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Johnson LCM, Khan SH, Ali MK, Galaviz KI, Waseem F, Ordóñez CE, Siedner MJ, Nyatela A, Marconi VC, Lalla-Edward ST. Understanding barriers and facilitators to integrated HIV and hypertension care in South Africa. Implement Sci Commun 2024; 5:87. [PMID: 39090730 PMCID: PMC11295645 DOI: 10.1186/s43058-024-00625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/27/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The burden of hypertension among people with HIV is high, particularly in low-and middle-income countries, yet gaps in hypertension screening and care in these settings persist. This study aimed to identify facilitators of and barriers to hypertension screening, treatment, and management among people with HIV in primary care clinics in Johannesburg, South Africa. Additionally, different stakeholder groups were included to identify discordant perceptions. METHODS Using a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by COM-B and the Theoretical Domains Framework were used to identify and compare determinants of hypertension care across stakeholder groups. RESULTS Data from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic's logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) and patients' knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care. CONCLUSIONS The convergence of multi-stakeholder data highlight key areas for improvement, where tailored implementation strategies targeting motivations of clinic staff and capacity of patients may address challenges to hypertension screening, treatment, and management recognized across groups.
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Affiliation(s)
- Leslie C M Johnson
- Department of Family and Preventive Medicine, School of Medicine, Emory University, 1518 Clifton Rd, 30322, Atlanta, GA, USA.
| | - Suha H Khan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, 30322, Atlanta, GA, USA
| | - Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, 1518 Clifton Rd, 30322, Atlanta, GA, USA
| | - Karla I Galaviz
- Applied Health Science, School of Public Health-Bloomington, Indiana University, 1025 E. Seventh Street, Suite 111, Bloomington, IN, 47405, USA
| | - Fatima Waseem
- Center for the Study of Human Health, College of Arts and Sciences, Emory University, 1518 Clifton Rd, 30322, Atlanta, GA, USA
| | - Claudia E Ordóñez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, 30322, Atlanta, GA, USA
| | - Mark J Siedner
- Harvard Medical School, Harvard University , Africa Health Research Institute, 55 Fruit St, Boston, MA, 02114, USA
| | - Athini Nyatela
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Emory University, 1518 Clifton Rd, 30322, Atlanta, GA, USA
| | - Samanta T Lalla-Edward
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Bune GT. Low-level physical activity predictors among adults living with HIV in Ethiopia's southern region, focusing on work, transportation, and recreation domains: unmatched case-control study. BMC Sports Sci Med Rehabil 2024; 16:78. [PMID: 38570812 PMCID: PMC10993537 DOI: 10.1186/s13102-024-00860-2] [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: 08/22/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Low-level physical activity (LLPA) is crucial for the well-being of adults living with HIV (PLWHs). However, many do not engage in enough physical activity, leading to adverse health outcomes. Identifying the determinants of LLPA can aid in developing effective interventions. Despite this, Ethiopia lacks evidence on this topic. This study aimed to identify predictors of LLPA among PLWHs in the Gedeo zone, located in southern Ethiopia. METHODS An unmatched case-control study was conducted on PLWHs in the Gedeo zone who visited two hospitals and healthcare institutions between December 29th, 2017 and January 22nd, 2019. Respondents were classified into three categories based on their total physical activity levels: high, moderate, and low. Cases were defined as those meeting the criteria for LLPA, while controls were those who did not fall under the cases category. Data was collected using the WHO Stepwise surveillance tool and analyzed using Epidata v3.1 templates and SPSS v22. Predictor variables with a P-value < 0.25 in bivariable analysis and < 0.05 with a 95% confidence interval in multivariable analysis were selected. RESULTS The study involved 633 HIV-positive adults, with a response rate of 92.41%. Most participants were under 34 years old, with an average age of 36.47±(9.055) for cases and 36.38±(8.389) for controls. The multivariable analysis revealed that educational status (AOR = 4.85, P = 0.02, 95%CI (1.28-18.44)), sex (AOR = 0.24, P = 0.04, 95%CI (0.07-0.90)), duration on ART being exposed for 1-4 Years (AOR = 0.12, P < 0.001, 95%CI (0.03-0.44)) and being exposed for 5-9 Years (AOR = 0.03, P < 0.001, 95%CI (0.01-0.16)), and former alcohol use (AOR = 0.11, P < 0.01, 95%CI (0.02-0.56) were significant predictors of LLPA performance. CONCLUSIONS The study concluded that educational status, sex, ART duration, and past alcohol use are key determinants of LLPA performance among PLWHs in southern Ethiopia. This suggests that policymakers should implement public health campaigns to promote healthy habits, particularly low-level physical activity, among PLWHs.
