The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis

Effect of tamarind (Tamarindus indica L.) on the cardiometabolic health of patients living with HIV and elevated triglyceride levels: a dose-response double-blind, randomized exploratory trial

Background: The increase in cardiometabolic diseases in sub-Saharan Africa calls for sustainable remedies. In particular, people living with HIV (PLWH) have an increased risk of metabolic syndrome. Tamarind (Tamarindus indica L.), a fruit native to Africa, is rich in polyphenols and may optimize cardiometabolic health. In an exploratory trial, we assessed the potential of tamarind fruit juice to improve lipid metabolism in PLWH. Methods: We conducted a 4-week, parallel double-blinded trial of 50 patients equally allocated to two doses of tamarind juice. The primary outcome was triglycerides (TG), and eligible participants were aged 30 to 60 years with TG ≥ 150 mg dL-1. Patients consumed 600 mL of tamarind juice daily, containing either 10% or 30% tamarind fruit pulp corresponding to 1556 mg or 1631 mg of the analyzed polyphenols, respectively. Fasted blood samples were analyzed for lipid profile. Blood pressure (BP) and vascular function were measured. Patients were required to maintain their habitual diet and lifestyle. Dietary intake, background polyphenol intake, and physical activity were measured. All analyses were performed according to intention-to-treat. Study registration was done at clinicalTrial.gov, NCT06058845. Results: The 30% fruit pulp juice significantly reduced TG by -39.8 mg dL-1 (95% CI: -67.7, -11.9), P = 0.006, corresponding to a 17.3% reduction of the baseline TG levels, while no statistically significant effect was noted for the 10% fruit pulp juice. None of the doses had a significant effect on total cholesterol, LDL, and HDL. The 10% fruit pulp juice significantly reduced systolic blood pressure (SBP), mean arterial pressure, and SBP (aorta) by -7.4 mmHg (95% CI: -14.5, -0.26), P = 0.043, -5.1 mmHg, 95% CI [-9.3, -0.99], P = 0.016, and -11.7 mmHg, 95% CI [-20.9, -2.6], P = 0.013, respectively. Physical activity, dietary intake, and background polyphenol intake between the study groups did not significantly change across the study period. Conclusion: Although our trial was not adequately powered to draw definitive conclusions, we showed that T. indica L. fruit juice potentially ameliorates TG metabolism and blood pressure homeostasis. This study provides a basis for future full-scale trials.

Weight changes among antiretroviral therapy-naïve people living with human immunodeficiency virus in Lagos, Nigeria

Introduction

The advent of antiretroviral therapy (ART) has converted HIV from a death sentence to a chronic disease. Subsequently, weight changes, including the development of overweight/obesity have been observed following ART initiation. Our study aimed to assess weight changes and the associated factors among ART-naïve people living with HIV (PLWH) following enrollment in an ART clinic in Lagos, Nigeria.

Methodology

Data were collected among adult ART-naïve PLWH enrolled at a large ART clinic over 10 consecutive years. Weight changes within the first 6 months of enrolment were determined by actual and relative weight differences expressed in kilogram (kg) and percentages (%) respectively. Weight changes were classified as neutral weight change, weight gain and weight loss. Logistic regressions were applied to identify variables associated with weight changes with statistical significance set at p < 0.05.

Results

A total of 6,737 study participants had their weights available at both visits. Most study participants were females (67.2%), employed (83.3%), married (57.1%), and had normal range body mass index (53.5%). Almost half (49.5%) of the study participants gained weight, while 25.5% recorded weight loss. Baseline variables, including viral load ≥ 100,000 copies/ml, CD4 counts ≤ 200 cells/μL, WHO clinical stages 3 and 4, male gender, presence of anaemia and tuberculosis were associated with weight gain after ART initiation.

Conclusion

Considering the high proportion of participants that gained weight, this study highlights the importance of monitoring weight changes following ART initiation. This will facilitate the identification of PLWH at greater risk for cardiometabolic diseases and other weight-related health outcomes.

Extreme geographic misalignment of healthcare resources and HIV treatment deserts in Malawi

The Joint United Nations Programme on HIV and AIDS has proposed that human rights should be at the center of efforts to end the HIV pandemic and achieving equity in access to antiretroviral therapy (ART) and HIV healthcare is essential. Here we present a geospatial and geostatistical modeling framework for conducting, at the national level, an equity evaluation of access to ART. We apply our framework to Malawi, where HIV prevalence is ~9%. Access depends upon the number of available healthcare facilities (HCFs), the travel times needed to reach these HCFs, the mode of transportation used (walking, biking, driving) and the supply-to-demand ratio for ART at the HCFs. We find extreme inequities in access to ART. Access maps show striking geographic patterns, revealing clusters of communities with very low or high levels of access. We discover that an extreme geographic misalignment of healthcare resources with respect to need has generated a new type of medical desert: an HIV treatment desert. Around 23% of people living with HIV reside in deserts where they have to walk up to 3 h to reach HCFs; in 2020, these HCFs only received 3% of the national supply of ART. We recommend strategies for shrinking deserts; if not implemented, deserts will grow in size and number.

