HBV co-infection significantly impacted ART outcomes in this Tanzanian HIV-infected population. Further research is needed to confirm the potential beneficial effects of TDF on mortality in HIV/HBV co-infected individuals in these settings.

BackgroundIn Sub-Saharan Africa, epidemiological studies have reported an increasing burden of non-communicable diseases (NCD) among people living with HIV. NCD management can be feasibly integrated into HIV care; however, clinic readiness to provide NCD services in these settings should first be assessed and gaps in care identified.MethodsA cross-sectional survey conducted in July 2013 assessed the resources available for NCD care at 14 HIV clinics in Dar es Salaam, Tanzania. Survey items related to staff training, protocols, and resources for cardiovascular disease risk factor screening, management, and patient education.Results43 % of clinics reported treating patients with hypertension; however, only 21 % had a protocol for NCD management. ECHO International Health standards for essential clinical equipment were used to measure clinic readiness; 36 % met the standard for blood pressure cuffs, 14 % for glucometers. Available laboratory tests for NCD included blood glucose (88 %), urine dipsticks (78 %), and lipid panel (57 %). 21 % had a healthcare worker with NCD training. All facilities provided some form of patient education, but only 14 % included diabetes, 57 % tobacco cessation, and 64 % weight management.ConclusionsA number of gaps were identified in this sample of HIV clinics that currently limit the ability of Tanzanian healthcare workers to diagnose and manage NCD in the context of HIV care. Integrated NCD and HIV care may be successfully achieved in these settings with basic measures incorporated into existing infrastructures at minimal added expense, i.e., improving access to basic functioning equipment, introducing standardized treatment guidelines, and improving healthcare worker education.

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Background In sub-Saharan Africa, the burden of liver disease associated with chronic hepatitis B (HBV) and HIV is unknown. We characterized liver disease using aspartate aminotransferase-to-platelet ratio index (APRI) and FIB-4 in patients with HIV, HBV, and HIV/HBV co-infection in Tanzania. Methods Using a cross sectional design, we compared the prevalence of liver fibrosis in treatment-naive HIV mono-infected, HBV mono-infected, and HIV/HBV co-infected adults enrolled at Management and Development for Health (MDH)-supported HIV treatment clinics in Dar es Salaam, Tanzania. Risk factors associated with significant fibrosis (APRI>0.5 and FIB-4 >1.45) were examined. Results 267 HIV-infected, 165 HBV-infected and 63 HIV/HBV co-infected patients were analyzed [44% male, median age 37 (IQR 14), BMI 23 (7)]. APRI and FIB-4 were strongly correlated (r = 0.78, p = < .001, R2 0.61). Overall median APRI scores were low [HIV/HBV [0.36 (IQR 0.4)], HIV [0.23 (0.17)], HBV [0.29 (0.15)] (p <0.01)]. In multivariate analyses, HIV/HBV co-infection was associated with APRI >0.5 [HIV/HBV vs. HIV: OR 3.78 (95% CI 1.91, 7.50)], [HIV/HBV vs. HBV: OR 2.61 (1.26, 5.44)]. HIV RNA per 1 log10 copies/ml increase [OR 1.53 (95% CI 1.04, 2.26)] and HBV DNA per 1 log10 copies/ml increase [OR 1.36 (1.15, 1.62)] were independently associated with APRI >0.5 in HIV-infected and HBV-infected patients, respectively. Conclusions HIV/HBV co-infection is an important risk factor for significant fibrosis. Higher levels of circulating HIV and HBV virus may play a direct role in liver fibrogenesis. Prompt diagnosis and aggressive monitoring of liver disease in HIV/HBV co-infection is warranted.