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Affiliation(s)
- Girma Tenkolu Bune
- School of Public Health (SPH), College of Medicine and Health Science (CMH), Dilla University (DU), Dilla, Ethiopia.
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Qin XM, Allan R, Park JY, Kim SH, Joo CH. Impact of exercise training and diet therapy on the physical fitness, quality of life, and immune response of people living with HIV/AIDS: a randomized controlled trial. BMC Public Health 2024; 24:730. [PMID: 38448851 PMCID: PMC10918898 DOI: 10.1186/s12889-024-17700-0] [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: 08/09/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Exercise and dietary nutrition are considered crucial in human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) treatment protocols and people living with HIV/AIDS (PLWHA) rehabilitation care. However, there is no well-studied research evaluating the effects of combined interventions on the fitness and immune systems of PLWHA. Therefore, this study aimed to analyze the effects of exercise and dietary intervention on physical fitness, quality of life and immune response in PLWHA. METHODS This was an experimental study, with a sample of 25 male PLWHA divided into two groups: the intervention group (IG: 12 participants) and the control group (CG: 13 participants). All participants have not had any exercise habits and nutritional supplements in the past six months. The participants in the IG completed 45 min of exercise (60-80% HRmax) 4 times per week for 4 weeks. The exercise was in the form of brisk walking or running. They were also given a nutritional dietary supplement 3 times a day for 4 weeks. The 13 individuals in the CG continued their normal daily life (physical activity and diet). The following parameters were evaluated before and after the intervention: body composition, physical fitness, immune response, quality of life (QoL), stress, dietary behavior, dietary habits, exercise motivation, and physical self-efficacy. RESULTS The significant changes were observed in burnout of stress variables and physical efficiency index (PEI) of physical fitness in the IG (p =.023). Moreover, in the saliva samples, sal-T levels significantly increased only after the intervention in the IG (p =.012). Additionally, regarding the analysis of the interaction (group × time), there was a significant improvement in the reaction speed (p =.001) and grip strength (left: p =.002, right: p =.030) and a significant difference in physical satisfaction in QoL (p =.001), stress burnout (p =.043), self-confidence in physical efficacy (p =.045), external display (p =.008), and fulfillment (p =.047) in exercise motivation. Moreover, the significant effect of the intervention on emotional eating in dietary behavior was shown in the comparison of the IG before and after intervention (p =.001) and in the comparison of the IG group with the CG after the experiment (p =.013). However, there was no significant effect of time or interaction between the condition and time on body composition. CONCLUSIONS In conclusion, exercise training and diet therapy caused changes in physical fitness and Sal-T levels, which had positive effects on the health promotion of PLWHA.
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Affiliation(s)
- Xin-Min Qin
- Department of Sport Science, Kangwon National University, 1 Gangwondaehakgil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea
- Department of Smart Health Science and Technology Convergence, Kangwon National University, 1 Gangwondaehakgil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea
| | - Robert Allan
- Research Centre for Applied Sport, University of Central Lancashire, Lancashire, UK
| | - Ji-Young Park
- Department of Sport Science, Kangwon National University, 1 Gangwondaehakgil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea
| | - Sung-Hoon Kim
- Department of Physical Education, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Chang-Hwa Joo
- Department of Sport Science, Kangwon National University, 1 Gangwondaehakgil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea.
- Department of Smart Health Science and Technology Convergence, Kangwon National University, 1 Gangwondaehakgil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea.
