban, South Africa
| | | | - Ozayr Haroon Mahomed
- School of Nursing and Public Health, Public Health Medicine Discipline, University of KwaZulu-Natal, Durban, South Africa
- Dasman Diabetes Institute, Kuwait City, Kuwait
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Jackson-Morris A, Masyuko S, Morrell L, Kataria I, Kocher EL, Nugent R. Tackling syndemics by integrating infectious and noncommunicable diseases in health systems of low- and middle-income countries: A narrative systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003114. [PMID: 38753811 PMCID: PMC11098501 DOI: 10.1371/journal.pgph.0003114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
The co-occurrence of infectious diseases (ID) and non-communicable diseases (NCD) is widespread, presenting health service delivery challenges especially in low-and middle-income countries (LMICs). Integrated health care is a possible solution but may require a paradigm shift to be successfully implemented. This literature review identifies integrated care examples among selected ID and NCD dyads. We searched PubMed, PsycINFO, Cochrane Library, CINAHL, Web of Science, EMBASE, Global Health Database, and selected clinical trials registries. Eligible studies were published between 2010 and December 2022, available in English, and report health service delivery programs or policies for the selected disease dyads in LMICs. We identified 111 studies that met the inclusion criteria, including 56 on tuberculosis and diabetes integration, 46 on health system adaptations to treat COVID-19 and cardiometabolic diseases, and 9 on COVID-19, diabetes, and tuberculosis screening. Prior to the COVID-19 pandemic, most studies on diabetes-tuberculosis integration focused on clinical service delivery screening. By far the most reported health system outcomes across all studies related to health service delivery (n = 72), and 19 addressed health workforce. Outcomes related to health information systems (n = 5), leadership and governance (n = 3), health financing (n = 2), and essential medicines (n = 4)) were sparse. Telemedicine service delivery was the most common adaptation described in studies on COVID-19 and either cardiometabolic diseases or diabetes and tuberculosis. ID-NCD integration is being explored by health systems to deal with increasingly complex health needs, including comorbidities. High excess mortality from COVID-19 associated with NCD-related comorbidity prompted calls for more integrated ID-NCD surveillance and solutions. Evidence of clinical integration of health service delivery and workforce has grown-especially for HIV and NCDs-but other health system building blocks, particularly access to essential medicines, health financing, and leadership and governance, remain in disease silos.
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Affiliation(s)
- Angela Jackson-Morris
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Sarah Masyuko
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Lillian Morrell
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
- Wilson Sheehan Lab for Economic Opportunities, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Erica L. Kocher
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
- Emory University, Emory University, Atlanta, Georgia, United States of America
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
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Amutuhaire W, Semitala FC, Kimera ID, Namugenyi C, Mulindwa F, Ssenyonjo R, Katwesigye R, Mugabe F, Mutungi G, Ssinabulya I, Schwartz JI, Katahoire AR, Musoke LS, Yendewa GA, Longenecker CT, Muddu M. Time to blood pressure control and predictors among patients receiving integrated treatment for hypertension and HIV based on an adapted WHO HEARTS implementation strategy at a large urban HIV clinic in Uganda. J Hum Hypertens 2024; 38:452-459. [PMID: 38302611 PMCID: PMC11076202 DOI: 10.1038/s41371-024-00897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 10/01/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
In this cohort study, we determined time to blood pressure (BP) control and its predictors among hypertensive PLHIV enrolled in integrated hypertension-HIV care based on the World Health Organization (WHO) HEARTS strategy at Mulago Immunosuppression Clinic in Uganda. From August 2019 to March 2020, we enrolled hypertensive PLHIV aged ≥ 18 years and initiated Amlodipine 5 mg mono-therapy for BP (140-159)/(90-99) mmHg or Amlodipine 5 mg/Valsartan 80 mg duo-therapy for BP ≥ 160/90 mmHg. Patients were followed with a treatment escalation plan until BP control, defined as BP < 140/90 mmHg. We used Cox proportional hazards models to identify predictors of time to BP control. Of 877 PLHIV enrolled (mean age 50.4 years, 62.1% female), 30% received mono-therapy and 70% received duo-therapy. In the monotherapy group, 66%, 88% and 96% attained BP control in the first, second and third months, respectively. For patients on duo-therapy, 56%, 83%, 88% and 90% achieved BP control in the first, second, third, and fourth months, respectively. In adjusted Cox proportional hazard analysis, higher systolic BP (aHR 0.995, 95% CI 0.989-0.999) and baseline ART tenofovir/lamivudine/efavirenz (aHR 0.764, 95% CI 0.637-0.917) were associated with longer time to BP control, while being on ART for >10 years was associated with a shorter time to BP control (aHR 1.456, 95% CI 1.126-1.883). The WHO HEARTS strategy was effective at achieving timely BP control among PLHIV. Additionally, monotherapy anti-hypertensive treatment for stage I hypertension is a viable option to achieve BP control and limit pill burden in resource limited HIV care settings.
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Affiliation(s)
- Willington Amutuhaire
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | | | | | | | - Frank Mulindwa
- Makerere University Infectious Diseases Institute, Kampala, Uganda
| | | | | | - Frank Mugabe
- Department of non-communicable diseases, Uganda Ministry of Health, Kampala, Uganda
| | - Gerald Mutungi
- Department of non-communicable diseases, Uganda Ministry of Health, Kampala, Uganda
| | | | - Jeremy I Schwartz
- Yale School of Medicine, Section of General Internal Medicine, Connecticut, CT, USA
| | - Anne R Katahoire
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lewis S Musoke
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Chris T Longenecker
- Department of Global Health and Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Martin Muddu
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
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Zhu S, Wang W, He J, Duan W, Ma X, Guan H, Wu Y, Li S, Li Y, Tian T, Kong W, Wu D, Zhang T, Huang X. Higher cardiovascular disease risks in people living with HIV: A systematic review and meta-analysis. J Glob Health 2024; 14:04078. [PMID: 38666515 PMCID: PMC11046517 DOI: 10.7189/jogh.14.04078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024] Open
Abstract
Background The prognosis of AIDS after active antiretroviral therapy (ART) and the quality of life of people living with HIV (PLWH) are both affected by non-AIDS-related diseases such as cardiovascular disease (CVD). However, the specific risk ratios between PLWH and individuals negative for HIV are poorly understood. We aimed to systematically review and investigate the CVD risk factors associated with HIV. Methods We searched PubMed, Embase, Web of Science, and Cochrane Library databases between 1 January 2015, and 12 May 2023 for articles reported the prevalence and risk factors of CVD such as hypertension, dyslipidaemia, coronary artery disease (CAD), and myocardial infarction (MI). Due to the high heterogeneity, we used a random-effects model to analyse the data. All statistical analyses were performed using Stata/MP 17.0 with 95% confidence intervals (CIs). Results We analysed 31 eligible studies including 312 913 PLWH. People living with HIV had higher risks of dyslipidaemia (hazard ratio (HR) = 1.53; 95% CI = 1.29, 1.82), CAD (HR = 1.37; 95% CI = 1.24, 1.51), and MI (HR = 1.47; 95% CI = 1.28, 1.68) compared to individuals without HIV. However, there were no significant differences in the prevalence of hypertension between groups (HR = 1.17; 95% CI = 0.97, 1.41). Subgroup analysis revealed that men with HIV, PLWH who smoked and the elderly PLWH had a high prevalence of CVD. Moreover, the disease prevalence patterns varied among regions. In the USA and Europe, for instance, some HRs for CVD were higher than in other regions. Active ART initiation after 2015 appears to have a lower risk of CVD (hypertension, hyperlipidaemia, CAD). All outcomes under analysis showed significant heterogeneity (I2>70%, P < 0.001), which the available study-level variables could only partially account for. Conclusions People living with HIV had a higher CVD risk than the general population; thus, CVD prevention in PLWH requires further attention. Rapid initiation of ART may reduce the incidence of CVD in PLWH. For timely screening of CVD high-risk individuals and thorough disease management to prevent CVD, further studies are required to evaluate the risk factors for CVD among PLWH, such as age, region, etc. Registration PROSPERO (CRD42021255508).
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Affiliation(s)
- San Zhu
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, PR China
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Wenjing Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Jiaze He
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Wenshan Duan
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | | | - Honglin Guan
- Hematology Department, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, PR China
| | - Yaxin Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Sibo Li
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Yanbing Li
- Cardiovascular Department, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Tian Tian
- Cardiovascular Department, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Wenjun Kong
- Department of Opthalmology, Beijing Youan Hosptial, Capital Medical University, Beijing, PR China
| | - Dongxia Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China
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Van Hout MC, Akugizibwe M, Shayo EH, Namulundu M, Kasujja FX, Namakoola I, Birungi J, Okebe J, Murdoch J, Mfinanga SG, Jaffar S. Decentralising chronic disease management in sub-Saharan Africa: a protocol for the qualitative process evaluation of community-based integrated management of HIV, diabetes and hypertension in Tanzania and Uganda. BMJ Open 2024; 14:e078044. [PMID: 38508649 PMCID: PMC10961519 DOI: 10.1136/bmjopen-2023-078044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Sub-Saharan Africa continues to experience a syndemic of HIV and non-communicable diseases (NCDs). Vertical (stand-alone) HIV programming has provided high-quality care in the region, with almost 80% of people living with HIV in regular care and 90% virally suppressed. While integrated health education and concurrent management of HIV, hypertension and diabetes are being scaled up in clinics, innovative, more efficient and cost-effective interventions that include decentralisation into the community are required to respond to the increased burden of comorbid HIV/NCD disease. METHODS AND ANALYSIS This protocol describes procedures for a process evaluation running concurrently with a pragmatic cluster-randomised trial (INTE-COMM) in Tanzania and Uganda that will compare community-based integrated care (HIV, diabetes and hypertension) with standard facility-based integrated care. The INTE-COMM intervention will manage multiple conditions (HIV, hypertension and diabetes) in the community via health monitoring and adherence/lifestyle advice (medicine, diet and exercise) provided by community nurses and trained lay workers, as well as the devolvement of NCD drug dispensing to the community level. Based on Bronfenbrenner's ecological systems theory, the process evaluation will use qualitative methods to investigate sociostructural factors shaping care delivery and outcomes in up to 10 standard care facilities and/or intervention community sites with linked healthcare facilities. Multistakeholder interviews (patients, community health workers and volunteers, healthcare providers, policymakers, clinical researchers and international and non-governmental organisations), focus group discussions (community leaders and members) and non-participant observations (community meetings and drug dispensing) will explore implementation from diverse perspectives at three timepoints in the trial implementation. Iterative sampling and analysis, moving between data collection points and data analysis to test emerging theories, will continue until saturation is reached. This process of analytic reflexivity and triangulation across methods and sources will provide findings to explain the main trial findings and offer clear directions for future efforts to sustain and scale up community-integrated care for HIV, diabetes and hypertension. ETHICS AND DISSEMINATION The protocol has been approved by the University College of London (UK), the London School of Hygiene and Tropical Medicine Ethics Committee (UK), the Uganda National Council for Science and Technology and the Uganda Virus Research Institute Research and Ethics Committee (Uganda) and the Medical Research Coordinating Committee of the National Institute for Medical Research (Tanzania). The University College of London is the trial sponsor. Dissemination of findings will be done through journal publications and stakeholder meetings (with study participants, healthcare providers, policymakers and other stakeholders), local and international conferences, policy briefs, peer-reviewed journal articles and publications. TRIAL REGISTRATION NUMBER ISRCTN15319595.
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Affiliation(s)
| | | | - Elizabeth Henry Shayo
- Health Systems, Policy and Translational Reseach Section, National Institute for Medical Research, Dar es Salaam, Tanzania, United Republic
| | - Moreen Namulundu
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | | | - Ivan Namakoola
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | | | - Joseph Okebe
- Institute for Global Health, University College London, London, UK
| | - Jamie Murdoch
- School of Life Course and Population Sciences, King's College London, London, London, UK
| | - Sayoki Godfrey Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research Tanzania, Dar es Salaam, Tanzania, United Republic of
| | - Shabbar Jaffar
- Institute for Global Health, University College London, London, UK
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11
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Ottaru TA, Kwesigabo GP, Butt Z, Caputo M, Chillo P, Siril H, Hirschhorn LR, Hawkins C. Prevalence and Risk Factors for Renal Insufficiency among Adults Living with HIV in Tanzania: Results from a Cross-Sectional Study in 2020-2021. Healthcare (Basel) 2024; 12:657. [PMID: 38540623 PMCID: PMC10970453 DOI: 10.3390/healthcare12060657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/20/2023] [Accepted: 02/05/2024] [Indexed: 05/23/2024] Open
Abstract
With improved survival, adults living with HIV (ALHIV) are increasingly likely to experience age-related and HIV-related comorbidities, including renal insufficiency. Other risk factors for renal insufficiency (high blood pressure (BP), obesity, diabetes, and dyslipidemia) are also growing more common among ALHIV. To determine the prevalence of renal insufficiency (defined as an eGFR < 60 mL/min/1.73 m2) and factors associated with reduced eGFR, we conducted a cross-sectional study at six HIV clinics in Dar-es-Salaam, Tanzania. We applied multivariable (MV) ordinal logistic regression models to identify factors associated with reduced eGFR and examined the interaction of age with BP levels. Among the 450 ALHIV on ART analyzed [26% males; median age 43 (IQR: 18-72) years; 89% on tenofovir-containing ART; 88% HIV viral load ≤50 copies/mL], 34 (7.5%) had renal insufficiency. Prevalence was higher among males (12%) vs. females (6%), p = 0.03; ALHIV ≥50 (21%) vs. <50 years (2.5%), p < 0.001; those with high [≥130/80 mmHg (15%)] vs. normal [<120/80 mmHg (4%)] BP, p < 0.01 and those with dyslipidemia (10%) vs. those without (4.5%), p < 0.03. After adjusting for covariates, age (in years) was the only covariate with a statistically significant association with reduced eGFR (OR = 1.09 (1.07-1.12), p < 0.001). No significant interaction between age and BP was found. Interventions to increase routine screening for renal insufficiency, especially among older ALHIV, and improve BP control are critical to reducing kidney disease-related morbidity and mortality.