Hyperglycaemia and Its Risk Factors Among Adults Living With HIV on Follow-Up at the Hawassa City Administration, Southern Ethiopia: A Cross-Sectional Study

BACKGROUND

Ethiopia implemented the universal test and treat in 2017 and later adopted dolutegravir-based regimens for people living with HIV (PLWH). However, the impact of these changes on glucose metabolism in Ethiopia remains unclear, highlighting the need for further investigation.

METHODS

A cross-sectional study was conducted in southern Ethiopia from 5 January 2023 to 30 May 2024. We included 443 adult PLWH using systematic random sampling. American Diabetes Association criteria was used to define hyperglycaemia. To identify factors associated with hyperglycaemia, binary logistic regression was used with adjusted odds ratio (AOR) and 95% confidence interval (CI).

RESULTS

Overall prevalence of hyperglycaemia was 24.4% (16.7% prediabetes and 7.7% diabetes mellitus [DM]). Of the participants with DM, 82.3% were newly diagnosed. Significant predictors of hyperglycaemia were age > 50 years (AOR 2.1; 95% CI 1.1-3.9), alcohol intake (AOR 2.1; 95% CI 1.02-4.2), obesity (AOR 3.2; 95% CI 1.3-7.9), high waist-hip ratio (AOR 2.6; 95% CI 1.4-5.05) and LDL-cholesterol (AOR 2.2; 95% CI 1.02-4.6). While significant predictors of DM were alcohol intake (AOR 3.0; 95% CI 1.1-8.4), co-morbidity (AOR 2.6; 95% CI 1.1-6.05), high waist circumference (AOR 7.5; 95% CI 1.3-43.3), high waist-hip ratio (AOR 4.1; 95% CI 1.02-16.2) and high triglycerides (AOR 3.2; 95% CI 1.3-7.7). Dolutegravir-based regimen was not associated with hyperglycaemia.

CONCLUSION

Hyperglycaemia prevalence among adult PLWH on antiretroviral therapy in southern Ethiopia is rising, with most diabetes cases newly identified. This emphasises the critical need for routine screening to enable early detection, prevention and management.

Traditional and psychosocial factors associated with non-communicable diseases among people living with HIV in Cambodia: a cross-sectional study

We examined traditional and psychosocial factors associated with self-reported diabetes, hypertension, raised cholesterol, and multimorbidity among 4,089 people living with HIV in Cambodia. Participants were recruited from 20 antiretroviral therapy (ART) clinics across nine provinces and the capital city in 2021. Multiple logistic regression analyses assessed the associations between sociodemographic variables, HIV-related information, and psychosocial factors with the outcome variables. The prevalence of diabetes, hypertension, and raised cholesterol were 7.8%, 16.9%, and 6.6%, respectively. Non-adherence to ART (adjusted odds ratio [aOR]: 1.55, 95% confidence interval [CI]: 1.04-2.32), low self-efficacy in attending ART clinics regularly (aOR: 2.02, 95% CI: 1.16-3.53), and poor quality of life (aOR: 1.48, 95% CI: 1.13-1.94) were significantly associated with all outcomes. Interestingly, lower perceived social support was significantly associated with lower odds of hypertension (aOR: 0.52, 95% CI: 0.33-0.83) and multimorbidity (aOR: 0.40, 95% CI: 0.20-0.80). Past experiences with HIV-related stigma and discrimination were significantly associated with a higher likelihood of diabetes (aOR: 1.97, 95% CI: 1.23-3.15) and multimorbidity (aOR: 1.87, 95% CI: 1.23-2.85). Community-based interventions to enhance peer support and reduce stigma and discrimination may help decrease non-communicable diseases (NCDs), and integrating HIV and NCD programs could improve healthcare access among people living with HIV.

Prevalence of metabolic syndrome in people living with HIV and its multi-organ damage: a prospective cohort study

INTRODUCTION

With the global scale-up of antiretroviral therapy (ART) and improved life expectancy, people living with HIV (PLWH) increasingly face non-infectious comorbidities, and metabolic syndrome (MetS) is one of the most prevalent. MetS is associated with unfavorable health outcomes, including cardiovascular disease, chronic kidney disease, and metabolic dysfunction-associated fatty liver disease. However, data on the prevalence and risk factors of MetS among treatment-naïve PLWH in China are limited. The aim was to investigate the prevalence and risk factors of MetS and to understand its association with multi-organ damage.

