Prevalence and determinants of non‐communicable diseases including depression among HIV patients on antiretroviral therapy in Dar es Salaam, Tanzania

Abstract

Objective People living with HIV/AIDS (PLHA) are experiencing growing co‐morbidities due to an increase in life expectancy and the use of long‐term antiretroviral therapy (ART). The lack of integrated non‐communicable diseases (NCDs) screening and management at the HIV care and treatment centres (CTCs) make it difficult to determine the trends of NCD co‐morbidity among patients with HIV. This study aimed to assess the burden and determinants of common NCDs, including depression among patients with HIV. Methods Analytical cross‐sectional study of 1318 HIV patients enrolled using systematic random sampling conducted from April to November 2020. Five large CTCs in district referral hospitals were selected representing the five districts of Dar es Salaam including Mwananyamala, Temeke, and Amana regional referral hospitals and Sinza and Vijibweni hospitals. The study population consisted of adult PLHA aged 18 years and above. The primary outcome measure was the prevalence of NCDs among HIV patients. Observation of actual NCD medications or their purchase receipts or booked NCD clinic appointments that PLHA had during the study period was used to verify the reported presence of NCDs. The secondary outcome measure was the prevalence of probable depression among PLHA. The locally validated Swahili Patient Health Questionnaire (PHQ‐9) was used to screen for depressive symptom severity. A logistic regression model was used to identify factors associated with common NCDs and those associated with probable depression. Potential risk factors that were statistically significant at a P‐value of 0.2 or less in univariable analysis were included as potential confounders in multivariable models. Results The median age of participants was 42 (IQR 35–49) years, with 32.7% in the 36–45 years age group. The majority of patients were women (69%). Most (80.5%) had achieved HIV viral (VL) suppression (a serum HIV VL of <1000 copies/ml). Overall, 14.3% of self‐reported an NCD with evidence of their current medication for the NCD from receipts for medication purchased and appointments from NCD clinics they attended. In the multivariable analyses, higher odds of NCDs were in older patients (>45 years) and those with a weight above 75 kg (P < 0.05). Male patients had 51% reduced odds of NCDs (aOR 0.49; 95% CI: 0.32–0.74) than females (P < 0.001). Probable depression prevalence was 11.8%, and depressed patients had more than twice the odds of having NCDs than those without depression (aOR 2.26; 95% CI: 1.45–3.51; P < 0.001). Conclusion This study determined co‐existing previously diagnosed NCDs among PLHA accessing care and high levels of depressive symptom severity. We recommend additional research on the feasibility, acceptability, and cost implications of screening and treating NCDs on HIV care platforms to provide evidence for Tanzania's integrated HIV/NCD care model.

Early Effects of Scaling Up Dolutegravir-Based ARV Regimens Among Children Living with HIV in Malawi

“…Although VL coverage post-transition was low, there was an increase in VS rates among those tested, with rates > 80%. These rates are similar to studies conducted in children and adolescents on DTG-based regimens that reported VS [ 28 , 29 ] but remain below the 2030 95–95–95 UNAIDS targets [ 25 ]. However, the proportion of CLHIV with VS was much higher than the Malawi Population-based HIV Impact Assessment (MPHIA) report from a population-based survey conducted in 2015–16 (54% VS) [ 30 ].…”

Missed HIV care appointments and high body mass index predict hypertension risks at diagnosis: a risk identifying opportunity among people living with HIV for global health

“…6 Understanding HIV-NCD epidemic dynamics is needed in integrating NCD screening and management services at HIV care and treatment centers. 6,7 Managing hypertension and diabetes by PLWHIV requires long-term regular medication access, treatment adherence, and continuous health status monitoring. 8 Besides, PLWHIV often miss clinic appointments interrupting their ART care and thus the effectiveness of HIV management programs while compromising the tracking of their conditions, including NCD, consequently promoting poor health outcomes and increasing healthcare costs or other indirect burdens.…”

Factors Associated with Treatment Outcomes among Patients Living with HIV and Hypertension Comorbidity in the Eastern Cape Province, South Africa

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