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Johnson LCM, Khan SH, Ali MK, Galaviz KI, Waseem F, Ordóñez CE, Siedner MJ, Nyatela A, Marconi VC, Lalla-Edward ST. Understanding Barriers and Facilitators to Integrated HIV and Hypertension Care in South Africa. RESEARCH SQUARE 2024:rs.3.rs-3885096. [PMID: 38352385 PMCID: PMC10862953 DOI: 10.21203/rs.3.rs-3885096/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background The burden of hypertension among people with HIV is high, particularly in low-and middle-income countries, yet gaps in hypertension screening and care in these settings persist. The objective of this study was to identify facilitators of and barriers to hypertension screening, treatment, and management among people with HIV seeking treatment in primary care clinics in Johannesburg, South Africa. Methods Using a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by the Theoretical Domains Framework was used to identify and compare determinants of hypertension care across different stakeholder groups. Results Data from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic's logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) the patients' knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care. Conclusions The convergence of multi-stakeholder data regarding barriers to hypertension screening, treatment, and management highlight key areas for improvement, where tailored implementation strategies may address challenges recognized by each stakeholder group.
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Wiechmann SL, Tejo AM, Inácio MVS, Mesas AE, Cabrera MAS. Prevalence of Frailty Phenotypes in Older People Living with HIV: A Cross-Sectional Study from Brazil. J Int Assoc Provid AIDS Care 2024; 23:23259582241241169. [PMID: 38715366 PMCID: PMC11078087 DOI: 10.1177/23259582241241169] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/23/2023] [Accepted: 03/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Frailty may affect people living with HIV (PLHIV) prematurely. Fried's frailty phenotype, composed of 5 criteria, is one of the most used instruments for its assessment. This study aimed to determine the prevalence of these criteria among PLHIV classified as prefrail and frail in Brazil. METHODS A cross-sectional study analyzed the prevalence of the Frailty Phenotype in Brazil with 670 individuals aged ≥ 50 years and undetectable viral load. RESULTS The prevalence of prefrail and frail individuals was 50.7% and 13.6%, respectively. A low level of physical activity was the most prevalent criterion (50.9%). Except for unintentional weight loss, all other criteria were more prevalent among individuals with lower education levels. All criteria were more prevalent among individuals of lower socioeconomic status than among those of moderate or high status (P < .05). CONCLUSIONS A low level of physical activity was the component that most contributed to PLHIV being considered prefrail or frail.
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Affiliation(s)
- Susana Lilian Wiechmann
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
| | - Alexandre Mestre Tejo
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
| | - Manuel Victor Silva Inácio
- Division of Infectious Diseases, Internal Medicine Department, Universidade Estadual de Londrina, Londrina, Brazil
| | - Arthur Eumann Mesas
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
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Tegene Y, Mengesha S, Kassa A, Toma A, Spigt M. Physical activity and survival in chronic comorbidity among adult HIV patients in Ethiopia: a prospective cohort study. BMC Infect Dis 2023; 23:666. [PMID: 37805463 PMCID: PMC10559655 DOI: 10.1186/s12879-023-08651-9] [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: 02/04/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Antiretroviral therapy enables people living with HIV to live long lives, and these advances have transformed HIV infection from an acute to a chronic disease. Many non-communicable diseases, including type 2 diabetes, heart disease, and stroke, are influenced by physical inactivity. Therefore, the aim of this study was to assess the level of physical activity and survival in chronic co-morbidity among adult people living with HIV in Ethiopia. METHODS An institution-based prospective cohort study of adult people living with HIV was conducted between 2019 and 2021. We included 422 people living with HIV at baseline. After the baseline visit, 364 patients without hypertension or diabetes, were followed up for two years. Nine trained nurses used a pre-tested, structured questionnaire to collect data during routine care consultations in three hospitals in southern Ethiopia. STATA version 15 was used to analyze the data. To estimate the survival probability of developing chronic comorbidities, a Kaplan-Meier survival curve was used. A Cox proportional hazards model was fitted to identify the predictors of the development of chronic comorbidities. RESULT In the current study, 39% of the participants were found to have a low level of physical activity. Those who had self-management skills to maintain physical activity (p = 0.023), considered physical activity an important aspect of their HIV management (p = 0.003), and regularly attended social support groups (p = 0.002) had significantly higher levels of physical activity. The risk of chronic comorbidity increased over time, with a rate of 10.83 chronic comorbidities per 1000 persons per month. Lack of regular exercise [AHR: 2.04; 95% CI: (1.03, 5.13)], low physical activity [AHR: 2.01; 95% CI: (1.03, 7.89)], BMI greater than 25 kg/m2 [AHR: 2.74; 95% CI: (1.31, 5.12)] and low fruit and vegetable intake [AHR = 2.57; 95% CI: (1.28, 6.49)] were all associated with the development of chronic comorbidity. CONCLUSION The prevalence of physical inactivity is high in the study population. A physical activity program for people living with HIV should be considered, and the promotion of self-management skills should be integrated into HIV care programs.