METHODS

Data on sociodemographic, physical, and clinical characteristics were collected from a completed multicenter, prospective cohort study in China. MetS was diagnosed according to criteria proposed by the China Diabetes Society. Univariate and multivariable logistic regression were applied to identify associated risk factors for MetS. The relationship with organ damage, including kidney, liver, heart, and bone health, were also been assessed.

RESULTS

Among the 449 participants (median age 30 years; 92.9% male), 16.9% met the criteria for MetS. Patients met MetS criteria in our study presented with low HDL-C concentration (49.8%), hypertriglyceridemia (26.1%), hypertension (23.1%), hyperglycemia (15.4%), and abdominal obesity (8.0%). Risk factors significantly associated with MetS included older age (OR 1.08; 95% CI 1.02-1.15) and alcohol consumption (OR 3.63; 95% CI 1.13-11.67). PLWH with MetS exhibited higher level of organ involvement, including reduced kidney function, elevated liver enzymes, and increased risks for cardiovascular events. Among them, 162 participants (36.0%) were classified as being at moderate or high risk using pooled cohort equations (PCEs). It is worth noting that in the MetS group, the dropped bone mineral density (BMD) in the spine decreased more significantly than that of the non-MetS group (P = 0.007).

CONCLUSION

The incidence of MetS in ART-naïve PLWH in China is relatively high. Older age and alcohol consumption are associated with higher risk of MetS. Multiple organ damage may occur accompanied with MetS. Early identification and intervention are critical in managing MetS in PLWH.

Experiences of Older People Living with Human Immunodeficiency Virus Comorbidity Attending Coordinated Healthcare Services

BACKGROUND

Older people living with human immunodeficiency virus (OPLWHIV) on antiretroviral therapy are aging and face an increased risk of non-communicable diseases. The burden is costly and demands sustainable care for HIV comorbidity. The aim is to understand the experiences of OPLWHIV comorbidity attending healthcare services.

METHODS

The 28 reviewed articles focused on experiences of OPLWHIV comorbidity attending healthcare services. The scoping review employed content analysis. A literature search was conducted on databases like PubMed, EBSCOhost, Google Scholar, and Subnet. Articles were restricted to English and published between 2013 and 2024. The study population included 50-85 years old.

RESULTS

OPLWHIV comorbidity needs standardized, coordinated, and resourced healthcare services because of the unique difficulties of older adults.

CONCLUSIONS

OPLWHIV comorbidity experienced difficulties accessing coordinated services addressing complex pharmacoeconomics and psycho-social issues in resourced primary health care institutions, with promotive and preventive care to strengthen the healthcare system.

Non-Communicable Diseases in Patients with Human Immunodeficiency Virus and Their Risk Factors

BACKGROUND

The increasingly widespread use of antiretroviral drugs (ARV) to manage human immunodeficiency virus (HIV) infection has significantly reduced mortality. Accordingly, the number of patients with HIV with a life expectancy >50 years is increasing. With advanced age, the risk of non-communicable diseases (NCD) increases. According to a study in Uganda in 2017, the prevalence of at least one NCD in patients with HIV was 20.7%, with 11-30% of deaths due to NCDs, especially cardiovascular disease. This emphasizes that NCDs in patients with HIV are of clinical concern, as are the factors that increase the risk of these diseases. However, most studies on HIV and NCDs focus on African countries, while research in Asia is limited. Differences in genetics, lifestyle, and co-existing health burdens may influenced NCD prevalence and risk factors. This study aimed to determine the prevalence of and risk factors for NCDs in patients with HIV.

MATERIALS AND METHODS

This was an analytical cross-sectional study conducted at the outpatient clinic of the Ngoerah Hospital from June 8, 2023, to July 7, 2023. Descriptive and multivariate analyses were performed.

RESULTS

In total, 1,644 patients with HIV were included in this study. The prevalence of NCDs was 1.9% for hypertension, 1.1% for diabetes mellitus, 0.7% for dyslipidemia, 1.0% for kidney disorders, 0.1% for stroke, 0.3% for cancer, 0.3% for cardiovascular disease, and 0.2% for autoimmune diseases. After conducting a multivariate test, we found that age >50 years increased the risk of comorbid NCDs by 7.886 times, while male sex increased the risk by 2.568 times, and an ARV regimen of two nucleoside reverse transcriptase inhibitors (NRTIs) + non-NRTI (NNRTI) decreased the risk by 2.625 times.

CONCLUSION

Hypertension was the most common NCD in patients with HIV, followed by diabetes mellitus. Male patients and those aged >50 years were at a greater risk of developing NCDs, whereas a history of using the two NRTIs + NNRTI regimen was associated with a lower risk of NCDs.

