The Burden of Non-Communicable Diseases among Hospitalized HIV Positive Patients at Lira Regional Referral Hospital, Northern Uganda: Retrospective Chart Review 2016-2020

Abstract

Background: Non-communicable diseases(NCDs) are increasing rapidly in sub-Sahara Africa including Uganda. Knowledge of the effect of long-term antiretroviral therapy(ART) and emergence of NCDs on hospital utilization remain scant. This study aimed to assess the burden of major NCDs and predictors of mortality among hospitalized HIV positive patients in the medical wards at Lira regional referral hospital in Northern Uganda.Method: We conducted a retrospective cross-sectional chart review of hospitalized patients from the male and female medical wards between 2016 and 2020. The prevalence of NCDs was estimated and status at discharge determined. Binary and multi-variable regression analyses were performed to determine predictors of mortality with statistical significance set at 0.05 p-value. Results: A total of 445 patient files were examined, with 49 percent (n=218) of them revealing HIV status. Males made up 53% of the total number of patients studied (n=226). In HIV positive patients, the prevalence of at least one NCD, two NCDs, and three or more NCDs multi-morbidity was 73 percent, 16 percent, and 2 percent, respectively. In HIV negative controls, the prevalence of at least one NCD, two NCDs, and three or more NCDs was 62 percent, 28 percent, and 6 percent, respectively, compared to HIV positive controls. Cardiovascular diseases, diabetes, cancers, chronic lung disease, liver diseases, and mental disorders were found in 19.52 percent (CI: 14.67-25.49) of HIV positive patients versus 36.99 percent (CI: 30.06-44.50), 4.4.65 percent (CI: 02.51-08.51) versus 22.65 percent (CI: 17.57-29.74 p-value= 0.001), 13.55 percent (CI: 09.56-18.87) versus 9. 56 percent (CI: 05.99-14.89), 04.65 percent (02.51-08.47) versus 5.62(03.03-10.18), 27.91 percent (22.27-34.32) versus 29.53 (23.48-36.41), and 26.63 percent (21.10-33.02)versus 06.82 (03.89-11.68,p-value-=<0.001). In HIV patients, being middle-aged (40-50 years) was the sole independent predictor of mortality.Conclusion. HIV positive inpatients had a lower prevalence of major NCDs than HIV negative inpatients, albeit, this was not statistically significant except for diabetes mellitus and mental disorders. Increasing age is a significant predictor of mortality in hospitalized HIV positive patients. Prioritizing screening infrastructure and service capacity to reduce the burden of NCDs in PLHIV is critically important.

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

“…The escalation levels of adults living with HIV and hypertension is concerning because it is associated with increased morbidity and mortality and has shown upward trends in the recent years [6,15,16]. However, it is reported that the use of ART medications improves the quality of life and life expectancy of PLWHA in Northern Uganda, though exposure to the effects of aging, including the influence of environmental risk factors, was known to act in the general population and contribute to the occurrence of NCDs such as hypertension, heart attacks, and stroke, chronic renal diseases, and osteoporotic fractures [17,18].…”