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Affiliation(s)
- Yadessa Tegene
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia.
| | - Selamawit Mengesha
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Andargachew Kassa
- School of Nursing, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Alemayehu Toma
- School of Medicine, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Mark Spigt
- School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Mabweazara SZ, Manne-Goehler J, Bibangambah P, Kim JH, Ruth S, Hemphill LC, Okello S, Hamer M, Siedner MJ. Correlates of physical activity among people living with and without HIV in rural Uganda. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1093298. [PMID: 37547804 PMCID: PMC10398393 DOI: 10.3389/frph.2023.1093298] [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: 11/08/2022] [Accepted: 06/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background Antiretroviral therapy (ART) has led to diminishing AIDS-related mortality but a concomitant increase in non-communicable diseases (NCDs) for people with HIV (PWH). Whereas physical activity (PA) has been shown to help prevent NCDs and NCD outcomes in other settings, there are few data on PA and its correlates among PWH in high-endemic settings. We aimed to compare PA by HIV serostatus in rural Uganda. Methods We analysed data from the UGANDAC study, an observational cohort including PWH in ambulatory HIV care in Mbarara, Uganda, and age- and gender-matched people without HIV (PWOH). Our primary outcome of interest was PA, which we assessed using the International Physical Activity Questionnaire and considered as a continuous measure of metabolic equivalents in minutes/week (MET-min/week). Our primary exposure of interest was HIV serostatus. We fit univariable and multivariable linear regression models to estimate the relationship between HIV and PA levels, with and without addition of sociodemographic and clinical correlates of PA (MET-min/week). In secondary analyses, we explored relationships restricted to rural residents, and interactions between gender and serostatus. Results We enrolled 309 participants, evenly divided by serostatus and gender. The mean age of PWH was 52 [standard deviation (SD) 7.2] and 52.6 (SD 7.3) for PWOH. In general, participants engaged in high levels of PA regardless of serostatus, with 81.2% (251/309) meeting criteria for high PA. However, PWOH reported higher mean levels of PA met-minutes/week than PWH (9,128 vs 7,152, p ≤ 0.001), and a greater proportion of PWOH (88.3%; 136/154) met the criteria for high PA compared to PWH (74.2%; 115/155). In adjusted models, lower levels of PA persisted among PWH (β = -1,734, 95% CI: -2,645, -824, p ≤ 0.001). Results were similar in a sensitivity analysis limited to people living in rural areas. Conclusion In a rural Ugandan cohort, PWOH had higher levels of PA than PWH. Interventions that encourage PA among PWH may have a role in improving NCD risk profiles among PWH in the region.
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Affiliation(s)
- Smart Z. Mabweazara
- Clinical Research Department, Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Jennifer Manne-Goehler
- Department of Medicine, Harvard Medical School, Boston MA, United States
- Department of Medicine Brigham and Women's Hospital Boston, MA, United States
| | - Prossy Bibangambah
- Faculties of Medicine and Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - June-Ho Kim
- Department of Medicine, Harvard Medical School, Boston MA, United States
- Ariadne Labs, Brigham and Women's Hospital, Boston, MA, United States
| | - Sentongo Ruth
- Faculties of Medicine and Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Linda C. Hemphill
- Department of Medicine, Harvard Medical School, Boston MA, United States
| | - Samson Okello
- Faculties of Medicine and Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Mark Hamer
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - Mark J. Siedner
- Clinical Research Department, Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Medicine, Harvard Medical School, Boston MA, United States
- Faculties of Medicine and Radiology, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Faculty of Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