Hospitalized with HIV in Zambia: individual and system factors driving the high burden of admissions and post-discharge mortality in the era of HIV epidemic control

BACKGROUND

Despite progress towards HIV epidemic control, people living with HIV (PLHIV) in Zambia continue to face high mortality during and especially after hospitalization, with suboptimal post-discharge care leading to poor outcomes. We conducted a qualitative study to better understand factors influencing post-discharge engagement in care for HIV and associated comorbidities.

METHODS

We conducted in-depth interviews with 16 recently discharged PLHIV, seven caregivers, and two doctors; and three focus group discussions with inpatient doctors (n = 8) and lay counsellors (n = 16) at two tertiary hospitals in Lusaka, guided by the social-ecological model. Data were audio-recorded, transcribed verbatim, managed with Atlas.ti 9, and thematically analyzed.

RESULTS

Individual and household-level barriers to post-discharge care for PLHIV included HIV status denial and stigma, limited disclosure, and limited social and emotional support. Health-related barriers included concomitant treatments for TB, HIV comorbidities, and behavioral health issues like depression and alcohol abuse. Health system barriers included limited confidentiality during admission and poor communication between healthcare providers and between facilities aftercare transitions following discharge. Social-economic factors included economic shocks of hospitalization and post-discharge recovery, which compounded pre-existing poverty and high transportation and food costs. Conversely, disclosure of HIV status, better social support, a financially stable household, and hospital follow-up appointment reminders facilitated better post-discharge care.

CONCLUSION

After hospital discharge with HIV, system and individual challenges exacerbate pre-existing interpersonal, health, environmental, and system-related factors to cause poor outcomes. Holistic community-based interventions to facilitate these patients' re-engagement in care after discharge could help HIV programs reach the last mile in epidemic control.

A systematic review of mediation analysis frameworks in studies examining the determinants of cardiometabolic outcomes in people living with HIV

INTRODUCTION

Mediation analysis provides a more flexible mechanistic view of the causal relationship between HIV-related factors and cardiometabolic diseases. However, there is limited evidence on how mediation analysis is implemented in this specific research area. We aimed to describe the frameworks used in mediation analysis and examine how these analyses are conducted and reported in studies focusing on cardiometabolic outcomes among people living with HIV (PLWH).

METHODS

Following the PRISMA 2020 Guidelines, we comprehensively searched Medline, CINAHL, Africa-Wide Information and SCOPUS to identify observational studies that employed mediation analysis before October 2023. Two reviewers independently screened studies for eligibility. One reviewer performed data extraction, and two others reviewed the extracted information.

RESULTS

Nine studies met the inclusion criteria, predominantly focusing on the mediation effects of weight and obesity-related factors on the relationship between HIV serostatus, ART, and cardiometabolic outcomes. The review revealed a diverse application of both traditional and causal mediation frameworks. However, inconsistencies and gaps in reporting were noted, particularly in handling missing data, detailing identifiability assumptions, and the use of sensitivity analyses.

CONCLUSION

While some studies of cardiometabolic risks among PLWH have embraced causal mediation frameworks, their overall application remains limited. In addition, we identified notable inconsistencies and gaps in reporting practices. To advance the field, researchers should not only integrate more rigorous causal mediation methods but also closely follow established reporting guidelines, such as the AGReMA Statement, to ensure greater transparency, reliability, and impact of future research.

The impact of COVID-19 on HIV care: a comprehensive analysis of patient and healthcare providers experiences at the largest HIV treatment center in Ghana

BACKGROUND

We sought to determine how the COVID-19 pandemic affected care delivery for HIV patients in Ghana.

METHODS

Guided by the Consolidated Framework for Implementation Research (CFIR), we performed a cross-sectional study between May and July 2021 among 40 people living with HIV and 19 healthcare providers caring for HIV patients. In-depth interviews and focus group discussions were done with HIV patients, doctors, nurses, pharmacists, laboratory scientists, data scientists, administrators, and counselors to ascertain barriers and facilitators to HIV care during the pandemic. We asked for their input on removing barriers to care during this and future pandemics. Data was analyzed thematically with the help of the qualitative software MAXQDA.

RESULTS

Pre-pandemic practices, such as using cards for appointments and making phone calls to patients, and intra-pandemic measures, such as re-arranging the clinic setup for patient safety, contributed to clinic attendance. However, the fear of infection, transportation costs, and fear of stigma impeded clinic attendance. Patients spent less time in the clinic because stable patients received medication refills without seeing the doctor. This meant many patients with chronic diseases like hypertension, diabetes, and hyperlipidemia did not get the necessary physician review during the pandemic's peak. Due to pervasive stigma, patients were cautious about home delivery of medications and telemedicine solutions.