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Affiliation(s)
- Theresia A. Ottaru
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania;
| | - Gideon P. Kwesigabo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania;
| | - Zeeshan Butt
- Phreesia, Inc., Wilmington, DE 19803, USA;
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Matthew Caputo
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (M.C.); (L.R.H.); (C.H.)
| | - Pilly Chillo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania;
| | - Hellen Siril
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania;
| | - Lisa R. Hirschhorn
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (M.C.); (L.R.H.); (C.H.)
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Claudia Hawkins
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (M.C.); (L.R.H.); (C.H.)
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12
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Max BL, Mashauri HL. Economic priorities over population health: A political dilemma in addressing noncommunicable diseases in developing countries. Health Sci Rep 2024; 7:e1974. [PMID: 38505686 PMCID: PMC10948585 DOI: 10.1002/hsr2.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/21/2024] Open
Abstract
The world is observing a rapid shift in the burden of diseases with predominance of noncommunicable diseases (NCDs). NCDs contribute to 41 million deaths which is equivalent to 74% of all death globally per year. There is ongoing debate on the approaches to reduce public exposure to NCDs' modifiable risk factors which are of economic potential. As the World Health Organization and the World Bank recommend the implementation of taxation to these factors, still questions arise on the effectiveness, sustainability, and practicality of this strategy. With the ongoing transition globally from consumption of natural to processed foods, it is important to counter-check the best interventions on how to protect people from unhealthy eating behaviors. While taxation on unhealthy food and other products like tobacco has been recommended as one among interventional approaches, its effectiveness on sugar sweetened beverages is not reliable compared to approaches that increase self-control. Despite the perceived economic benefits of tobacco and sugar sweetened products, there is detrimental implication in terms of public health. The introduction of taxation which favors public health faces challenges due to conflict of interest from government authorities and other stakeholders. The intertwined relationship between public health and economic development becomes more obvious during implementation of preventive and control measures against modifiable risk factors for NCDs. It is evident that reaching a balanced rational decision on choosing between economic growth and public health is difficult. Countries should enhance both local and international intersectoral and multisectoral approaches in creating integrative policies which include health component in all non-health policies including economic policies so as to harmonize public health and economic growth during this era of extensive globalization.
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Affiliation(s)
- Baraka L. Max
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Health, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Internal MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Harold L. Mashauri
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Health, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Internal MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Internal MedicineKamanga Medics HospitalMwanzaTanzania
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13
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Mody A, Sohn AH, Iwuji C, Tan RKJ, Venter F, Geng EH. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403:471-492. [PMID: 38043552 DOI: 10.1016/s0140-6736(23)01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 12/05/2023]
Abstract
The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability. Nonetheless, innovations in prevention and treatment have often failed to reach large segments of the global population (eg, key and marginalised populations), and these major disparities in access and uptake at multiple levels have caused progress to fall short of their potential to affect public health. Moving forward, sharper epidemiologic tools based on longitudinal, person-centred data are needed to more accurately characterise remaining gaps and guide continued progress against the HIV epidemic. We should also increase prioritisation of strategies that address socio-behavioural challenges and can lead to effective and equitable implementation of existing interventions with high levels of quality that better match individual needs. We review HIV epidemiologic trends; advances in HIV prevention, treatment, and care delivery; and discuss emerging challenges for ending the HIV epidemic over the next decade that are relevant for general practitioners and others involved in HIV care.
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Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annette H Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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14
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Saad RK, Khader Y, Aqel AJ, Satyanarayana S, Wilson N, Abaza H. HIV- related knowledge, attitude, practices, and stigma among healthcare providers caring for HIV in Jordan: Identification of several organizational challenges. Heliyon 2024; 10:e24423. [PMID: 38293408 PMCID: PMC10827484 DOI: 10.1016/j.heliyon.2024.e24423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024] Open
Abstract
Background There is a paucity of data on Healthcare Providers (HCPs) caring for people living with HIV in Jordan. Objective We aimed to understand HCPs' knowledge, attitude, stigma, and practices, to assess the gaps in HIV care in Jordan. Methods We conducted recorded in-depth interviews with all five HCPs working at the only HIV Service Center in Jordan, using semi-structured questions in 2021. Content analysis was performed. Results Several organizational challenges were identified. Only one had received HIV training. All were uncertain of updated recommendations with little knowledge of international guidelines, vertical transmission, contraception, sexually transmitted infections (STIs), non-communicable diseases (NCDs), and prophylaxis. Four HCPs perform counseling, focusing on easing anxieties, risk modification, and the importance of treatment adherence. However, their counseling on contraception, risk of transmission, STIs, and NCDs is inadequate, and they have little-to-no experience with prophylaxis. Most had a positive attitude towards people living with HIV, especially HCPs working at the center the longest, encouraging marriage and reproduction. Most do not approve of mandatory testing, or of breaching patient confidentiality. They repetitively described risky behavior as 'immoral behavior', empathizing more with patients who caught HIV through blood transfusion or birth, and demonstrating embedded stigmatized beliefs. They reported people living with HIV experience anticipated stigma and stigma by their general community including by other HCPs. Conclusion This is the first study on HCPs caring for people living with HIV in Jordan. It highlights the suboptimal knowledge, practices, and stigma which improve with greater participatory exposure to HIV care. HCPs had an overall positive attitude, more evident in HCPs working at the clinic the longest.
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Affiliation(s)
- Randa K. Saad
- Center of Excellence for Applied Epidemiology, Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Yousef Khader
- Department of Community Medicine, Public Health, and Family Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Ashraf Jamil Aqel
- The Department of Sexually Transmitted Diseases, Jordan Ministry of Health, Jordan
| | | | - Nevin Wilson
- Migration Health Division, International Organization for Migration (IOM), Jordan
| | - Hiba Abaza
- Migration Health Division, International Organization for Migration (IOM), Jordan
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15
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Sawe SJ, Mugo R, Wilson-Barthes M, Osetinsky B, Chrysanthopoulou SA, Yego F, Mwangi A, Galárraga O. Gaussian process emulation to improve efficiency of computationally intensive multidisease models: a practical tutorial with adaptable R code. BMC Med Res Methodol 2024; 24:26. [PMID: 38281017 PMCID: PMC10821551 DOI: 10.1186/s12874-024-02149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/11/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND The rapidly growing burden of non-communicable diseases (NCDs) among people living with HIV in sub-Saharan Africa (SSA) has expanded the number of multidisease models predicting future care needs and health system priorities. Usefulness of these models depends on their ability to replicate real-life data and be readily understood and applied by public health decision-makers; yet existing simulation models of HIV comorbidities are computationally expensive and require large numbers of parameters and long run times, which hinders their utility in resource-constrained settings. METHODS We present a novel, user-friendly emulator that can efficiently approximate complex simulators of long-term HIV and NCD outcomes in Africa. We describe how to implement the emulator via a tutorial based on publicly available data from Kenya. Emulator parameters relating to incidence and prevalence of HIV, hypertension and depression were derived from our own agent-based simulation model and other published literature. Gaussian processes were used to fit the emulator to simulator estimates, assuming presence of noise for design points. Bayesian posterior predictive checks and leave-one-out cross validation confirmed the emulator's descriptive accuracy. RESULTS In this example, our emulator resulted in a 13-fold (95% Confidence Interval (CI): 8-22) improvement in computing time compared to that of more complex chronic disease simulation models. One emulator run took 3.00 seconds (95% CI: 1.65-5.28) on a 64-bit operating system laptop with 8.00 gigabytes (GB) of Random Access Memory (RAM), compared to > 11 hours for 1000 simulator runs on a high-performance computing cluster with 1500 GBs of RAM. Pareto k estimates were < 0.70 for all emulations, which demonstrates sufficient predictive accuracy of the emulator. CONCLUSIONS The emulator presented in this tutorial offers a practical and flexible modelling tool that can help inform health policy-making in countries with a generalized HIV epidemic and growing NCD burden. Future emulator applications could be used to forecast the changing burden of HIV, hypertension and depression over an extended (> 10 year) period, estimate longer-term prevalence of other co-occurring conditions (e.g., postpartum depression among women living with HIV), and project the impact of nationally-prioritized interventions such as national health insurance schemes and differentiated care models.
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Affiliation(s)
- Sharon Jepkorir Sawe
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
| | - Richard Mugo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Marta Wilson-Barthes
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Brianna Osetinsky
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Faith Yego
- Department of Health Policy Management & Human Nutrition, Moi University School Public Health, Eldoret, Kenya
| | - Ann Mwangi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Mathematics, Physics & Computing, School of Science and Aerospace Studies, Moi University, Eldoret, Kenya
| | - Omar Galárraga
- Academic Model Providing Access to Healthcare, Eldoret, Kenya.
- Department of Health Services, Policy and Practice, and International Health Institute, Brown University School of Public Health, Providence, RI, USA.
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Mahalie R, Angula P, Mitonga KH, Oladimeji O. Patterns of availability and accuracy of risk factor data for cardiovascular diseases among people initiated on antiretroviral therapy at selected health facilities in Khomas region, Namibia: a retrospective, cross-sectional, quantitative study. Pan Afr Med J 2024; 47:33. [PMID: 38586067 PMCID: PMC10998256 DOI: 10.11604/pamj.2024.47.33.25340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/27/2023] [Indexed: 04/09/2024] Open
Abstract
Introduction quality data is a prerequisite for timely decision-making and measuring health outcomes in public health settings. Comorbidities such as cardiovascular diseases (CVDs) among people living with HIV (PLHIV), require a robust system that ensures credible data at all data-producing levels. The study at determining the level of availability and completeness of CVDs risk factors data of PLHIV. Methods a quantitative study was conducted to extract CVDs risk factors data retrospectively from 529 patient care booklets (PCBs) between 2004 and 2017. The analysis was done with the Statistical Package for Social Sciences (SPSS) version 25. Pearson Chi-Square was used to test for associations. The level of significance was at p ≤ 0.05. Results the study revealed that 72.8% of patients are at risk of CVDs due to incomplete demographics (73.72%) and other systemic data (41.18%). A significant association was found (Pearson Chi-Square test 19.907; p-value of 0.001) between average visits per year, accurate data recording, and active status of the patient. Lost to follow-up (15%) and true retention (27.2%) was significantly associated with the last Antiretroviral Therapy (ART) status of a patient (Pearson Chi-Square test 87.754; p-value of 0.001). Conclusion the study that despite concerted efforts to improve data quality, the availability and completeness of data remain unsatisfactory. Lack of harmonised data screening and analysis efforts for CVDs risk factors is found to be a significant risk factor in ensuring integrated routine measuring of CVDs health outcomes for PLHIV.
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Affiliation(s)
- Roswitha Mahalie
- Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia
| | - Penehafo Angula
- School of Public Health, Oshakati Campus, Faculty of Health Sciences, University of Namibia, Oshakati, Namibia
| | - Kabwebwe Honoré Mitonga
- School of Public Health, Oshakati Campus, Faculty of Health Sciences, University of Namibia, Oshakati, Namibia
| | - Olanrewaju Oladimeji
- Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Lamontagne E, Leroy V, Yakusik A, Parker W, Howell S, Ventelou B. Assessment and determinants of depression and anxiety on a global sample of sexual and gender diverse people at high risk of HIV: a public health approach. BMC Public Health 2024; 24:215. [PMID: 38238673 PMCID: PMC10795213 DOI: 10.1186/s12889-023-17493-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/14/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Sexual and gender diverse people face intersecting factors affecting their well-being and livelihood. These include homophobic reactions, stigma or discrimination at the workplace and in healthcare facilities, economic vulnerability, lack of social support, and HIV. This study aimed to examine the association between such factors and symptoms of anxiety and depression among sexual and gender diverse people. METHODS This study is based on a sample of 108,389 gay, bisexual, queer and questioning men, and transfeminine people from 161 countries collected through a cross-sectional internet survey. We developed a multinomial logistic regression for each group to study the associations of the above factors at different severity scores for anxiety and depression symptoms. RESULTS Almost a third (30.3%) of the participants reported experiencing moderate to severe symptoms of anxiety and depression. Higher severity scores were found for transfeminine people (39%), and queer or questioning people (34.8%). Severe symptoms of anxiety and depression were strongly correlated with economic hardship for all groups. Compared to those who are HIV-negative, those living with HIV were more likely to report severe symptoms of anxiety and depression, and the highest score was among those who do not know their HIV status. Transfeminine people were the most exposed group, with more than 80% higher risk for those living with HIV suffering from anxiety and depression. Finally, homophobic reactions were strongly associated with anxiety and depression. The relative risk of severe anxiety and depression was 3.47 times higher for transfeminine people facing transphobic reactions than those with no symptoms. Moreover, anxiety and depression correlate with stigma or discrimination in the workplace and healthcare facilities. CONCLUSIONS The strong association between the severity of anxiety and depression, and socioeconomic inequality and HIV status highlights the need for concrete actions to meet the United Nations' pledge to end inequalities faced by communities and people affected by HIV. Moreover, the association between stigma or discrimination and anxiety and depression among sexual and gender diverse people is alarming. There is a need for bold structural public health interventions, particularly for transfeminine, queer and questioning people who represent three communities under the radar of national HIV programmes.