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Sahel-Gozin N, Loutfy M, O'Brien KK. Exploring experiences engaging in exercise from the perspectives of women living with HIV: A qualitative study. PLoS One 2023; 18:e0286542. [PMID: 37267270 DOI: 10.1371/journal.pone.0286542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES To explore experiences engaging in exercise from the perspectives of women living with HIV, specifically, i) nature and extent of exercise, ii) components that characterize exercise experiences, iii) facilitators and barriers, and iv) strategies for uptake and sustainability of exercise. DESIGN Qualitative descriptive study involving online semi-structured interviews. RECRUITMENT We recruited women living with HIV from a specialty hospital, community-based organization, and medical clinic in Toronto, Canada. PARTICIPANTS Ten women living with HIV who may or may not have engaged in exercise. DATA COLLECTION Using a semi-structured interview guide, we asked participants to describe their experiences with, facilitators and barriers to, and strategies to facilitate uptake of exercise. We electronically administered a demographic questionnaire to describe personal, HIV and physical activity characteristics of participants. We conducted a descriptive thematic analysis with the interview data, and descriptive analysis (medians, frequencies, percentages) of questionnaire responses. RESULTS Women characterized their experiences with exercise with six intersecting components: (1) culture, (2) gender, (3) HIV-related stigma, (4) episodic nature of HIV, (5) sense of belonging, and (6) perceptions of exercise. Facilitators to exercise included: aspirations to achieve a healthy lifestyle, using exercise as a mental diversion, having an exercise companion, and receiving financial support from community-based organizations to facilitate engagement. Barriers to exercise included: limited resources (lack of mental-health support and fitness resources in the community), financial limitations, time and gym restrictions, and cold winter weather conditions. Strategies to facilitate uptake of exercise included: creating social interactions, provision of online exercise classes, raising awareness and education about exercise, and offering practical support. CONCLUSIONS Experiences with exercise among women living with HIV were characterized by intersecting personal and environmental contextual components. Results may help inform tailored implementation of exercise rehabilitation programs to enhance uptake of exercise and health outcomes among women living with HIV.
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Affiliation(s)
- Nora Sahel-Gozin
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelly K O'Brien
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON, Canada
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Tegene Y, Mengesha S, Putman E, Toma A, Spigt M. Development of Hypertension and Diabetes Mellitus, and Associated Factors, Among Adult HIV Patients in Ethiopia. HIV AIDS (Auckl) 2023; 15:41-51. [PMID: 36814681 PMCID: PMC9940654 DOI: 10.2147/hiv.s397511] [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: 11/14/2022] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Background Medical improvements and increased access to treatment have turned HIV from a highly fatal disease into a treatable and controllable disease. With the improvement in lifespan, HIV patients face increasing morbidity and mortality from chronic comorbidities (hypertension and diabetes mellitus). There is, nevertheless, a paucity of information on the scale of HIV noncommunicable disease comorbidity and its associated factors. This study aimed to investigate the incidence and predictors of chronic comorbidity in HIV patients in a resource-limited setting. Methods A prospective cohort study was conducted from 2019 to 2021. We included 520 HIV patients at baseline. Patients without hypertension or diabetes were followed for two years to determine the incidence of developing comorbidities. Nine trained nurses used a pre-tested structured questionnaire to collect data during routine care consultations in three hospitals in southern Ethiopia. To find predictors of these chronic comorbidities, a multivariable logistic regression analysis was used. Results After two years, 54 out of 377 participants, or 14%, had chronic comorbidity, which is defined as having diabetes and/or hypertension. Hypertension (12%) and diabetes (4%), respectively, were observed. When compared to those who were not overweight, the risk of developing chronic comorbidity was three times higher in overweight people [AOR = 3.45, 95% CI: (1.04, 11.45), P = 0.045]. Older participants were about 6 times more likely than younger participants to have chronic comorbidity [AOR = 4.93, 95% CI: (1.56, 15.57), P = 0.007]. Those who did not engage in regular physical activity were twice as likely to develop chronic comorbidity [AOR = 2.16, 95% CI: (1.09, 4.29), P = 0.027]. Conclusion The incidence of chronic comorbidity was high in the study population. Targeted screening for early signs of chronic comorbidity, nutritional counseling, and awareness creation in regular physical activity programs should be integrated into HIV care to prevent and control chronic comorbidity in resource-limited settings.