CONCLUSION

While solutions like telemedicine and home visits may work for primary care or other chronic conditions during pandemics, stigma makes these interventions unattractive options for many HIV patients.

Reduced heart rate variability is associated with altered clinical laboratory profile in people living with HIV

Background

We compared heart rate variability (HRV) indices between people living with HIV (PLWH) and HIV-negative individuals to ascertain the independent association between HIV infection and reduced HRV, and further investigated whether distinct clinical laboratory profiles exist between PLWH with and without reduced HRV.

Methods

This cross-sectional analysis included 304 PLWH and 147 HIV-negative individuals with comparable age and sex. Thirty-two routine clinical laboratory indices (including hematology and biochemistry) closest to the survey were extracted from the Electronic Medical Record System. HRV indices were divided into two categories: low (lowest quartile, Q1) and moderate-to-high (combined, Q2‒Q4).

Results

The time domain indices, ln(SDNN), ln(RMSSD), and ln(PNN50), as well as the frequency domain indices, ln(HF), ln(LF), and ln(VLF), were all significantly reduced in PLWH versus HIV-negative individuals (all p < 0.05). These associations remained for ln(SDNN), ln(PNN50), ln(HF) and ln(LF) even after adjusting for potential confounders in multivariable models. PLWH with low HRV indices exhibited distinct clinical laboratory profiles that were characterized by an elevation in fasting plasma glucose, white blood cell count, neutrophil count, neutrophil%, and a reduction in albumin, total protein, urine creatinine, lymphocyte%, red blood cell count (RBC) and nadir CD4 count. The final stepwise logistic regression models for low SDNN included older age, decreased total cholesterol levels, elevated neutrophil count, and the use of antidiabetic medications, whereas the final model for low LF included older age, reduced RBC and the use of antidiabetic medications.

Conclusion

PLWH exhibit impaired parasympathetic activity, as evidenced by reduced SDNN, PNN50, LF and HF. Furthermore, PLWH who have reduced HRV indices exhibits distinct clinical laboratory profiles that are related to systematic inflammatory response and diabetes.

Challenges in managing HIV and non-communicable diseases and health workers' perception regarding integrated management of non-communicable diseases during routine HIV care in South Central Uganda: A qualitative study

BACKGROUND

Non-communicable diseases are highly prevalent among adults living with HIV, emphasizing the need for comprehensive healthcare strategies. However, a dearth of knowledge exists regarding the health systems challenges in managing HIV and non-communicable diseases and the perception of health workers regarding the integrated management of non-communicable diseases during routine HIV care in rural Ugandan settings. This study aims to bridge this knowledge gap by exploring the health system challenges in managing HIV and non-communicable diseases and health workers' perception regarding the integration of non-communicable diseases in routine HIV care in South Central Uganda.

METHODS

In this qualitative study, we collected data from 20 purposively selected key informants from Kalisizo Hospital and Rakai Hospital in South Central Uganda. Data were collected from 15th December 2020 and 14th January 2021. Data were analyzed using a thematic content approach with the help of NVivo 11.

RESULTS

Of the 20 health workers, 13 were females. In terms of work duration, 9 had worked with people living with HIV for 11-15 years and 9 were nurses. The challenges in managing HIV and non-communicable diseases included difficulty managing adverse events, heavy workload, inadequate communication from specialists to lower cadre health workers, limited financial and human resources, unsupportive clinical guidelines that do not incorporate non-communicable disease management in HIV care and treatment, and inadequate knowledge and skills required to manage non-communicable diseases appropriately. Health workers suggested integrating non-communicable disease management into routine HIV care and suggested the need for training before this integration.

CONCLUSION

The integration of non-communicable disease management into routine HIV care presents a promising avenue for easing the burden on health workers handling these conditions. However, achieving successful integration requires not only the training of health workers but also ensuring the availability of sufficient human and financial resources.

Perceived Impacts of Urban Gardens and Peer Nutritional Counseling for People Living With HIV in the Dominican Republic

OBJECTIVE

Explore participants' perceptions of urban gardens and peer nutritional counseling intervention for people with HIV and food insecurity on antiretroviral therapy in the Dominican Republic.

METHODS

Semistructured endline interviews (n = 21) with intervention participants about their perceptions of diet, health, and quality of life. A codebook was applied to verbatim transcripts, and coded data were analyzed using matrices to identify themes.

RESULTS

Participants were mostly Dominican (86%; 14% Haitian); 57% were men; the mean age was 45 years. The most salient experiences described by intervention participants were improved dietary quality and diversity, improved food security, and saving money. Participants also emphasized improved social interactions, mental health, and emotional well-being.

