Magnitude and risk factors of non-communicable diseases among people living with HIV in Tanzania: a cross sectional study from Mbeya and Dar es Salaam regions

Kagaruki, Gibson B.; Mayige, Mary; Ngadaya, Esther; Kimaro, Godfather; Kalinga, Akili; Kilale, Andrew M.; Kahwa, Amos; Materu, Godlisten S.; Mfinanga, Sayoki

doi:10.1186/1471-2458-14-904

Cited by 85 publications

(123 citation statements)

References 29 publications

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“…After screening, 20 articles met the eligibility criteria [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and were included in the analysis (figure 1). Of these, seven 17-23 articles reported incidence of T2DM in HIV-infected participants, eight 24-31 reported prevalence of T2DM in HIV-infected participants compared with uninfected controls and five 32-36 reported prevalence of T2DM in HIV-infected participants on treatment compared with untreated controls.…”

Section: Resultsmentioning

confidence: 99%

Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

et al. 2017

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ObjectivesThis systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations.SettingOnly studies reporting data from Africa were included.ParticipantsA systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively.Main outcome measuresIncidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool.ResultsOf 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I2=87% and 52%, respectively).ConclusionsMeta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary.Trial registration numberPROSPERO42016038689.

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Section: Resultsmentioning

confidence: 99%

Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

et al. 2017

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“…Several other studies from the region found more comparable hypertension prevalence among ART patients. In two urban studies from Tanzania, prevalence was 28.7% [13] and 26.2% [14] and in a large peri-urban cohort in Uganda 27.9% [15]. In a referral hospital in Cameroon 38% of ART patients had hypertension [16].…”

Section: Discussionmentioning

confidence: 99%

“…This category included protease inhibitors and stavudine, drugs known to increase the risk of diabetes [17, 18]. Studies among sub-Saharan African ART patients showed fairly similar diabetes prevalences: 1.2% raised blood glucose in Blantyre, Malawi [6], 3.7% diabetes in Tanzanians [14] and 4.1% in South Africans [19]. A small study from Tanzania found a very high diabetes prevalence of 18% in a population of whom 12% used protease inhibitors [20].…”

Section: Discussionmentioning

confidence: 99%

The burden of hypertension, diabetes mellitus, and cardiovascular risk factors among adult Malawians in HIV care: consequences for integrated services

et al. 2016

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BackgroundHypertension and diabetes prevalence is high in Africans. Data from HIV infected populations are limited, especially from Malawi. Integrating care for chronic non-communicable co-morbidities in well-established HIV services may provide benefit for patients by preventing multiple hospital visits but will increase the burden of care for busy HIV clinics.MethodsCross-sectional study of adults (≥18 years) at an urban and a rural HIV clinic in Zomba district, Malawi, during 2014. Hypertension and diabetes were diagnosed according to stringent criteria. Proteinuria, non-fasting lipids and cardio/cerebro-vascular disease (CVD) risk scores (Framingham and World Health Organization/International Society for Hypertension) were determined. The association of patient characteristics with diagnoses of hypertension and diabetes was studied using multivariable analyses. We explored the additional burden of care for integrated drug treatment of hypertension and diabetes in HIV clinics. We defined that burden as patients with diabetes and/or stage II and III hypertension, but not with stage I hypertension unless they had proteinuria, previous stroke or high Framingham CVD risk.ResultsNine hundred fifty-two patients were enrolled, 71.7% female, median age 43.0 years, 95.9% on antiretroviral therapy (ART), median duration 47.7 months. Rural and urban patients’ characteristics differed substantially. Hypertension prevalence was 23.7% (95%-confidence interval 21.1–26.6; rural 21.0% vs. urban 26.5%; p = 0.047), of whom 59.9% had stage I (mild) hypertension. Diabetes prevalence was 4.1% (95%-confidence interval 3.0–5.6) without significant difference between rural and urban settings. Prevalence of proteinuria, elevated total/high-density lipoprotein-cholesterol ratio and high CVD risk score was low. Hypertension diagnosis was associated with increasing age, higher body mass index, presence of proteinuria, being on regimen zidovudine/lamivudine/nevirapine and inversely with World Health Organization clinical stage at ART initiation. Diabetes diagnosis was associated with higher age and being on non-standard first-line or second-line ART regimens.ConclusionAmong patients in HIV care 26.6% had hypertension and/or diabetes. Close to two-thirds of hypertension diagnoses was stage I and of those few had an indication for antihypertensive pharmacotherapy. According to our criteria, 13.0% of HIV patients in care required drug treatment for hypertension and/or diabetes.

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“…Measures of effectiveness of integration 32 studies evaluated one or more measures of effectiveness of the integrated intervention, program or model. We • Identified with substance misuse disorder (1) • ART uptake (1) • ART adherence (2) • BUP/NX adherence (1) • CD4 count (2) • Virological suppression (2) • ASI score (2) • Patient satisfaction and perspectives (5) • Substance Use -Opioid (1 • Staff satisfaction and perspectives (2) • Total annual cost per client served (1) • Quality review (1) Other Facility (n =7 ;n = 3 reported outcomes)…”

Section: Type 3: Hiv Treatment + Other Conditions At a Substance Use mentioning

confidence: 99%

Integrating HIV and substance use services: a systematic review

Haldane

Cervero-Liceras

Chuah

et al. 2017

Journal of the International AIDS Society

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Introduction: Substance use is an important risk factor for HIV, with both concentrated in certain vulnerable and marginalized populations. Although their management differs, there may be opportunities to integrate services for substance use and HIV. In this paper we systematically review evidence from studies that sought to integrate care for people living with HIV and substance use problems.Methods: Studies were included if they evaluated service integration for substance use and HIV. We searched multiple databases from inception until October 2015. Articles were screened independently by two reviewers and assessed for risk of bias.Results and discussion: 11,057 records were identified, with 7616 after removal of duplicates. After screening titles and abstracts, 51 met the inclusion criteria. Integration models were categorized by location (HIV, substance use and other facilities), level of integration from mirco (integrated care delivered to individuals) to macro (system level integrations) and degree of integration from least (screening and counselling only) to most (care for HIV, substance use and/or other illnesses at the same facility). Most reported descriptive or cohort studies; in four randomized control trials integrated activities improved patient outcomes. There is potential for integrating services at all facility types, including mobile health services. While services offering screening only can achieve synergies, there are benefits from delivering integrated treatment for HIV and substance use, including ease of referral to other mental health and social services.Conclusions: Our review used a wide range of databases and conference archives to increase representation of papers from low- and middle-income countries. Limitations include the overrepresentation of studies from the United States, and the descriptive nature of the majority of papers. The evidence reviewed shows that greater integration offers important benefits in both patient and service outcomes but further research and outcome reporting is needed to better understand innovative and holistic care models at the complex intersection of substance use and HIV services.

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Magnitude and risk factors of non-communicable diseases among people living with HIV in Tanzania: a cross sectional study from Mbeya and Dar es Salaam regions

Cited by 85 publications

References 29 publications

Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

The burden of hypertension, diabetes mellitus, and cardiovascular risk factors among adult Malawians in HIV care: consequences for integrated services

Integrating HIV and substance use services: a systematic review

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