High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

Abstract

Introduction People Living with HIV (PLHIV) bear a disproportionate burden of non-communicable diseases (NCDs). Despite their significant toll across populations globally, the NCD burden among key populations (KP) in Kenya remains unknown. The burden of four NCD-categories (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) was evaluated among female sex workers (FSWs) and men who have sex with men (MSM) at the Sex Workers Outreach Program (SWOP) clinics in Nairobi Kenya. Methods A retrospective medical chart review was conducted at the SWOP clinics among KP clients �15 years living with HIV enrolled between October 1, 2012 and September 30, 2015. The prevalence of the four NCD-categories were assessed at enrollment and during subsequent routine quarterly follow-up care visits as per the Ministry of Health guidelines. Prevalence at enrollment was determined and distributions of co-morbidities assessed using Chi-square and t-tests as appropriate during follow-up visits. Univariate and multivariate analysis were conducted to identify factors associated with NCD diagnoses. Results Overall, 1,478 individuals' records were analyzed; 1,392 (94.2%) were from FSWs while 86 (5.8%) were from MSM over the three-year period. FSWs' median age was 35.3 years (interquartile range (IQR) 30.1-41.6) while MSM were younger at 26.8 years (IQR 23.2-32.1). At enrollment into the HIV care program, most KPs (86.6%) were at an early WHO clinical stage (stage I-II) and 1462 (98.9%) were on first-line anti-retroviral therapy (ART). A total of 271, 18.3% (95% CI: 16.4-20.4%), KPs living with HIV had an NCD diagnosis in

Incidence of non-communicable diseases (NCDs) in HIV patients on ART in a developing country: Case of Zimbabwe’s Chitungwiza Central Hospital—A retrospective cohort study (2010–2019)

“…One of the least prevalent NCDs was cancer in the scoping review by Mudie et al [11], a result which was also confirmed by this study. Despite the cancer incidence and prevalence being reported as low in our study and in other studies, it must be given equally high priority in management because of the difficulty in managing the condition and the high fatality rates associated with cancer [2][3][4][5].…”

“…Chitungwiza has a high prevalence of hypertension and diabetes in PLHIV and therefore there is a need for a multiple stakeholder approach to managing these NCDs [3,4,6,15]. Despite the relatively lower prevalence and incidence in cancer and cardiovascular diseases, there is a need for the Zimbabwean government to increase resources and efforts in managing cancer in the population living with HIV and AIDS [3,4].…”

“…The persistent HIV burden predisposes HIV positive patients to NCDs due to persistent inflammation [2]. Moreover, behavioral risk factors such as tobacco smoking and alcohol use, and occupational hazards also increase the chances of PLHIV developing NCDs [3,4].…”

Women living with HIV, diabetes and/or hypertension multi-morbidity in Uganda: a qualitative exploration of experiences accessing an integrated care service

“…The negative impacts of these conditions are notably more severe within vulnerable and poor populations, especially people living with HIV (PLHIV) and with women disproportionately affected by HIV and NCDs, particularly diabetes and hypertension (Ibrahim and Damasceno, 2012;McCombe et al, 2021;UNAIDS, 2021;Cheza et al, 2021). For example in Kenya, PLHIV have a high prevalence of NCD diagnoses (Achwoka et al, 2019), particularly concentrated in key populations living with HIV (which include female sex workers) (Achwoka et al, 2020). NCDs are also the leading cause of both death and disability-adjusted life years for women older than 50 years in sub-Saharan Africa (IHME, 2017;NCD Alliance, 2022).…”

Causes of mortality among female sex workers: Results of a multi-country study

“…For example, in some African countries, up to 55% of FSW are infected with HIV, while in Kenya, 17·0% of FSW had a diagnosed cardiovascular disease. 2 , 3 In addition, many FSW are at risk for physical and sexual violence; among FSW in Côte d'Ivoire, the prevalence of physical and sexual abuse was 53·6% and 43·2%, respectively. 4 , 5 , 6 FSW also experience substance use disorders, which can increase their risk for other health problems such as hepatitis C infection, overdoses, and other related health problems.…”