CONCLUSIONS AND IMPLICATIONS

Urban gardens and peer nutritional counseling may improve participants' diet and psychosocial well-being. Nutrition programs with marginalized populations may need to improve access to healthy foods and build camaraderie and linkages to programs addressing structural factors.

Mapping evidence on barriers to and facilitators of diagnosing noncommunicable diseases among people living with human immunodeficiency virus in low- and middle-income countries in Africa: A scoping review

Objectives

To map the evidence on the barriers to and facilitators of diagnosing noncommunicable diseases among people living with HIV in low- and middle-income countries in Africa.

Introduction

Noncommunicable diseases are increasing among people living with HIV. Thus, strengthened and sustained diagnosis of noncommunicable diseases through integrated noncommunicable diseases and HIV care is needed to improve patient outcomes. However, there is paucity of evidence on the barriers and facilitators diagnosing noncommunicable diseases among people living with HIV in low- and middle-income countries.

Methods

The Arksey and O'Malley methodological framework was used. A comprehensive systematic search of academic databases (MEDLINE, Academic Search Complete, APA PsycInfo, CAB, and Health Source/Nursing) was performed via EBSCO search and PubMed. The articles were reviewed independently by three reviewers. The results were structured using Capability-Opportunity-Motivation-Behavior model and Theoretical Domains Framework.

Results

A total of 152 articles were retrieved for full-text review. Forty-one articles met the inclusion criteria. The identified barriers were relevant to all the Capability-Opportunity-Motivation-Behavior constructs and 14 Theoretical Domains Framework domains. A lack of knowledge and awareness of noncommunicable diseases, fear of stigma, financial problems and out-of-pocket payments were the most cited patient-level barriers. Healthcare providers (knowledge and awareness gaps, skill and competence deficiencies, unwillingness, burnout, low motivation, and apathy) were frequently cited. Lack of equipment, noncommunicable disease medications and supply chain challenges, lack of integrated noncommunicable disease and HIV care, and shortage of trained healthcare providers were identified as health-system-level barriers.

Conclusion

This scoping review is the first to identify barriers and facilitators using a theoretical framework. The most cited barriers include a lack of integrated HIV and noncommunicable disease care, equipment and logistics chain challenges for noncommunicable diseases, patients' and healthcare providers' lack of knowledge and awareness of noncommunicable diseases, and healthcare provider's skill and competency deficiencies. Addressing these issues is crucial for improving patient outcomes and reducing the burden on healthcare providers and health systems.

The Role of Helicobacter pylori and Metabolic Syndrome-Related Mast Cell Activation Pathologies and Their Potential Impact on Pregnancy and Neonatal Outcomes

Helicobacter pylori infection, a significant global burden beyond the gastrointestinal tract, has long been implicated in various systemic pathologies. Rising evidence suggests that the bacterium's intricate relationship with the immune system and its potential to induce chronic inflammation impact diverse pathophysiological processes in pregnant women that may in turn affect the incidence of several adverse pregnancy and neonate outcomes. Helicobacter pylori infection, which has been linked to metabolic syndrome and other disorders by provoking pericyte dysfunction, hyperhomocysteinemia, galectin-3, atrial fibrillation, gut dysbiosis, and mast cell activation pathologies, may also contribute to adverse pregnancy and neonatal outcomes. Together with increasing our biological understanding of the individual and collective involvement of Helicobacter pylori infection-related metabolic syndrome and concurrent activation of mast cells in maternal, fetus, and neonatal health outcomes, the present narrative review may foster related research endeavors to offer novel therapeutic approaches and informed clinical practice interventions to mitigate relevant risks of this critical topic among pregnant women and their offspring.

Associations of HIV and prevalent type 2 diabetes mellitus in the context of obesity in South Africa

It is unclear how rising obesity among people with HIV (PWH) in sub-Saharan Africa (SSA) impacts their risk of type 2 diabetes mellitus (diabetes). Using a South African national cross-sectional sample of adult PWH and their peers without HIV (PWOH), we examined the associations between HIV and prevalent diabetes across the spectrum of body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WtHR). Analyses were sex stratified, and adjusted for age, sociodemographic and behavioral factors. The prevalence of diabetes among males was similar between PWH and PWOH, overall and at all levels of adiposity. In contrast, overall diabetes prevalence was higher among female PWOH than female PWH. However, there were differences according to adiposity such that, compared to female PWOH, relative diabetes prevalence in female PWH was reduced with obesity but accentuated with leanness. These differences in the relationship between adiposity and diabetes by HIV serostatus call for better mechanistic understanding of sex-specific adipose tissue biology in HIV in South Africa, and possibly in other HIV endemic settings in SSA.