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Affiliation(s)
- Erik Lamontagne
- UNAIDS, 20 Ave Appia, 1211, Geneva, Switzerland.
- Aix-Marseille University, CNRS, EHESS, Centrale Marseille, Aix-Marseille School of Economics, 5-9 Boulevard Maurice Bourdet 13205, Marseille, France.
| | - Vincent Leroy
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | - Anna Yakusik
- UNAIDS, 20 Ave Appia, 1211, Geneva, Switzerland
- Imperial College London, Faculty of Medicine, School of Public Health, London, SW7 2AZ, England
| | | | | | - Bruno Ventelou
- Aix-Marseille University, CNRS, EHESS, Centrale Marseille, Aix-Marseille School of Economics, 5-9 Boulevard Maurice Bourdet 13205, Marseille, France
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Jere J, Ruark A, Bidwell JT, Butterfield RM, Neilands TB, Weiser SD, Mulauzi N, Mkandawire J, Conroy AA. "High blood pressure comes from thinking too much": Understandings of illness among couples living with cardiometabolic disorders and HIV in Malawi. PLoS One 2023; 18:e0296473. [PMID: 38153924 PMCID: PMC10754453 DOI: 10.1371/journal.pone.0296473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023] Open
Abstract
Cardiometabolic disorders (CMD) such as hypertension and diabetes are increasingly prevalent in sub-Saharan Africa, placing people living with HIV at risk for cardiovascular disease and threatening the success of HIV care. Spouses are often the primary caregivers for people living with CMD, and understanding patients' and partners' conceptions of CMD could inform care. We conducted semi-structured interviews with 25 couples having a partner living with HIV and either hypertension or diabetes. Couples were recruited from HIV clinics in Malawi and were interviewed on beliefs around symptoms, causation, prevention, and treatment for CMD. Data were analyzed at the individual and dyadic levels using framework analysis and Kleinman's theory of explanatory models as a lens. On average, participants were 51 years old and married for 21 years. Approximately 57%, 14%, and 80% had hypertension, diabetes, and HIV. Couples endorsed a combination of biomedical explanatory models (beliefs around physical and mental health) and traditional explanatory models (beliefs around religion and natural remedies), although tended to emphasize the biomedical model. Half of couples believed stress was the main cause of hypertension. For diabetes, diet was believed to be a common cause. In terms of prevention, dietary changes and physical activity were most frequently mentioned. For disease management, medication adherence and diet modifications were emphasized, with some couples also supporting herbal remedies, stress reduction, and faith in God as strategies. Participants were generally more concerned about CMD than HIV due to poor access to CMD medications and beliefs that CMD could lead to sudden death. Within couples, partners often held many of the same beliefs but diverged around which etiological or preventive factors were most important (e.g., stress versus diet) and the best diet for CMD. Health education programs should involve primary partners to build knowledge of CMD and address overlap with HIV, and reinforce accurate information on lifestyle factors for the prevention and treatment of CMD.
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Affiliation(s)
- Jane Jere
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Allison Ruark
- Wheaton College, Biological and Health Sciences, Wheaton, IL, United States of America
| | - Julie T. Bidwell
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, United States of America
| | - Rita M. Butterfield
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | | | | | - Amy A. Conroy
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States of America
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Badacho AS, Mahomed OH. Mapping evidence on barriers to and facilitators of diagnosing noncommunicable diseases (NCDs) among people living with human immunodeficiency virus (PLWH) in low- and middle-income countries (LMICs) in Africa: A scoping review protocol. PLoS One 2023; 18:e0294979. [PMID: 38100401 PMCID: PMC10723733 DOI: 10.1371/journal.pone.0294979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs) represent a global public health challenge in all population groups, but the prevalence of major NCDs, such as depression, hypercholesterolemia, hypertension, obesity and diabetes, is increasing at a rapid rate among people living with human immunodeficiency virus (PLWH). Studies show that integrated NCDs and human immunodeficiency virus (HIV) services have improved the patient outcome of PLWH with comorbidities with NCDs. It requires a strengthened and sustainable way of diagnosing major NCDs early among PLWH. However, there is limited evidence regarding the barriers to and facilitators of early diagnosis of NCDs (depression, hypercholesterolemia, hypertension, obesity and diabetes) among PLWH in low- and middle-income countries (LMICs). This review will systematically map the literature and describe the barriers and facilitators of diagnosing NCDs (depression, hypercholesterolemia, hypertension, obesity and diabetes) among PLWH in LMICs in Africa. METHODS The methodology presented by Arksey and O'Malley and the recommendation set out by Levac and colleagues will be used. PubMed, MEDLINE with full text via the EBSCO host, Google Scholar, Science Direct and Scopus will be used for a comprehensive search for data extraction. The search will be conducted using keywords, Boolean terms, and Medical Subject Headings (MeSH). All studies with eligible titles will be exported to the EndNote citation manager for deduplication and imported to Rayyan software for screening. Two reviewers will independently screen abstracts, and the preferred reporting items for systematic review and meta-analysis extension to scoping review (PRISMA-Sc) guidelines will be used to guide the search in conducting the scoping review. We will perform descriptive data analysis for quantitative studies, NVivo software version 12 will be used for qualitative studies, and thematic content analysis will be carried out. This scoping review will include studies that included PLWH with those diagnosed with major NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) in LMICs in Africa. DISCUSSION This scoping review will highlight evidence mapping on barriers and facilitators of diagnosing NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) among PLWH LMICs in Africa. Scoping Review Registration: registered on Open Science Framework (https://osf.io/xvtwd/).
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Affiliation(s)
- Abebe Sorsa Badacho
- School Public Health, Wolaita Sodo University, Soddo, Ethiopia
- School of Nursing and Public Health, Public Health Medicine Discipline, The University of KwaZulu-Natal, Durban, South Africa
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Ozayr Harron Mahomed
- School of Nursing and Public Health, Public Health Medicine Discipline, The University of KwaZulu-Natal, Durban, South Africa
- Dasman Diabetes Research Institute, Kuwait City, Kuwait
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20
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Gizamba JM, Davies J, Africa C, Choo-Kang C, Goedecke JH, Madlala H, Lambert EV, Rae DE, Myer L, Luke A, Dugas LR. Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:861. [PMID: 38062372 PMCID: PMC10704741 DOI: 10.1186/s12879-023-08736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND HIV has become a manageable chronic condition due to the success and scale-up of antiretroviral therapy (ART). Globally, South Africa has the highest number of people living with HIV (PLHIV) and research evidence indicates that countries with the highest burden of PLHIV have a substantial burden of obesity, hypertension (HPT) and type 2 diabetes (T2D). We sought to summarize the burden of these three common NCDs among PLHIV in South Africa. METHODS In this systematic review, multiple databases were searched for articles reporting on the prevalence of obesity, HPT, and T2D among PLHIV in South Africa published since journal inception until March 2022. A meta-analysis was conducted using random-effects models to obtain pooled prevalence estimates of the three NCDs. Heterogeneity was assessed using X2 test on Cochran's Q statistic. RESULTS We included 32 studies, with 19, 22 and 18 studies reporting the prevalence of obesity, HPT, and T2D among PLHIV, respectively. The overall prevalence of obesity, HPT, and T2D was 23.2% [95% CI 17.6; 29.9], 25.5% [95% CI 15.6; 38.7], and 6.1% [95% CI 3.8; 9.7] respectively. The prevalence of obesity was significantly higher among women (P = 0.034) compared to men, however the prevalence of HPT and T2D did not differ by sex. The prevalence of each of the three NCDs did not differ significantly between rural, urban, and peri-urban areas. The prevalence of obesity and T2D was higher in studies conducted between 2013 and 2022 compared to studies conducted between 2000 and 2012, while the prevalence of HPT was higher between 2000 and 2012 compared to between 2013 and 2022. CONCLUSIONS These findings suggest that South Africa is experiencing a syndemic of NCDs among people PLHIV highlighting the need to increase cost-effective interventions and management strategies that involve integrated HIV and NCD care in the South African setting.
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Affiliation(s)
- Jacob M Gizamba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
- Spatial Science Institute, University of Southern California, Los Angeles, USA
| | - Jess Davies
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Chad Africa
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Candice Choo-Kang
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Julia H Goedecke
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Hlengiwe Madlala
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Estelle V Lambert
- Health Through Physical Activity, Lifestyle and Sport Research Centre, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dale E Rae
- Health Through Physical Activity, Lifestyle and Sport Research Centre, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Amy Luke
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Lara R Dugas
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa.
- Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
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Khunti K, Chudasama YV, Gregg EW, Kamkuemah M, Misra S, Suls J, Venkateshmurthy NS, Valabhji J. Diabetes and Multiple Long-term Conditions: A Review of Our Current Global Health Challenge. Diabetes Care 2023; 46:2092-2101. [PMID: 38011523 DOI: 10.2337/dci23-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/26/2023] [Indexed: 11/29/2023]
Abstract
Use of effective treatments and management programs is leading to longer survival of people with diabetes. This, in combination with obesity, is thus contributing to a rise in people living with more than one condition, known as multiple long-term conditions (MLTC or multimorbidity). MLTC is defined as the presence of two or more long-term conditions, with possible combinations of physical, infectious, or mental health conditions, where no one condition is considered as the index. These include a range of conditions such as cardiovascular diseases, cancer, chronic kidney disease, arthritis, depression, dementia, and severe mental health illnesses. MLTC has major implications for the individual such as poor quality of life, worse health outcomes, fragmented care, polypharmacy, poor treatment adherence, mortality, and a significant impact on health care services. MLTC is a challenge, where interventions for prevention and management are lacking a robust evidence base. The key research directions for diabetes and MLTC from a global perspective include system delivery and care coordination, lifestyle interventions and therapeutic interventions.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Yogini V Chudasama
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Edward W Gregg
- School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Monika Kamkuemah
- Innovation Africa and Department of Architecture, Faculty of Engineering, Built Environment and Information Technology, University of Pretoria, Pretoria, South Africa
| | - Shivani Misra
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Jerry Suls
- Institute for Health System Science, Feinstein Institutes for Medical Research Northwell Health, New York, NY
| | - Nikhil S Venkateshmurthy
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Jonathan Valabhji
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, U.K
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Moyo-Chilufya M, Maluleke K, Kgarosi K, Muyoyeta M, Hongoro C, Musekiwa A. The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102255. [PMID: 37842552 PMCID: PMC10570719 DOI: 10.1016/j.eclinm.2023.102255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing among people living with HIV (PLHIV), especially in Sub-Saharan Africa (SSA). We determined the prevalence of NCDs and NCD risk factors among PLHIV in SSA to inform health policy makers. Methods We conducted a systematic review and meta-analysis on the prevalence of NCDs and risk factors among PLHIV in SSA. We comprehensively searched PubMed/MEDLINE, Scopus, and EBSCOhost (CINAHL) electronic databases for sources published from 2010 to July 2023. We applied the random effects meta-analysis model to pool the results using STATA. The systematic review protocol was registered on PROSPERO (registration number: CRD42021258769). Findings We included 188 studies from 21 countries in this meta-analysis. Our findings indicate pooled prevalence estimates for hypertension (20.1% [95% CI:17.5-22.7]), depression (30.4% [25.3-35.4]), diabetes (5.4% [4.4-6.4]), cervical cancer (1.5% [0.1-2.9]), chronic respiratory diseases (7.1% [4.0-10.3]), overweight/obesity (32.2% [29.7-34.7]), hypercholesterolemia (21.3% [16.6-26.0]), metabolic syndrome (23.9% [19.5-28.7]), alcohol consumption (21.3% [17.9-24.6]), and smoking (6.4% [5.2-7.7]). Interpretation People living with HIV have a high prevalence of NCDs and their risk factors including hypertension, depression, overweight/obesity, hypercholesterolemia, metabolic syndrome and alcohol consumption. We recommend strengthening of health systems to allow for improved integration of NCDs and HIV services in public health facilities in SSA. NCD risk factors such as obesity, hypercholesterolemia, and alcohol consumption can be addressed through health promotion campaigns. There is a need for further research on the burden of NCDs among PLHIV in most of SSA. Funding This study did not receive any funding.