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Affiliation(s)
- Yadessa Tegene
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia,Correspondence: Yadessa Tegene, Master of Science in Nutrition, School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia, Email
| | - Selamawit Mengesha
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Erin Putman
- School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, Netherlands
| | - Alemayehu Toma
- School of Medicine, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Mark Spigt
- School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, Netherlands,General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Zou Y, Sun P, Zhang Y, Li Y. Physical Activities and Associated Factors Among HIV/AIDS Patients: A Questionnaire Survey. Patient Prefer Adherence 2022; 16:1703-1712. [PMID: 35898922 PMCID: PMC9309313 DOI: 10.2147/ppa.s360517] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/17/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose Regular physical activity is essential for maintaining health and improving people's overall quality of life living with HIV; improving metabolic side effects associated with taking highly active antiretroviral therapy (HAART). This study investigated physical activity levels and associated factors among HIV/AIDS patients. Patients and Methods A single-center, cross-sectional study was conducted from July to September 2021. A convenience sample of 377 HIV/AIDS patients was recruited from a medical center in Zhuhai, China. Data were collected through self-report questionnaires and patients' medical records. Results The average physical activity of HIV/AIDS patients was 1007.15±868.63 met-min/w; 53.8% of patients expressed medium-level activity, and 46.2% in low-level activity. Log-link gamma generalized linear model results showed that gender, T-CD4+ at the latest visit, self-efficacy, and perceived barriers were significant predictors of assessing physical activity levels. Conclusion Nearly half of HIV/AIDS patients have low levels of physical activity. In particular, women and patients with lower CD4 cells, lower self-efficacy, and more perceived barriers had lower levels of physical activity. More knowledge is needed on the causes of physical inactivity among people with HIV, and physical activity programs need to be developed for people living with HIV in developing countries.
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Affiliation(s)
- Youqing Zou
- Infectious Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Ping Sun
- Infectious Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - YanYan Zhang
- Infection Intensive Care Unit, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Ying Li
- Infectious Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China
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Nkinda L, Buberwa E, Memiah P, Ntagalinda A, George M, Msafiri F, Joachim A, Majigo M, Ramaiya K, Sunguya B. Impaired fasting glucose levels among perinatally HIV-infected adolescents and youths in Dar es Salaam, Tanzania. Front Endocrinol (Lausanne) 2022; 13:1045628. [PMID: 36561566 PMCID: PMC9763284 DOI: 10.3389/fendo.2022.1045628] [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: 09/15/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study assessed impaired fasting glucose and associated factors among perinatally HIV-infected adolescents and youths in Dar es salaam Tanzania. BACKGROUND Impaired fasting glucose is a marker of heightened risk for developing type 2 diabetes among perinatally HIV-infected individuals. Therefore, identifying individuals at this stage is crucial to enable early intervention. Therefore, we assessed impaired fasting glucose (IFG) and associated factors among perinatally HIV-infected population in Dar es salaam Tanzania. METHODS A cross-sectional study was conducted among 152 adolescents and youth attending HIV clinic at Muhimbili National Hospital and Infectious Disease Centre from July to August 2020. Fasting blood glucose (>8 hours) was measured using one-touch selects LifeScan, CA, USA. We also examined C-Reactive Protein and interleukin-6 inflammatory biomarkers in relation to impaired fasting glucose (IFG). Associations between categorical variables were explored using Chi-square, and poison regression with robust variance was used to calculate the prevalence ratios. RESULTS Of the 152 participants, the majority were male (n=83[54.6%]), and the median age was 15(14-18) years. Overweight or obesity was prevalent in 16.4%, while more than one in ten (13.2%) had high blood pressure (≥149/90mmHg). All participants were on antiretroviral therapy (ART); 46% had used medication for over ten years, and about one in three had poor medication adherence. Among the recruited participants, 29% had impaired fasting glucose. The odds of IFG were two times higher in males compared to females (PR, 2.07, 95% CI 1.19 -3.59 p=0.001). Moreover, we found with every increase of Interleukin 6 biomarker there was a 1.01 probability increase of impaired fasting glucose (PR, 1.01, 95% CI 1.00 - 1.02 p=0.003). CONCLUSION About one in three perinatally HIV-infected youths had impaired fasting glucose in Dar es Salaam, Tanzania, with males bearing the biggest brunt. Moreover, with every increase of 1.101 of the probability of having IFG increased. This calls for urgent measures to interrupt the progression to diabetes disease and prevent the dual burden of disease for this uniquely challenged population.
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Affiliation(s)
- Lilian Nkinda
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- *Correspondence: Lilian Nkinda,
| | - Eliud Buberwa
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Peter Memiah
- Division of Epidemiology and Prevention: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Alieth Ntagalinda
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martin George
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frank Msafiri
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Agricola Joachim
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mtebe Majigo
- Department of Microbiology an Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kaushik Ramaiya
- Department of Internal Medicine, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Department of Community Health, School of Public Health and Social Science, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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