Impact of Helicobacter pylori and metabolic syndrome-related mast cell activation on cardiovascular diseases

Helicobacter pylori, a widely renowned bacterium, has recently gained attention owing to its potential impact on extragastric health. The emergence of research linking H. pylori infection with metabolic syndrome (MetS)-related cardiovascular diseases (CVDs) has raised intriguing questions about the pathogenic linkage and its translational implications for clinicians. MetS encompasses a collection of metabolic abnormalities that considerably elevate the risk of CVDs and cerebrovascular diseases. Emerging evidence supports a potential pathogenetic role of H. pylori for MetS-related disorders through mechanisms implicating chronic smoldering inflammation, insulin resistance (IR), and modulation of immune responses. One intriguing aspect of this possible connection is the role of mast cells (MCs), a subset of immune cells representing innate immune system effector cells. They play a fundamental role in innate immune responses and the modulation of adaptive immunity. Activated MCs are commonly found in patients with MetS-related CVD. Recent studies have also suggested that H. pylori infection may activate MCs, triggering the release of pro-inflammatory mediators that contribute to IR and atherosclerosis. Understanding these intricate interactions at the cellular level provides new insights into the development of therapeutic strategies targeting both H. pylori infection and MetS-related MCs activation. This review investigates the current state of research regarding the potential impact of H. pylori infection and MetS-related MCs activation on the pathophysiology of CVD, thereby opening up new avenues for related research and paving the way for innovative approaches to prevention and treatment in clinical practice

Building capacity for network meta-analysis in Sub-Saharan Africa: reflections and future direction

Robust, relevant, comprehensive, and up-to-date evidence syntheses are the cornerstone for evidence-informed healthcare decisions. When considering multiple treatment options, network meta-analysis (NMA) systematic reviews play a key role in informing impactful decisions and clinical practice guidelines. However, the capacity and literacy to conduct NMA systematic reviews and interpret its results remains out of reach for many clinicians and review authors, especially in low-to-middle-income countries. Despite ample resources and guides, NMA capacity and training opportunities remain limited to non-existent in Sub-Saharan Africa. Towards solutions and strengthening evidence synthesis and NMA capacity in the Sub-Saharan African region, we describe and reflect on two courses that build NMA capacity and aim to address NMA literacy in Sub-Saharan Africa.The Primer in NMA systematic reviews aimed for participants to be able to find, appraise, interpret, and consider the use of NMA SRs of intervention effects. It is a 6-week online course for clinicians, policy-makers, and researchers wanting to learn more about using NMA systematic reviews. The Global NMA Masterclass workshop aimed for participants to be able to understand and apply pairwise and NMA in STATA and R, evaluate NMA assumptions and confidence in NMA results, and appropriately report NMA results. This course was offered over 5 weeks to clinicians, biostatisticians, and researchers with basic knowledge of epidemiology and biostatics. Although the bulk of learning occurred through self-study, we had weekly, synchronous question-and-answer sessions for both courses. Using relevant examples throughout the courses helped to enable an authentic learning environment.This was the first NMA training developed in Africa for Africa. Development of the courses was a collaborative effort from a multi-disciplinary team. Both NMA courses were well received and attended by a diverse group of participants spread across Sub-Saharan African countries. Participants felt the courses were applicable to their setting. Although most participants appreciated the benefits of online learning, we also experienced some challenges. There is great potential to conduct NMA systematic reviews in Sub-Saharan Africa. The NMA Primer and NMA workshop can play an essential role in expanding and developing NMA SR capacity and literacy in SSA.

Associations of HIV and prevalent type 2 diabetes mellitus in the context of obesity in South Africa

Background

It is unclear how rising obesity among people with HIV (PWH) impacts their risk of type 2 diabetes mellitus (diabetes). We examined associations between HIV, prevalent diabetes and adiposity among South African PWH and their peers without HIV (PWOH).

Methods

HIV status was ascertained by antibody testing. Diabetes was defined as current use of oral hypoglycemics, insulin, and/or HbA1c ≥6.5%. Adiposity was measured by body mass index (BMI), waist circumference and waist-to-height ratio. Their associations were examined using sex-stratified multivariable fractional polynomial generalized linear models, reporting adjusted prevalence and prevalence ratios (adjPR).

Results

The mean age among 1,254 PWH and 4,381 PWOH was 41 years (95%CI 28, 56). The prevalence of diabetes among males was similar between PWH [11.3% (7.1, 15.5)] and PWOH [9.8% (8.5, 11.1); p=0.740]. By contrast, diabetes prevalence was higher among female PWOH [15.7% (14.4, 17.0)] than female PWH [10.5 (8.3, 12.8)%; adjPR: 0.67 (0.51, 0.82); p<0.001]. This difference was accentuated with obesity but reversed with leanness. At BMI ≥25 kg/m2, female PWH had lower diabetes prevalence [adjPR: 0.58 (0.41, 0.76); p<0.001] than female PHIV. In contrast, at BMI <18 kg/m2, female PWH had higher prevalence [adjPR: 1.72 (-1.53, 4.96); p=0.756] than female PWOH.