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Affiliation(s)
- Maureen Moyo-Chilufya
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kuhlula Maluleke
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kabelo Kgarosi
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Charles Hongoro
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Human Sciences Research Council, Pretoria, South Africa
| | - Alfred Musekiwa
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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23
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Tegegne KD, Adela GA, Kassie GA, Mengstie MA, Seid MA, Zemene MA, Feleke SF, Dejenie TA, Abebe EC, Anley DT, Dessie AM, Gesese MM, Yimer N, Gebeyehu NA. Prevalence and factors associated with hypertension among peoples living with HIV in East Africa, a systematic review and meta-analysis. BMC Infect Dis 2023; 23:724. [PMID: 37880643 PMCID: PMC10601241 DOI: 10.1186/s12879-023-08679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND In recent years, improved access to effective antiretroviral therapy has meant that people living with human immune virus are living longer than before. The burden of non-communicable diseases particularly, hypertension parallels with the increase in age. Although hypertension screening is thought to be an effective indicator of overall health status and paves the way for early interventions in peoples living with human immune virus, the exact prevalence of hypertension in this population remained unknown. We aimed to report the prevalence of hypertension and examine the factors associated with hypertension among people living with human immune virus in East Africa. METHODS In this systematic review and meta-analysis, we searched PubMed, Science Direct, Scopus, Cochrane library, and Google Scholar databases for studies published until January 1, 2023. The search period was from January 10/2023, to February 10/ 2023. Random-effect models were used to calculate the pooled prevalence of hypertension. Subgroup analyses were conducted to explore potential heterogeneity. The Funnel plot and Egger's test were used to assess publication bias. RESULT A total of 15 studies with 10,916 individuals were included in the present meta-analysis. The pooled prevalence of hypertension among people living with human immune virus was19.75% (95% CI, 16.07%-23.42%)),). The prevalence of hypertension was not differed between studies conducted 2014- 2019 and, studies conducted 2020-2022. The prevalence of hypertension was lowest in Ethiopia (16.13%) and highest in Tanzania (26.76%). Alcohol consumption (Adjusted Odds Ratio (AOR): 3.39, 95% CI: 2.35-4.43), diabetes (AOR: 2.64, 95% CI: 1.89-3.39), longer duration of HIV (AOR: 1.72, 95% CI: 1.15-2.3), male sex (AOR: 1.62, 95% CI: 1.43-1.8), obesity (AOR: 2.89, 95% CI: 1.94-3.84), and older age (AOR: 2.25, 95% CI: 2.0-2.5), were the factors associated with the presence of hypertension in people living with human immune virus. CONCLUSION Our study shows that one in five peoples living with human immune virus have hypertension causing symptoms and impairment, therefore requiring treatment. Designing effective health screening and hypertension management intervention programs helps to prevent the occurrence of hypertension and promotes peoples' overall quality of life.
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Affiliation(s)
- Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Getachew Asmare Adela
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajaw Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Health Science, Gondar University, Gondar, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalign Melese Gesese
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
| | - Nega Yimer
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo, Ethiopia
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24
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Wainberg ML, Wolvaardt GG, Gouveia L, Ferenchick E. World Mental Health Day 2023: We must leave no one behind in the response to HIV and mental health. J Int AIDS Soc 2023; 26:e26183. [PMID: 37814801 PMCID: PMC10562895 DOI: 10.1002/jia2.26183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023] Open
Affiliation(s)
| | | | - Lidia Gouveia
- Department of Mental HealthMinistry of HealthMaputoMozambique
| | - Erin Ferenchick
- Center for Family and Community MedicineColumbia UniversityNew YorkNYUSA
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25
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Masunda K, Khan Z. The Burden of Hypertension in HIV-Infected Adults on Retroviral Therapy in Masvingo Province, Zimbabwe: A Retrospective Cohort Study. Cureus 2023; 15:e46476. [PMID: 37927754 PMCID: PMC10624240 DOI: 10.7759/cureus.46476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Background and objective The global HIV epidemic has evolved in the past 30 years with a decline in mortality and morbidity and improved survival since the introduction of antiretroviral therapy (ART). However, this has brought on new challenges through the emergence of non-communicable disease (NCD) as a pandemic at par with, if not more serious than, HIV, and patients well maintained on ART are now faced with the increased risk of developing NCDs such as hypertension, which also require lifelong therapy. This study was designed to determine the burden of hypertension in patients under HIV care in Masvingo province, Zimbabwe. Methods A retrospective cohort study was conducted in six districts of Masvingo province based on the data collected from the electronic Patient Monitoring System (ePMS), along with an analysis of secondary data. Of the 94,821 records gathered, 877 met the inclusion criteria to be included in the study. Data were analyzed using Microsoft Excel and Stata statistical software and statistical analysis was performed using the χ2 test. Results The study revealed a hypertension prevalence of 7.64% among the 877 patients analyzed and the independent risk factors for the development of hypertension were determined to be the age of patients, with a one-year increase in age resulting in an 8% increase in the risk of developing hypertension, and the duration on ART, with a one-year increase on ART duration increasing the risk of hypertension by 27%, and an increase in BMI by a factor of 1 increasing the risk of getting hypertension by 9%. Conclusion Our findings showed that there are patients who have both hypertension and HIV on ART care, and they would need to be managed for both. There is a need for improved data collection of important variables that improve the quality of care of clients. Clinical management of HIV needs to evolve with the evolving needs of patients and NCD care has to be factored in.
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Affiliation(s)
| | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend on Sea, GBR
- Cardiology, Barts Heart Centre UK, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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26
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Lebina L, Malatji T, Nabeemeeah F, Motsomi K, Siwelana T, Hlongwane K, Martinson N. The prevalence of multimorbidity in virally suppressed HIV-positive patients in Limpopo. South Afr J HIV Med 2023; 24:1495. [PMID: 37795429 PMCID: PMC10546900 DOI: 10.4102/sajhivmed.v24i1.1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/31/2023] [Indexed: 10/06/2023] Open
Abstract
Background Non-communicable diseases (NCDs) are an emerging global public health problem. Objectives To assess the prevalence of NCDs and their risk factors among adults on antiretroviral therapy (ART). Method This was a cross-sectional study (July 2019 - January 2020) in Limpopo, South Africa. Patients were enrolled if they were ≥ 40 years, HIV-positive, and virologically suppressed on ART. Data were analysed descriptively, and a binomial regression model was used to identify risk factors for NCDs. Results The majority of participants (65%; 319/488) were women. Most (83%; 405/488) were aged 40-59 years; 60% (285/472) were overweight or obese. Based on self-report, 22% (107/488) were currently smokers. Almost half (44%) 213/488) reported daily consumption of vegetables and 65% (319/488) exercised regularly and 39% (190/488) reported treatment for another chronic disease. The leading comorbid conditions were hypertension (32%; 158/488) and diabetes mellitus (5%; 24/488). Risk factors for hypertension included age 60 years and older (relative risk [RR]: 1.72; 95% confidence interval [CI]: 1.29-2.30) diabetes (RR: 1.42; 95% CI: 1.08-1.87), overweight (RR: 1.32; 95% CI: 1.03-1.69) and obesity (RR: 1.69; 95% CI: 1.32-2.17). Conclusion There is a high prevalence, both of risk factors for NCDs and multimorbidity (> 1 chronic disease) in patients who are ≥ 40 years and virologically suppressed on ART.
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Affiliation(s)
- Limakatso Lebina
- Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
- Clinical Research Department, Africa Health Research Institute, Durban, South Africa
| | - Tumiso Malatji
- Department of Public Health Medicine, University of Limpopo, Polokwane, South Africa
| | - Firdaus Nabeemeeah
- Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Kegaugetswe Motsomi
- Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Tsundzukani Siwelana
- Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
- Center for TB Research, Johns Hopkins University, Baltimore, United States of America
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27
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Singh U, Olivier S, Cuadros D, Castle A, Moosa Y, Zulu T, Edwards JA, Kim HY, Gunda R, Koole O, Surujdeen A, Gareta D, Munatsi D, Modise TH, Dreyer J, Nxumalo S, Smit TK, Ordering-Jespersen G, Mpofana IB, Khan K, Sikhosana ZEL, Moodley S, Shen YJ, Khoza T, Mhlongo N, Bucibo S, Nyamande K, Baisley KJ, Grant AD, Herbst K, Seeley J, Pillay D, Hanekom W, Ndung'u T, Siedner MJ, Tanser F, Wong EB. The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey. Lancet Glob Health 2023; 11:e1372-e1382. [PMID: 37591585 PMCID: PMC10447220 DOI: 10.1016/s2214-109x(23)00239-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health needs for individuals living with infectious and non-communicable diseases. METHODS We analysed data collected between May 25, 2018, and March 13, 2020, from participants of a large, community-based, cross-sectional multimorbidity survey (Vukuzazi) that offered community-based HIV, hypertension, and diabetes screening to all residents aged 15 years or older in a surveillance area in the uMkhanyakude district in KwaZulu-Natal, South Africa. Data from the Vukuzazi survey were linked with data from demographic and health surveillance surveys with a unique identifier common to both studies. Questionnaires were used to assess the diagnosed health conditions, treatment history, general health, and sociodemographic characteristics of an individual. For each condition (ie, HIV, hypertension, and diabetes), individuals were defined as having no health needs (absence of condition), met health needs (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimisation). We analysed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution. FINDINGS Of 18 041 participants who completed the survey (12 229 [67·8%] were female and 5812 [32·2%] were male), 9898 (54·9%) had at least one of the three chronic diseases measured. 4942 (49·9%) of these 9898 individuals had at least one unmet health need (1802 [18·2%] of 9898 needed treatment optimisation, 1282 [13·0%] needed engagement in care, and 1858 [18·8%] needed a diagnosis). Unmet health needs varied by disease; 1617 (93·1%) of 1737 people who screened positive for diabetes, 2681 (58·2%) of 4603 people who screened positive for hypertension, and 1321 (21·7%) of 6096 people who screened positive for HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed and unmet health needs for all three conditions had specific sites of concentration; all three conditions had an overlapping geographical pattern for the need for diagnosis. INTERPRETATION Although people living with HIV predominantly have a well controlled condition, there is a high burden of unmet health needs for people living with hypertension and diabetes. In South Africa, adapting current, widely available HIV care services to integrate non-communicable disease care is of high priority. FUNDING Fogarty International Center and the National Institutes of Health, the Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, the South African Medical Research Council, the South African Population Research Infrastructure Network, and the Wellcome Trust. TRANSLATION For the isiZulu translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Urisha Singh
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Diego Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Alison Castle
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Yumna Moosa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Thando Zulu
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Jonathan Alex Edwards
- International Institute for Rural Health, University of Lincoln, Lincoln, UK; Department of Biostatistics and Bioinformatics, Rollins School of Public Health and Department of Biomedical Informatics, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Hae-Young Kim
- Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, USA
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Olivier Koole
- Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Day Munatsi
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Theresa K Smit
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | | | - Khadija Khan
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Sashen Moodley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Yen-Ju Shen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Thandeka Khoza
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Ngcebo Mhlongo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Sanah Bucibo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kennedy Nyamande
- Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Hospital, Durban, South Africa
| | - Kathy J Baisley
- Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, UK
| | - Alison D Grant
- Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, UK; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Department of Science and Innovation, Medical Research Council, South African Population Research Infrastructure, Durban, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; London School of Hygiene and Tropical Medicine, London, UK
| | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infection and Immunity, University College London, London, UK
| | - Willem Hanekom
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infection and Immunity, University College London, London, UK
| | - Thumbi Ndung'u
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Ragon Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Division of Infection and Immunity, University College London, London, UK; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Durban, South Africa
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; College of Health Sciences, and Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa; International Institute for Rural Health, University of Lincoln, Lincoln, UK; School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
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Kalinjuma AV, Hussey H, Mollel GJ, Letang E, Battegay M, Glass TR, Paris D, Vanobberghen F, Weisser M. Body mass index trends and its impact of under and overweight on outcome among PLHIV on antiretroviral treatment in rural Tanzania: A prospective cohort study. PLoS One 2023; 18:e0290445. [PMID: 37607169 PMCID: PMC10443839 DOI: 10.1371/journal.pone.0290445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Increased body weight is an important risk factor for cardiovascular disease and is increasingly reported as a health problem in people living with HIV (PLHIV). There is limited data from rural sub-Saharan Africa, where malnutrition usually presents with both over- and undernutrition. We aimed to determine the prevalence and risk factors of underweight and overweight/obesity in PLHIV enrolled in a cohort in rural Tanzania before the introduction of integrase inhibitors. METHODS This nested study of the prospective Kilombero and Ulanga Antiretroviral Cohort included adults aged ≥19 years initiated on antiretroviral therapy between 01/2013 and 12/2018 with follow-up through 06/2019. Body Mass Index (BMI) was classified as underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), or overweight/obese (≥25.0 kg/m2). Stratified piecewise linear mixed models were used to assess the association between baseline characteristics and follow-up BMI. Cox proportional hazard models were used to assess the association between time-updated BMI and death/loss to follow-up (LTFU). RESULTS Among 2,129 patients, 22,027 BMI measurements (median 9 measurements: interquartile range 5-15) were analysed. At baseline, 398 (19%) patients were underweight and 356 (17%) were overweight/obese. The majority of patients were female (n = 1249; 59%), and aged 35-44 years (779; 37%). During the first 9 months, for every three additional months on antiretroviral therapy, BMI increased by 2% (95% confidence interval 1-2%, p<0.0001) among patients underweight at baseline and by 0.7% (0.5-0.6%, p<0.0001) among participants with normal BMI. Over a median of 20 months of follow-up, 107 (5%) patients died and 592 (28%) were LTFU. Being underweight was associated with >2 times the hazard of death/LTFU compared to participants with normal BMI. CONCLUSION We found a double burden of malnutrition, with underweight being an independent predictor of mortality. Monitoring and measures to address both states of malnutrition among PLHIV should be integrated into routine HIV care.
