title: A cross-sectional, facility based study of comorbid non-communicable diseases among adults living with HIV infection in Zimbabwe.
abstract: BACKGROUND
  Increased antiretroviral therapy uptake in sub-Saharan Africa has resulted in improved survival of the infected. Opportunistic infections are declining as leading causes of morbidity and mortality. Though comprehensive data are lacking, concern has been raised about the rapid emergence of non-communicable diseases (NCDs) in the African HIV care setting. We therefore set out to characterise the NCD/HIV burden among adults living and ageing with HIV infection in Zimbabwe.
  
  
  METHODS
  We conducted a cross-sectional study among patients receiving care in a public sector facility. We reviewed patient records and determined the prevalence of comorbid and multi-morbid NCDs. Associations with patient characteristics were evaluated using univariate and multi-variate logistic regression modelling. Significance testing was done using 2-sided p values and 95 % confidence intervals calculated.
  
  
  RESULTS
  We recruited 1033 participants. 31 % were men. Significant gender differences included: older median age, more advanced disease at baseline, and greater use of stavudine and protease inhibitor containing regimens in men compared to women. The prevalence of comorbidity and multi-morbidity were, respectively, 15.3 % (95 % CI 13.3-17.7 %) and 4.5 % (95 % CI 3.4-6.0 %). Women had higher rates than men of both co-morbidity and multi-morbid ity: 21.8 vs. 14.9 %; p = 0.010 and 5.3 vs. 2.9 %; p = 0.025 respectively. The commonly observed individual NCDs were hypertension [10.2 %; (95 % CI 8.4-12.2 %)], asthma [4.3 % (95 % CI 3.1-5.8 %)], type 2 diabetes mellitus [2.1 % (95 % CI 1.3-3.2 %)], cancer [1.8 % (95 % CI 1.1-2.8 %)], and congestive cardiac failure [1.5 % (95 % CI 0.9-2.5 %)]. After adjusting for confounding, only age categories 45-≤55 years (AOR 2.25; 95 % CI 1.37-3.69) and >55 years (AOR 5.42; 95 % CI 3.17-9.26), and female gender (AOR 2.12; 95 % CI 1.45-3.11) remained significantly and strongly associated with comorbidity risk.
  
  
  CONCLUSIONS
  We found a substantial burden of comorbid non-communicable diseases among HIV infected patients in a high HIV and low-income setting. Integrating non-communicable diseases care, including active screening, with HIV care is recommended.
authors.affiliation: IMM, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 800, South Africa. dr.itai.magodoro@gmail.com.
authors.forename: Itai M
authors.initials: IM
authors.lastname: Magodoro
authors.affiliation: Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, TME, Centre for Evidence Based Health Care, Stellenbosch University, PO Box 241, Cape Town, 800, South Africa.
authors.forename: Tonya M
authors.initials: TM
authors.lastname: Esterhuizen
authors.affiliation: Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, TC, Centre for Evidence Based Health Care, Stellenbosch University, PO Box 241, Cape Town, 800, South Africa.|Department of Medicine, Faculty of Health Sciences, Chronic Disease Initiative for Africa, University of Cape Town, Observatory, 7925, South Africa.
authors.forename: Tawanda
authors.initials: T
authors.lastname: Chivese
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D015995:Prevalence; D012307:Risk Factors; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: Comorbidity; HIV; Multimorbidity; Non-communicable diseases; Sub-Saharan Africa