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Affiliation(s)
- Aneth Vedastus Kalinjuma
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Tanzania
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hannah Hussey
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Tanzania
- Division of Public Health, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Getrud Joseph Mollel
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Tanzania
- St. Francis Referral Hospital, Ifakara, Tanzania
| | - Emilio Letang
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Barcelona Institute for Global Health, Hospital Clínic-University of Barcelona, Barcelona, Spain
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tracy R. Glass
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel Paris
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Maja Weisser
- Department of Interventions and Clinical Trials, Ifakara Health Institute, Ifakara, Tanzania
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Hadavandsiri F, Shafaati M, Mohammad Nejad S, Ebrahimzadeh Mousavi M, Najafi A, Mirzaei M, Narouee S, Akbarpour S. Non-communicable disease comorbidities in HIV patients: diabetes, hypertension, heart disease, and obstructive sleep apnea as a neglected issue. Sci Rep 2023; 13:12730. [PMID: 37543699 PMCID: PMC10404291 DOI: 10.1038/s41598-023-39828-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023] Open
Abstract
The present study evaluates the non-communicable disease (NCD) patterns and related risk factors among people living with HIV (PLWH) in Iran. This national cross-sectional survey study was conducted on 1173 confirmed PLWHs with a mean age of 35.35 (56.82 Over 50 years old, 33.90 Under 50 years old) admitted from 15 different provinces in the country. Logistic regression was used to analyze the association of factors with having at least one NCD comorbidity. From 1173 PLWH, 225(19.18%) participants experienced at least one NCD (15.20% and 38.69% among under- and over-50-year-old patients, respectively). The prevalence of heart disease, hypertension, diabetes, and sleep apnea among all patients was 1.59%, 2.05%, 1.55%, and 10.26%, respectively. The similar prevalence for each NCD among those over 50 years was 10.11%, 15.71%, 9.01%, 25.44%, and 1.01%, 1.12%, 1.04%, and 9.23% among those under 50 years, respectively. The odds of being at risk of at least one NCD stood higher in patients over 50 years (ORadj = 2.93, 95% CI 1.96-4.37), married (ORadj = 2.48, 95% CI 1.41-4.35), divorced or widowed (ORadj = 2.78, 95% CI 1.48-5.20), and obese (ORadj = 3.82, 95% CI 2.46-5.91). According to our findings regarding the prevalence of NCDs among patients under 50 years of age, we recommend that policymakers give greater consideration to this group in the screening and care programs for NCDs since adults and the elderly are both vulnerable to the risk factors for developing NCDs.
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Affiliation(s)
- Fatemeh Hadavandsiri
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Shafaati
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Science, Tehran, Iran.
- Department of Microbiology, Faculty Science, Jahrom Branch, Islamic Azad University, Jahrom, Iran.
| | - Safieh Mohammad Nejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical, Tehran, Iran
| | | | - Arezu Najafi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mirzaei
- Hamadan Health Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sakineh Narouee
- Department of Epidemiology, Kerman University Medical of Sciences, Kerman, Iran
| | - Samaneh Akbarpour
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Sleep Breathing Disorders Research Center (SBDRC), Tehran University of Medical Sciences, Tehran, Iran.
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Mulindwa F, Schwarz JM, Brusselaers N, Nabwana M, Bollinger R, Buzibye A, Amutuhaire W, Yendewa G, Laker E, Kiguba R, Castelnuovo B. Blood glucose outcomes of anti-retroviral therapy naïve Ugandan people with HIV with pre-diabetes mellitus initiated on dolutegravir for 48 weeks. RESEARCH SQUARE 2023:rs.3.rs-3154716. [PMID: 37577475 PMCID: PMC10418540 DOI: 10.21203/rs.3.rs-3154716/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background The Uganda ministry of Health recommends frequent blood glucose monitoring for the first six months on dolutegravir, in people with HIV (PWH) having pre-diabetes mellitus (pre-DM). We sought to determine if indeed PWH with pre-diabetes started on dolutegravir had worse blood glucose outcomes at 48 weeks compared to those with normal blood glucose. Methods In this matched cohort study, we compared 44 PWH with pre-DM and 88 PWH with normal blood glucose at baseline. The primary outcome was change in mean fasting blood glucose (FBG) from baseline to week 48 and 2-hour blood glucose (2hBG) from baseline to week 36 compared between the two groups. Results There was significant increase in FBG in PWH with normal blood glucose (mean change in FBG(FBG): 3.9mg/dl, 95% confidence interval (95% CI): (2.2, 5.7), p value (p) = < 0.0001) and decrease in those with pre-DM (FBG: -6.1mg/dl, 95%CI (-9.1, -3.2), p = < 0.0001) at 48 weeks. 2hBG at 36 weeks was significantly lower than at baseline in both groups with the magnitude of reduction larger in those with pre-DM at 12 weeks (adjusted differences in mean drop in 2hBG (a2hBG): -19.69mg/dl, 95%CI (-30.19, -9.19), p = < 0.0001) and 36 weeks (a2hBG: -19.97mg/dl, 95%CI (-30.56, -9.39), p = < 0.0001). Conclusion We demonstrated that Ugandan ART naïve PWH with pre-diabetes at enrollment have consistent improvement in both fasting blood glucose and glucose tolerance over 48 weeks on dolutegravir. Intensified blood glucose monitoring of these patients in the first six months of dolutegravir may be unnecessary.
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Affiliation(s)
| | | | | | - Martin Nabwana
- Makerere University Johns Hopkins University Research Collaboration
| | | | | | | | | | - Eva Laker
- Makerere University Infectious Diseases Institute
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Hines JZ, Prieto JT, Itoh M, Fwoloshi S, Zyambo KD, Sivile S, Mweemba A, Chisemba P, Kakoma E, Zachary D, Chitambala C, Minchella PA, Mulenga LB, Agolory S. Hypertension among persons living with HIV-Zambia, 2021; A cross-sectional study of a national electronic health record system. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001686. [PMID: 37428721 DOI: 10.1371/journal.pgph.0001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/07/2023] [Indexed: 07/12/2023]
Abstract
Hypertension is a major risk factor for cardiovascular disease, which is a common cause of death in Zambia. Data on hypertension prevalence in Zambia are scarce and limited to specific geographic areas and/or populations. We measured hypertension prevalence among persons living with HIV (PLHIV) in Zambia using a national electronic health record (EHR) system. We did a cross-sectional study of hypertension prevalence among PLHIV aged ≥18 years during 2021. Data were extracted from the SmartCare EHR, which covers ~90% of PLHIV on treatment in Zambia. PLHIV with ≥2 clinical visits in 2021 were included. Hypertension was defined as ≥2 elevated blood pressure readings (systolic ≥140 mmHg/diastolic ≥90 mmHg) during 2021 and/or on anti-hypertensive medication recorded in their EHR ≤5 years. Logistic regression was used to assess for associations between hypertension and demographic characteristics. Among 750,098 PLHIV aged ≥18 years with ≥2 visits during 2021, 101,363 (13.5%) had ≥2 recorded blood pressure readings. Among these PLHIV, 14.7% (95% confidence interval [CI]: 14.5-14.9) had hypertension. Only 8.9% of PLHIV with hypertension had an anti-hypertensive medication recorded in their EHR. The odds of hypertension were greater in older age groups compared to PLHIV aged 18-29 years (adjusted odds ratio [aOR] for 30-44 years: 2.6 [95% CI: 2.4-2.9]; aOR for 45-49 years: 6.4 [95% CI: 5.8-7.0]; aOR for ≥60 years: 14.5 [95% CI: 13.1-16.1]), urban areas (aOR: 1.9 [95% CI: 1.8-2.1]), and on ART for ≥6-month at a time (aOR: 1.1 [95% CI: 1.0-1.2]). Hypertension was common among PLHIV in Zambia, with few having documentation of treatment. Most PLHIV were excluded from the analysis because of missing BP measurements. Strengthening integrated management of non-communicable diseases in HIV clinics might help to diagnose and treat hypertension in Zambia. Addressing missing data of routine clinical data (like blood pressure) could improve non-communicable diseases surveillance in Zambia.
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Affiliation(s)
- Jonas Z Hines
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Megumi Itoh
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Sombo Fwoloshi
- Ministry of Health, Lusaka, Zambia
- University of Zambia, School of Medicine, Lusaka, Zambia
| | | | | | | | | | | | - Dalila Zachary
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | | | | | - Simon Agolory
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
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Goldstein D, Salvatore M, Ferris R, Phelps BR, Minior T. Integrating global HIV services with primary health care: a key step in sustainable HIV epidemic control. Lancet Glob Health 2023; 11:e1120-e1124. [PMID: 37349037 DOI: 10.1016/s2214-109x(23)00156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/27/2023] [Accepted: 03/06/2023] [Indexed: 06/24/2023]
Abstract
Ending the HIV epidemic relies in part on integrating stand-alone HIV programming with primary health-care platforms to improve population-level health and ensure sustainability. Integration of HIV and primary health care services in sub-Saharan Africa improves both outcomes. Existing models support both integrating primary health care services into existing HIV services, and incorporating HIV services into primary health care platforms, with optimal programming based on local contexts and local epidemic factors. Person-centred differentiated service delivery, community-based interventions, and a well supported health workforce form the backbone of successful integration. Strategic financing to optimise HIV and primary health care integration requires well-coordinated partnerships with host governments, private sector companies, multilateral stakeholders, development banks, and non-government organisations. Programme success will require increased flexibility of international donors' implementation guidance as well as involvement of local communities and civil society organisations. As we seek to end the HIV epidemic by 2030 amidst a constrained global economic climate, integration of HIV programming with primary health care offers an avenue of opportunity and hope.
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Affiliation(s)
- Deborah Goldstein
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA.
| | | | - Robert Ferris
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
| | - Benjamin Ryan Phelps
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
| | - Thomas Minior
- Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
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Goldstein D, Ford N, Kisyeri N, Munsamy M, Nishimoto L, Osi K, Kambale H, Minior T, Bateganya M. Person-centred, integrated non-communicable disease and HIV decentralized drug distribution in Eswatini and South Africa: outcomes and challenges. J Int AIDS Soc 2023; 26 Suppl 1:e26113. [PMID: 37408477 PMCID: PMC10323318 DOI: 10.1002/jia2.26113] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/09/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) are highly prevalent in people living with HIV above 50 years of age and account for increasing mortality. There is little published evidence supporting person-centred, integrated models of HIV care, hypertension and diabetes treatment in southern Africa, and no data demonstrating mortality reduction. Where clinical visits for NCDs and HIV cannot be combined, integrated medication delivery presents an opportunity to streamline care and reduce patient costs. We present experiences of integrated HIV and NCD medication delivery in Eswatini and South Africa, focusing on programme successes and implementation challenges. Programmatic data from Eswatini's Community Health Commodities Distribution (CHCD) from April 2020 to December 2021 and South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) from January 2016 to December 2021 were provided by programme managers and are summarized here. DISCUSSION Launched in 2020, Eswatini's CHCD provides over 28,000 people with and without HIV with integrated services, including HIV testing, CD4 cell count testing, antiretroviral therapy refills, viral load monitoring and pre-exposure prophylaxis alongside NCD services, including blood pressure and glucose monitoring and hypertension and diabetes medication refills. Communities designate neighbourhood care points and central gathering places for person-centred medication dispensing. This programme reported fewer missed medication refill appointments among clients in community settings compared to facility-based settings. South Africa's CCMDD utilizes decentralized drug distribution to provide medications for over 2.9 million people, including those living with HIV, hypertension and diabetes. CCMDD incorporates community-based pickup points, facility "fast lanes" and adherence clubs with public sector health facilities and private sector medication collection units. There are no out-of-pocket payments for medications or testing commodities. Wait-times for medication refills are lower at CCMDD sites than facility-based sites. Innovations to reduce stigma include uniformly labelled medication packages for NCD and HIV medications. CONCLUSIONS Eswatini and South Africa demonstrate person-centred models for HIV and NCD integration through decentralized drug distribution. This approach adapts medication delivery to serve individual needs and decongest centralized health facilities while efficiently delivering NCD care. To bolster programme uptake, additional reporting of integrated decentralized drug distribution models should include HIV and NCD outcomes and mortality trends.
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Affiliation(s)
| | - Nathan Ford
- Global HIVHepatitis and Sexually Transmitted Infections ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Nicholas Kisyeri
- Eswatini National AIDS ProgramMbabaneEswatini
- ICAPColumbia UniversityMbabaneEswatini
| | | | | | | | - Herve Kambale
- ICAPColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
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Brown MJ, Gao C, Kaur A, Qiao S, Li X. Social Support, Internalized HIV Stigma, Resilience and Depression Among People Living with HIV: A Moderated Mediation Analysis. AIDS Behav 2023; 27:1106-1115. [PMID: 36094638 PMCID: PMC10115436 DOI: 10.1007/s10461-022-03847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/30/2022]
Abstract
Internalized HIV stigma has been associated with depression among people living with HIV (PLWH). However, it is still unclear whether resilience would mediate the association between internalized HIV stigma and depression and how this indirect effect would be moderated by social support. Data were collected from 402 PLWH in South Carolina using a cross-sectional survey. Data were fitted using a path model that specified the extent to which internalized HIV stigma and depression were related through resilience and how this effect was moderated by social support. Sociodemographic characteristics were included in the model as covariates. The indirect effect of internalized HIV stigma on depression through resilience was statistically significant for high social support but not for low social support. To mitigate negative impacts of internalized HIV stigma on mental health of PLWH, intervention efforts should integrate multilevel components for promoting both resilience and social support.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States.
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, United States.
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, United States.
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, United States.
| | - Chuanji Gao
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Shan Qiao
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Xiaoming Li
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, United States
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
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Singh U, Olivier S, Cuadros D, Castle A, Moosa Y, Edwards JA, Kim HY, Siedner MJ, Tanser F, Wong EB. Quantifying met and unmet health needs for HIV, hypertension and diabetes in rural KwaZulu-Natal, South Africa. RESEARCH SQUARE 2023:rs.3.rs-2702048. [PMID: 36993494 PMCID: PMC10055615 DOI: 10.21203/rs.3.rs-2702048/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
The convergence of infectious and non-communicable diseases (NCDs) in South Africa poses a challenge to health systems. Here we establish a framework to quantify met and unmet health needs for individuals living with infectious and NCDs. In this study, we screened adult residents >15 years of age within the uMkhanyakude district in KwaZulu- Natal, South Africa for HIV, hypertension (HPTN) and diabetes mellitus (DM). For each condition, individuals were defined as having no unmet health needs (absence of condition), met health need (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimization). We analyzed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution. We found that of 18,041 participants, 9,898 (55%) had at least one chronic condition. 4,942 (50%) of these individuals had at least one unmet health need (18% needed treatment optimization, 13% needed engagement in care, and 19% needed diagnosis). Unmet health needs varied by disease: 93% of people with DM, 58% of people with HPTN and 21% of people with HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed, unmet health needs had specific sites of concentration whilst the need for diagnosis for all three conditions was co-located. Whilst people living with HIV are predominantly well-controlled, there is a high burden of unmet health needs for people living with HPTN and DM. Adaptation of HIV models of care to integrate HIV and NCD services is of high priority.
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Affiliation(s)
- Urisha Singh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Nelson R Mandela School of Medicine; University of KwaZulu-Natal, Durban, SA
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Diego Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, USA
| | - Alison Castle
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yumna Moosa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Jonathan Alex Edwards
- International Institute for Rural Health, University of Lincoln, Lincolnshire, UK
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Biomedical Informatics, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Hae-Young Kim
- Department of Population Health, New York University Grossman School of Medicine, NY, USA
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Nelson R Mandela School of Medicine; University of KwaZulu-Natal, Durban, SA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- International Institute for Rural Health, University of Lincoln, Lincolnshire, UK
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, South Africa
| | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, USA
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Ruamtawee W, Tipayamongkholgul M, Aimyong N, Manosuthi W. Prevalence and risk factors of cardiovascular disease among people living with HIV in the Asia-Pacific region: a systematic review. BMC Public Health 2023; 23:477. [PMID: 36915099 PMCID: PMC10009940 DOI: 10.1186/s12889-023-15321-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/25/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) due to atherosclerosis have become one of the major causes of death among people living with HIV (PLHIV) since effective antiretroviral therapy (ART) has been available throughout the world. However, the epidemiologic evidence of this problem from the Asia-Pacific region remains unclear. We conducted a systematic review of the situation and risk factors for CVD among PLHIV in countries with the greatest impact of CVD attributable to HIV in the Asia-Pacific region. METHODS A systematic search in PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews databases for articles published before 2019 was conducted. Publications reported situations and risk factors both traditional and HIV-specific for CVD among PLHIV in the region were included. Two reviewers working on duplicate and quality assessments, independently extracted data, and thematically analyzed the data. RESULTS Among PLHIV, the prevalence of subclinical CVD ranged from 10 to 28% and the incidence rate of clinical CVD ranged from 0.37 to 1.17 /100 person-years. Clinical CVD was frequently observed in the early era of the highly active antiretroviral therapy. A higher prevalence of subclinical CVD such as abnormal cIMT and carotid plaques was frequently observed in the PLHIV rather than in the nonHIV population and a high proportion of early onset of CVD was found among young PLHIV adults. The traditional risk factors for CVD such as hypertension, diabetes and smoking behavior were prevalent in both PLHIV and nonHIV populations ranging from 5 to 45%. HIV-specific risk factor, and lower CD4 presented almost twice the significantly increased risks for CVD while the synergistic interaction among traditional risk factors, i.e., diabetes mellitus, dyslipidemia and family history steeply increased the risk for CVD among PLHIV by almost 20 times. CONCLUSION The limited existing data suggested the risk of early CVD among PLHIV. We identified the crucial gaps in HIV/CVD work from the Asia-Pacific region and recommended longer prospective studies with larger sample sizes or meta-analyses to better capture CVD risk and interactions of crucial risk factors of this vulnerable population in this region. REGISTRATION NUMBER INPLASY202290108 ( https://inplasy.com/inplasy-2022-9-0108/ ).
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Affiliation(s)
- Witchakorn Ruamtawee
- Department of Epidemiology, Faculty of Public health, Mahidol University, 420/1 Ratchawithi Road, Ratchathewi, 10400, Bangkok, Thailand
| | - Mathuros Tipayamongkholgul
- Department of Epidemiology, Faculty of Public health, Mahidol University, 420/1 Ratchawithi Road, Ratchathewi, 10400, Bangkok, Thailand.
| | - Natnaree Aimyong
- Department of Epidemiology, Faculty of Public health, Mahidol University, 420/1 Ratchawithi Road, Ratchathewi, 10400, Bangkok, Thailand
| | - Weerawat Manosuthi
- Department of Medicine, Department of Disease Control, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, 11000, Nonthaburi, Thailand
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Murudi-Manganye NS, Makhado L, Sehularo LA. A Conceptual Model to Strengthen Integrated Management of HIV and NCDs among NIMART-Trained Nurses in Limpopo Province, South Africa. Clin Pract 2023; 13:410-421. [PMID: 36961062 PMCID: PMC10037621 DOI: 10.3390/clinpract13020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
Integrated management of human immune deficiency virus (HIV) and non-communicable diseases (NCDs) in primary health care facilities remains a challenge. Despite research that has been conducted in South Africa, it is evident that in Limpopo Province there are slits in the implementation thereof. There is a need to develop a conceptual model to guide in strengthening the clinical competence of nurse-initiated management of antiretroviral therapy (NIMART)-trained nurses to implement the integrated management of HIV and NCDs to improve clinical outcomes of patients with the dual burden of diseases in Limpopo Province, South Africa. This study aimed to develop a conceptual model to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses to improve clinical outcomes of patients with the dual burden of communicable and non-communicable diseases in Limpopo Province, South Africa. An explanatory, sequential, mixed-methods research design was followed. Data were collected from patient records and the skills audit of 25 Primary Health Care (PHC) facilities and from 28 NIMART trained nurses. Donabedian's structure process outcome model and Miller's pyramid of clinical competence provided a foundation in the development of the conceptual model. The study revealed a need to develop a conceptual model to strengthen the implementation of integrated HIV and NCDs implementation in PHC, as evidenced by differences in the management of HIV and NCDs. Conclusion: The study findings were conceptualised to describe and develop a model needed to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses working in PHC facilities. The study was limited to Limpopo Province; the model must be implemented in conjunction with the available frameworks to achieve better clinical outcomes.
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Affiliation(s)
| | - Lufuno Makhado
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Leepile Alfred Sehularo
- School of Nursing Science, Faculty of Health Sciences, North-West University, Potchefstroom 2531, South Africa
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Nagai M, Matsumoto S, Tanuma J, Nguyen DHT, Nguyen DT, Mizushima D, Oka S, Pham TN. Prevalence of and factors associated with diabetes mellitus among people living with HIV in Vietnam. Glob Health Med 2023; 5:15-22. [PMID: 36865893 PMCID: PMC9974227 DOI: 10.35772/ghm.2022.01061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
Studies have shown that people living with HIV (PLWH) have a higher risk of having non-communicable diseases (NCDs) than do people without HIV. In Vietnam, HIV remains a major public health concern, and with recent rapid economic growth, NCDs such as diabetes mellitus (DM) have become a significant disease burden. This cross-sectional study was conducted to examine the prevalence of DM and the factors associated with DM among PLWH on antiretroviral therapy (ART). In total, 1,212 PLWH were included in the study. The age-standardized prevalence of DM and pre-diabetes were 9.29% and 10.32%, respectively. In the multivariate logistic regression analysis, male sex, age above 50 years, and body mass index ≥ 25 kg/m2 were associated with DM, and borderline p-value was found for associations with current smoking and years on ART. The results suggest higher DM prevalence among PLWH and that longer time on ART could be an important risk factor for DM among PLWH. These findings also suggest that interventions such as weight control and smoking cessation support could be provided at outpatient clinics. Integration of HIV/AIDS and NCDs services is essential to address health needs comprehensively and enhance health-related quality of life for PLWH.
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Affiliation(s)
- Moeko Nagai
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan;,Address correspondence to:Moeko Nagai, AIDS Clinical Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo 162-8655, Japan. E-mail:
| | - Shoko Matsumoto
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | - Daisuke Mizushima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
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Talukder MR, Woodman R, Pham H, Wilson K, Gessain A, Kaldor J, Einsiedel L. High Human T-Cell Leukemia Virus Type 1c Proviral Loads Are Associated With Diabetes and Chronic Kidney Disease: Results of a Cross-Sectional Community Survey in Central Australia. Clin Infect Dis 2023; 76:e820-e826. [PMID: 35903021 DOI: 10.1093/cid/ciac614] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A link between chronic inflammation and several noncommunicable diseases (NCDs) has been established. Although chronic infection with the human T-cell leukemia virus type 1 (HTLV-1) is the recognized cause of several inflammatory diseases and these are associated with a high number of HTLV-1-infected cells in peripheral blood (proviral load [PVL]), possible interactions between PVL and NCDs have not been studied at a community level. METHODS Adult Aboriginal residents of 7 remote communities were invited to complete a health survey between 25 August 2014 and 30 June 2018. Blood was drawn for HTLV-1 serology and PVL, and relevant medical conditions were obtained from health records. Associations between HTLV-1 PVL and diabetes, chronic kidney disease (CKD), and coronary artery disease (CAD) were determined using logistic regression, adjusting for available confounders. RESULTS Among 510 participants (56% of the estimated adult resident population, 922), 197 (38.6%) were HTLV-1-infected. A high HTLV-1 PVL was associated with a 2-fold increase in the odds of diabetes and CKD (diabetes, adjusted odds ratio [aOR], 1.95; 95% confidence interval [CI], 1.06-3.61; P = .033 and CKD: aOR, 2.00; 95% CI, 1.03-3.8; P = .041). A nonsignificant association between high PVL and CAD (aOR, 7.08; 95% CI, 1.00-50.18; P = .05) was found for participants aged <50 years at the time of angiography. CONCLUSIONS In a community-based study in central Australia, people with HTLV-1 who had high HTLV-1 PVL were more likely to have diabetes and CKD. These findings have potential clinical implications.
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Affiliation(s)
- Mohammad Radwanur Talukder
- HTLV-1 Research, Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Richard Woodman
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Hai Pham
- HTLV-1 Research, Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Kim Wilson
- National Serology Reference Laboratory, Melbourne, Australia
| | - Antoine Gessain
- Oncogenic Virus Epidemiology and Pathophysiology (EPVO) Unit and Joint Research Unit (UMR) 3569 National Reference Centre (CNRS), Virology Department, Institut Pasteur, Paris, France
| | - John Kaldor
- Global Health Program, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Lloyd Einsiedel
- HTLV-1 Research, Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.,Department of Medicine, NT Health, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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Advanced HIV disease and health-related suffering-exploring the unmet need of palliative care. Lancet HIV 2023; 10:e126-e133. [PMID: 36427522 PMCID: PMC7614396 DOI: 10.1016/s2352-3018(22)00295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/24/2022]
Abstract
With more than 38 million people living with HIV worldwide, the scale-up of antiretroviral therapy ensures nearly 28 million of them receive regular treatment. However, a substantial number of deaths still occur every year from AIDS-related complications, with approximately 680 000 deaths in 2021. Of the estimated 56·8 million people globally in need of palliative care in 2020, only 7 million can access services. Providing palliative care services can help alleviate health-related suffering, such as pain and disease-related symptoms, and improve wellbeing. This Viewpoint discusses the unrealised potential of palliative care in individuals with advanced HIV disease. Key areas of training for health-care workers include appropriate sensitisation, training in palliative care, and effective communication. Advance care planning supports both the individual and their family and is therefore of crucial importance. Integration of palliative care in HIV programmes is needed to address health-related suffering, particularly for advanced HIV disease.
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Mulindwa F, Kamal H, Castelnuovo B, Byonanebye DM, Schwarz JM, Bollinger R, Brusselaers N. Association between integrase strand transfer inhibitor use with insulin resistance and incident diabetes mellitus in persons living with HIV: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2023; 11:11/1/e003136. [PMID: 36754450 PMCID: PMC9923267 DOI: 10.1136/bmjdrc-2022-003136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
Whether integrase strand transfer inhibitors (INSTIs) are associated with a higher risk of incident type 2 diabetes mellitus (DM) than other antiretroviral therapies (ART) needs to be established.MEDLINE, Embase, Web of Science, and ClinicalTrials.gov registries were searched for studies published between 1 January 2000 and 15 June 2022. Eligible studies reported incident DM or mean changes in insulin resistance measured by Homeostatic Model for Insulin Resistance (HOMA-IR) in patients on INSTIs compared with other ARTs. We performed random-effects meta-analyses to obtain pooled relative risks (RRs) with 95% CIs.A total of 16 studies were pooled: 13 studies meta-analyzed for incident diabetes with a patient population of 72 404 and 3 for changes in HOMA-IR. INSTI therapy was associated with a lower risk of incident diabetes in 13 studies (RR 0.80, 95% CI 0.67 to 0.96, I2=29%), of which 8 randomized controlled trials demonstrated a 22% reduced risk (RR 0.88, 95% CI 0.81 to 0.96, I2=0%). INSTIs had a lower risk compared with non-nucleoside reverse transcriptase inhibitors (RR 0.75, 95% CI 0.63 to 0.89, I2=0%) but similar to protease inhibitor-based therapy (RR 0.78, 95% CI 0.61 to 1.01, I2=27%). The risk was lower in studies with longer follow-up (RR 0.70, 95% CI 0.53 to 0.94, I2=24%) and among ART-naïve patients (RR 0.78, 95% CI 0.65 to 0.94, I2=3%) but increased in African populations (RR 2.99, 95% CI 2.53 to 3.54, I2=0%).In conclusion, exposure to INSTIs was not associated with increased risk of DM, except in the African population. Stratified analyses suggested reduced risk among ART-naïve patients and studies with longer follow-up.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42021273040.
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Affiliation(s)
- Frank Mulindwa
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
- Global Health Institute, University of Antwerp, Antwerpen, Belgium
| | - Habiba Kamal
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Barbara Castelnuovo
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Dathan M Byonanebye
- Biostatistics and Databases Program, Kirby Institute University of New South Wales, Sydney, New South Wales, Australia
- Community and Behavioral Sciences, Makerere University, Kampala, Uganda
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Robert Bollinger
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nele Brusselaers
- Global Health Institute, University of Antwerp, Antwerpen, Belgium
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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Mehmandoust M, Soylak M, Erk N. Innovative molecularly imprinted electrochemical sensor for the nanomolar detection of Tenofovir as an anti-HIV drug. Talanta 2023; 253:123991. [PMID: 36228557 DOI: 10.1016/j.talanta.2022.123991] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/30/2022] [Accepted: 10/02/2022] [Indexed: 11/23/2022]
Abstract
Tenofovir (TNF) is an antiviral medicine that is utilized to treat the human immunodeficiency virus (HIV). However, its level must be controlled in the human body and environment at the risk of causing kidney and liver problems. Therefore, determining TNF concentration in real samples with more advanced, inexpensive, and accurate sensing systems is essential. In this work, a novel electrochemical nanosensor for TNF determination based on molecularly imprinted polymer (MIP) on the screen-printed electrode modified with functionalized multi-walled carbon nanotubes, graphite carbon nitride, and platinum nanoparticles (MIP-Pt@g-C3N4/F-MWCNT/SPE) was constructed through the electro-polymerization approach. The molecularly imprinted polymers were prepared on the electrode surface with TNF as the template molecule and 2-aminophenol (2-AP) as the functional monomer. Moreover, factors that affect sensor response were optimized. Pt@g-C3N4/F-MWCNT nanocomposite had an excellent synergistic effect on MIP, allowing rapid and specific identification of the test substance. The results demonstrated that the electro-polymerization of 2-AP supplies large amounts of functional groups for the binding of the template molecules, which remarkably enhances the sensitivity and specific surface area of the MIP sensor. This surface enlargement increased the analyte accessibility to imprinted molecular cavities. Under optimum conditions, the oxidation peak current had a linear relationship with TNF concentration ranging from 0.005 to 0.69 μM with a low detection limit of 0.0030 μM (S/N = 3). The results demonstrated that the designed MIP sensor possesses acceptable sensitivity, repeatability, and reproducibility toward TNF determination. Moreover, the developed sensor was applied to biological and water samples to determine TNF, and satisfactory recovery results of 95.6-104.8% were obtained (RSD less than 10.0%). We confirm that combining as-synthesized nanocomposite Pt@g-C3N4/F-MWCNT with MIP improves the limitations of MIP-based nanosensors. The proposed electrode is also compatible with portable potentiostats, allowing on-site measurements and showing tremendous promise as a point-of-care (POC) diagnostic platform.
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Affiliation(s)
- Mohammad Mehmandoust
- Ankara University, Faculty of Pharmacy, Department of Analytical Chemistry, Ankara, Turkey
| | - Mustafa Soylak
- Erciyes University, Faculty of Sciences, Department of Chemistry, 38039, Kayseri, Turkey; Technology Research & Application Center (TAUM), Erciyes University, 38039, Kayseri, Turkey; Turkish Academy of Sciences (TUBA), Cankaya, Ankara, Turkey
| | - Nevin Erk
- Ankara University, Faculty of Pharmacy, Department of Analytical Chemistry, Ankara, Turkey.
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Roomaney RA, van Wyk B, Cois A, Pillay van-Wyk V. Multimorbidity patterns in South Africa: A latent class analysis. Front Public Health 2023; 10:1082587. [PMID: 36711391 PMCID: PMC9875075 DOI: 10.3389/fpubh.2022.1082587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction South Africa has the largest burden of HIV worldwide and has a growing burden of non-communicable diseases; the combination of which may lead to diseases clustering in ways that are not seen in other regions. This study sought to identify common disease classes and sociodemographic and lifestyle factors associated with each disease class. Methods Data were analyzed from the South African Demographic and Health Survey 2016. A latent class analysis (LCA) was conducted using nine disease conditions. Sociodemographic and behavioral factors associated with each disease cluster were explored. All analysis was conducted in Stata 15 and the LCA Stata plugin was used to conduct the latent class and regression analysis. Results Multimorbid participants were included (n = 2 368). Four disease classes were identified: (1) HIV, Hypertension and Anemia (comprising 39.4% of the multimorbid population), (2) Anemia and Hypertension (23.7%), (3) Cardiovascular-related (19.9%) and (4) Diabetes and Hypertension (17.0%). Age, sex, and lifestyle risk factors were associated with class membership. In terms of age, with older adults were less likely to belong to the first class (HIV, Hypertension and Anemia). Males were more likely to belong to Class 2 (Anemia and Hypertension) and Class 4 (Diabetes and Hypertension). In terms of alcohol consumption, those that consumed alcohol were less likely to belong to Class 4 (Diabetes and Hypertension). Current smokers were more likely to belong to Class 3 (Cardiovascular-related). People with a higher body mass index tended to belong to Class 3 (Cardiovascular-related) or the Class 4 (Diabetes and Hypertension). Conclusion This study affirmed that integrated care is urgently needed, evidenced by the largest disease class being an overlap of chronic infectious diseases and non-communicable diseases. This study also highlighted the need for hypertension to be addressed. Tackling the risk factors associated with hypertension could avert an epidemic of multimorbidity.
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Affiliation(s)
- Rifqah Abeeda Roomaney
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa,School of Public Health, University of the Western Cape, Cape Town, South Africa,*Correspondence: Rifqah Abeeda Roomaney ✉
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Annibale Cois
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa,Division of Health Systems and Public Health, Department of Global Health, University of Stellenbosch, Stellenbosch, South Africa
| | - Victoria Pillay van-Wyk
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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Qian Z, Li B, Liao L, Liao G, Chen H, Han J, Yu T, Xu X, Peng J, Cai S. Loneliness as a mediation from social support leading to a decrease of health-related quality of life among PLWHIV. Front Public Health 2023; 10:1067870. [PMID: 36684920 PMCID: PMC9846772 DOI: 10.3389/fpubh.2022.1067870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/01/2022] [Indexed: 01/06/2023] Open
Abstract
This study focused on the mental health of people living with HIV(PLWHIV) and explored their relationship between loneliness and perceived social support, health related quality of life (HRQoL) with a method of structural equation model. We collected clinical and psychological data from consecutively enrolled PLWHIV. A total of 201 PLWHIVs were enrolled and measured with self-reporting survey instruments of UCLA Loneliness Scale, Self-Rating Depression Scale, Self-Rating Anxiety Scale, Social Support Ratio Scale and Short Form Health Survey-36. The levels of loneliness, depression, anxiety, perceived social support and HRQoL were assessed. PLWHIV enrolled were divided into two groups of loneliness and non-loneliness based on their UCLA Loneliness Scale scores. Multivariable analysis indicated that being married is a protective factor associated with loneliness (OR = 0.226; P = 0.032). We further found the loneliness group had a higher level of depression (P < 0.001) and anxiety (P < 0.001), but lower level of HRQoL (P < 0.001) than the non-loneliness group. We found there was a positive linear correlation between social support and HRQoL among the enrolled PLWHIVs (r2 = 0.0592; P = 0.0005). A structural equation model (SEM) was established to evaluate whether the loneliness played as a mediation role between social support and HRQoL. The model showed loneliness as a mediation from social support leading to a decrease of HRQoL. Our findings showed a potential psychological pathway from social support to HRQoL, suggesting the need for interventions focusing on social support may improve poor HRQoL lead by loneliness.
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Affiliation(s)
- Zhe Qian
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bing Li
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Leyi Liao
- Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Guichan Liao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongjie Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | - Tao Yu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuwen Xu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shaohang Cai
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Kamkuemah M, Gausi B, Oni T, Middelkoop K. Multilevel correlates of abdominal obesity in adolescents and youth living with HIV in peri-urban Cape Town, South Africa. PLoS One 2023; 18:e0266637. [PMID: 36693111 PMCID: PMC9873196 DOI: 10.1371/journal.pone.0266637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Chronic non-communicable disease comorbidities are a major problem faced by people living with HIV (PLHIV). Obesity is an important factor contributing to such comorbidities and PLHIV face an elevated risk of obesity. However, there is data paucity on the intersection of obesity and HIV in adolescents and youth living with HIV (AYLHIV) in sub-Saharan Africa. We therefore aimed to investigate the prevalence of abdominal obesity and associated multilevel factors in AYLHIV in peri-urban Cape Town, South Africa. METHODS We conducted a cross-sectional study enrolling AYLHIV aged 15-24 years attending primary healthcare facilities in peri-urban Cape Town in 2019. All measures, except for physical examination measures, were obtained via self-report using a self-administered electronic form. Our outcome of interest was abdominal obesity (waist-to-height ratio ≥ 0.5). We collected individual-level data and data on community, built and food environment factors. Data was summarized using descriptive statistics, stratified by obesity status. Multilevel logistic regression was conducted to investigate factors associated with abdominal obesity, adjusted for sex and age. FINDINGS A total of 87 participants were interviewed, 76% were female and the median age was 20.7 (IQR 18.9-23.0) years. More than two fifths had abdominal obesity (41%; 95% CI: 31.0-51.7%), compared to published rates for young people in the general population (13.7-22.1%). In multilevel models, skipping breakfast (aOR = 5.42; 95% CI: 1.32-22.25) was associated with higher odds of abdominal obesity, while daily wholegrain consumption (aOR = 0.20; 95% CI: 0.05-0.71) and weekly physical activity (aOR = 0.24; 95% CI: 0.06-0.92) were associated with lower odds of abdominal obesity. Higher anticipated stigma was associated with reduced odds of obesity (aOR = 0.58; 95% CI: 0.33-1.00). Land-use mix diversity (aOR = 0.52; 95% CI: 0.27-0.97), access to recreational places (aOR = 0.37; 95% CI: 0.18-0.74), higher perceived pedestrian and traffic safety (aOR = 0.20; 95% CI: 0.05-0.80) and having a non-fast-food restaurant within walking distance (aOR = 0.30; 95% CI: 0.10-0.93) were associated with reduced odds of abdominal obesity. The main limitations of the study were low statistical power and possible reporting bias from self-report measures. CONCLUSIONS Our findings demonstrate a high prevalence of abdominal obesity and highlight multilevel correlates of obesity in AYLHIV in South Africa. An intersectoral approach to obesity prevention, intervening at multiple levels is necessary to intervene at this critical life stage.
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Affiliation(s)
- Monika Kamkuemah
- Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Blessings Gausi
- Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tolu Oni
- Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease & Molecular Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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ADEBAJO SB, ADEBIYI R, CHAMA J, BELLO S, ONONAKU U, AKA A, LAI S, BARAL SD, DYER TV, CROWELL TA, NOWAK RG, CHARURAT M. Depression and Sexual Stigma Are Associated With Cardiometabolic Risk Among Sexual and Gender Minorities Living With HIV in Nigeria. J Acquir Immune Defic Syndr 2023; 92:50-58. [PMID: 36150037 PMCID: PMC9742173 DOI: 10.1097/qai.0000000000003096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND People living with HIV are vulnerable to cardiometabolic diseases. We assessed the prevalence of cardiometabolic risk factors (CMRF) and associations with sexual stigma and depression among sexual and gender minorities (SGM) in Abuja and Lagos, Nigeria. METHODS The TRUST/RV368 study enrolled SGM between March 2013 and February 2020. Participants were assessed for depression, sexual stigma, and CMRF. Robust multinomial logistic regression was used to estimate adjusted odds ratio (aORs) and 95% confidence intervals (CIs) for associations of depression, sexual stigma, and other factors with increasing numbers of CMRF. RESULTS Among 761 SGM, the mean age was 25.0 ± 6.0 years; 580 (76%) identified as cisgender men, 641 (84%) had ≥1 CMRF, 355 (47%) had mild-severe depression, and 405 (53%) reported moderate-high sexual stigma. Compared with individuals without depression, those with mild (aOR 8.28; 95% CI: 4.18 to 16.40) or moderate-severe depression (aOR 41.69; 95% CI: 9.60 to 181.04) were more likely to have 3-5 CMRF. Individuals with medium (aOR 3.17; 95% CI: 1.79 to 5.61) and high sexual stigma (aOR 14.42; 95% CI: 2.88 to 72.29) compared with those with low sexual stigma were more likely to have 3-5 CMRF. Participants age 25-34 years were less likely to have 3-5 CMRF (aOR 0.41; 95% CI: 0.23 to 0.73) compared with participants age younger than 25 years. CONCLUSION CMRF increased with severity of depression and sexual stigma, potentially predisposing SGM living with HIV to cardiometabolic diseases. Integrating interventions that address depression and sexual stigma in HIV care programs for SGM may improve cardiometabolic outcomes.
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Affiliation(s)
- Sylvia B ADEBAJO
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | - Ruxton ADEBIYI
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | - John CHAMA
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | - Segun BELLO
- Center for International Health Education Biosecurity – University of Maryland Baltimore, Abuja, Nigeria
| | | | - Abayomi AKA
- International Centre for Advocacy on Right to Health - ICARH, Abuja, Nigeria
| | - Shenghan LAI
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stefan D. BARAL
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Typhanye V. DYER
- University of Maryland School of Public Health, College Park, MD, USA
| | - Trevor A. CROWELL
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rebecca G. NOWAK
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Man CHARURAT
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
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Kafu C, Wachira J, Omodi V, Said J, Pastakia SD, Tran DN, Onyango JA, Aburi D, Wilson-Barthes M, Galárraga O, Genberg BL. Integrating community-based HIV and non-communicable disease care with microfinance groups: a feasibility study in Western Kenya. Pilot Feasibility Stud 2022; 8:266. [PMID: 36578093 PMCID: PMC9795156 DOI: 10.1186/s40814-022-01218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Harambee study is a cluster randomized trial in Western Kenya that tests the effect, mechanisms, and cost-effectiveness of integrating community-based HIV and non-communicable disease care within microfinance groups on chronic disease treatment outcomes. This paper documents the stages of our feasibility study conducted in preparation for the Harambee trial, which include (1) characterizing the target population and gauging recruitment capacity, (2) determining community acceptability of the integrated intervention and study procedures, and (3) identifying key implementation considerations prior to study start. METHODS Feasibility research took place between November 2019 and February 2020 in Western Kenya. Mixed methods data collection included surveys administered to 115 leaders of 105 community-based microfinance groups, 7 in-person meetings and two workshops with stakeholders from multiple sectors of the health system, and ascertainment of field notes and geographic coordinates for group meeting locations and HIV healthcare facilities. Quantitative survey data were analyzed using STATA IC/13. Longitude and latitude coordinates were mapped to county boundaries using Esri ArcMap. Qualitative data obtained from stakeholder meetings and field notes were analyzed thematically. RESULTS Of the 105 surveyed microfinance groups, 77 met eligibility criteria. Eligible groups had been in existence from 6 months to 18 years and had an average of 22 members. The majority (64%) of groups had at least one member who owned a smartphone. The definition of "active" membership and model of saving and lending differed across groups. Stakeholders perceived the community-based intervention and trial procedures to be acceptable given the minimal risks to participants and the potential to improve HIV treatment outcomes while facilitating care integration. Potential challenges identified by stakeholders included possible conflicts between the trial and existing community-based interventions, fear of group disintegration prior to trial end, clinicians' inability to draw blood for viral load testing in the community, and deviations from standard care protocols. CONCLUSIONS This study revealed that it was feasible to recruit the number of microfinance groups necessary to ensure that our clinical trial was sufficient powered. Elicitation of stakeholder feedback confirmed that the planned intervention was largely acceptable and was critical to identifying challenges prior to implementation. TRIAL REGISTRATION The original trial was prospectively registered with ClinicalTrials.gov (NCT04417127) on 4 June 2020.
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Affiliation(s)
- Catherine Kafu
- Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya. .,School of Literature, Language and Media, Department of Media Studies, University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa.
| | - Juddy Wachira
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256School of Medicine, Department of Behavioral Science, Moi University College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - Victor Omodi
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya
| | - Jamil Said
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256School of Medicine, Department of Human Anatomy, Moi University College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - Sonak D. Pastakia
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.169077.e0000 0004 1937 2197Center for Health Equity and Innovation, Purdue University College of Pharmacy, 640 Eskenazi Ave, Indianapolis, IN 46202 USA
| | - Dan N. Tran
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya ,grid.264727.20000 0001 2248 3398Department of Pharmacy Practice, Temple University School of Pharmacy, 3307 N Broad St, Philadelphia, PA 19140 USA
| | - Jael Adongo Onyango
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya
| | - Dan Aburi
- grid.512535.50000 0004 4687 6948Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya
| | - Marta Wilson-Barthes
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912 USA
| | - Omar Galárraga
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912 USA
| | - Becky Lynn Genberg
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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Minchella PA, Chanda D, Hines JZ, Fwoloshi S, Itoh M, Kampamba D, Chirwa R, Sivile S, Zyambo KD, Agolory S, Mulenga LB. Clinical Characteristics and Outcomes of Patients Hospitalized With COVID-19 During the First 4 Waves in Zambia. JAMA Netw Open 2022; 5:e2246152. [PMID: 36512359 PMCID: PMC9856263 DOI: 10.1001/jamanetworkopen.2022.46152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Few epidemiologic studies related to COVID-19 have emerged from countries in Africa, where demographic characteristics, epidemiology, and health system capacity differ from other parts of the world. OBJECTIVES To describe the characteristics and outcomes of patients admitted to COVID-19 treatment centers, assess risk factors for in-hospital death, and explore how treatment center admissions were affected by COVID-19 waves in Zambia. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study assessed patients admitted to COVID-19 treatment centers in 5 Zambian cities between March 1, 2020, and February 28, 2022. EXPOSURES Risk factors for in-hospital mortality, including patient age and severity of COVID-19, at treatment center admission. MAIN OUTCOMES AND MEASURES Patient information was collected, including inpatient disposition (discharged or died). Differences across and within COVID-19 waves were assessed. Mixed-effects logistic regression models were used to assess associations between risk factors and in-hospital mortality as well as between characteristics of admitted patients and timing of admission. RESULTS A total of 3876 patients were admitted during 4 COVID-19 waves (mean [SD] age, 50.6 [19.5] years; 2103 male [54.3%]). Compared with the first 3 waves (pooled), the proportion of patients who were 60 years or older admitted during wave 4, when the Omicron variant was circulating, was significantly lower (250 of 1009 [24.8%] vs 1116 of 2837 [39.3%]; P < .001). Factors associated with in-hospital mortality included older age (≥60 vs <30 years; adjusted odds ratio [aOR], 3.55; 95% CI, 2.34-5.52) and HIV infection (aOR, 1.39; 95% CI, 1.07-1.79). Within waves, patients who were admitted during weeks 5 to 9 had significantly higher odds of being 60 years or older (aOR, 2.09; 95% CI, 1.79-2.45) or having severe COVID-19 at admission (aOR, 2.49; 95% CI, 2.14-2.90) than those admitted during the first 4 weeks. CONCLUSIONS AND RELEVANCE The characteristics of admitted patients during the Omicron wave and risk factors for in-hospital mortality in Zambia reflect data reported elsewhere. Within-wave analyses revealed a pattern in which it appeared that admission of higher-risk patients was prioritized during periods when there were surges in demand for health services during COVID-19 waves. These findings support the need to expand health system capacity and improve health system resiliency in Zambia and other countries with resource-limited health systems.
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Affiliation(s)
| | | | - Jonas Z. Hines
- Centers for Disease Control and Prevention–Zambia, Lusaka, Zambia
| | | | - Megumi Itoh
- Centers for Disease Control and Prevention–Zambia, Lusaka, Zambia
| | | | | | | | | | - Simon Agolory
- Centers for Disease Control and Prevention–Zambia, Lusaka, Zambia
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Hertz JT, Prattipati S, Kweka GL, Mlangi JJ, Tarimo TG, Mmbaga BT, Thielman NM, Sakita FM, Rubach MP, Bloomfield GS, Manavalan P. Prevalence and predictors of uncontrolled hypertension, diabetes, and obesity among adults with HIV in northern Tanzania. Glob Public Health 2022; 17:3747-3759. [PMID: 35282776 PMCID: PMC9468185 DOI: 10.1080/17441692.2022.2049344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/19/2022] [Indexed: 02/06/2023]
Abstract
HIV is associated with increased risk of cardiovascular disease, but there has been less study of cardiovascular comorbidities among people with HIV in sub-Saharan Africa. In a cross-sectional observational study, Tanzanian adults presenting for outpatient HIV care completed a questionnaire and underwent weight, height, blood pressure, and blood glucose measurement. Hypertension was defined by blood pressure ≥140/90 mmHg or self-reported hypertension. Uncontrolled hypertension was defined as measured blood pressure ≥140/90 mmHg. Diabetes was defined by fasting glucose ≥126 mg/dl, random glucose ≥200 mg/dl, or self-reported diabetes. Obesity was defined by body mass index ≥30 kg/m2. Multivariate logistic regression was performed to identify predictors of uncontrolled hypertension. Among 500 participants, 173 (34.6%) had hypertension, 21 (4.2%) had diabetes, and 99 (19.8%) were obese. Of those with hypertension, 116 (67.1%) were unaware of their hypertension, and 155 (89.6%) had uncontrolled hypertension. In multivariate analysis, uncontrolled hypertension was associated with older age (OR 1.07, 95% CI: 1.05-1.10, p < 0.001) and higher body mass index (OR 1.17, 95% CI: 1.11-1.22, p < 0.001). Interventions are needed to improve screening and treatment for hypertension, diabetes, and obesity among Tanzanians with HIV.
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Affiliation(s)
- Julian T Hertz
- Duke University School of Medicine, Durham, NC
- Duke Global Health Institute, Durham, NC
| | | | | | | | | | - Blandina T Mmbaga
- Kilimanjaro Christian Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Nathan M Thielman
- Duke University School of Medicine, Durham, NC
- Duke Global Health Institute, Durham, NC
| | - Francis M Sakita
- Kilimanjaro Christian Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Matthew P Rubach
- Duke University School of Medicine, Durham, NC
- Duke Global Health Institute, Durham, NC
| | - Gerald S Bloomfield
- Duke University School of Medicine, Durham, NC
- Duke Global Health Institute, Durham, NC
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Ndlazi GJ, Hanley S, Maddocks ST, Chetty V. Perceptions of women enrolled in a cardiovascular disease screening and prevention in HIV study. S Afr Fam Pract (2004) 2022. [DOI: 10.4102/safp.v64i1.5554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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