Conclusion

We found sex-specific differences in the relationship between adiposity and diabetes prevalence by HIV serostatus in South Africa. Notably, females living with obesity and HIV had lower prevalence of diabetes than females living with obesity and without HIV, which may have particular implications for diabetes prevention programs in the region.

Disclosure of HIV Status in Healthcare Settings: Practices and Considerations among Women Living with HIV/AIDS in Vietnam

OBJECTIVE

This study investigated women living with HIV/AIDS (WLHA)'s practices and decision-making regarding disclosure of HIV status in healthcare settings in Vietnam. Introduction: Disclosure of HIV status in healthcare settings is under-studied.

METHODS

We conducted in-depth interviews with 30 WLHA in Hanoi, Vietnam. Thematic analysis was conducted to investigate the patterns, considerations, and consequences of HIV disclosure. Results: Most participants chose a selective disclosure strategy based on the type of procedure and healthcare setting. They considered several factors: concerns about stigma/discrimination, risks of confidentiality breach, relevance to healthcare provision, and altruism towards protecting providers and other patients. Selective disclosure or non-disclosure often prevented participants from accessing comprehensive care. Conclusion: The study underscores the need to prepare WLHA to make informed decisions regarding disclosure and provide them with service navigations and support. It also highlights the necessity of reducing stigma and enhancing confidentiality protection to ensure safe disclosure in healthcare settings.

The association between dolutegravir-based antiretrovirals and high blood pressure among adults with HIV in southern Ethiopia: a cross-sectional study

Background

Dolutegravir (DTG), a novel antiretroviral therapy (ART) for HIV, is increasingly adopted across sub-Saharan Africa. However, its impact on blood pressure in Ethiopia remains unclear, highlighting a need for further studies.

Objective

This study aimed to investigate the association between DTG-based first-line regimens and other covariates of high blood pressure (HBP) among adults living with HIV receiving care at health facilities in Hawassa City, southern Ethiopia.

Design

A cross-sectional study.

Methods

Data were collected between January 2023 and May 2024 among 444 systematically selected adults, complemented with a review of their medical records. HBP was defined according to the seventh report of the Joint National Committee (JNC7) guidelines, with a threshold of systolic or diastolic blood pressure of ⩾120/80 mmHg. Multivariable logistic regression analysis was performed to identify predictors of HBP. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were computed to determine statistically significant associations.

Results

Of the study participants, 58.3% were women and 41.7% were men, resulting in a response rate of 95.5%. The mean (standard deviation (SD]) age of the participants was 38.4(±8.9) years. The prevalence of HBP was 57.9% (95% CI: 52.5-62.4), with 40.5% classified as prehypertension and 17.3% as hypertension. Among participants with hypertension, 84.4% were newly diagnosed. Initiating ART with DTG-based regimens was associated with higher odds of HBP (AOR 5.9; 95% CI: 1.5-22.7) and switching to DTG-based regimens also increased the odds of HBP (AOR 3.8; 95% CI: 1.1-13.9). Other significant covariates associated with HBP included being male (AOR 2.6; 95% CI: 1.4-4.9), age >45 years (AOR 2.0; 95% CI: 1.2-3.4), high waist-to-height ratio (AOR 2.4; 95% CI: 1.1-4.9), inadequate vegetable intake (AOR 1.7; 95% CI: 1.0-2.7), low physical activity (AOR 2.4; 95% CI: 1.1-5.4), and LDL-cholesterol (AOR 1.1; 95% CI: 1.0-1.2).

Conclusion

Proactive blood pressure screening and management are important for individuals on DTG-based regimens. In addition, early identification and intervention of modifiable risk factors through comprehensive strategies and regular screenings are pivotal for improving cardiovascular health among individuals on ART.

Prevalence of depression among people living with HIV in rural hospitals in South-Western Nigeria-Association with clinico-demographic factors

Major depression is the most common neuropsychiatric disorder among people living with HIV (PLWH) and is predictive of high morbidity and mortality among them. This study estimated the prevalence and explored factors associated with depression among PLWH in two rural secondary health facilities providing anti-retroviral therapy (ART) services in Southwestern Nigeria between September and December 2020. The Patient Health Questionnaire-9 (PHQ-9) was used to screen and identify PLWH aged 18 years or older with depression. Descriptive statistics, bivariate and multivariate analyses were performed with SPSS version 23. A total of 172 respondents were screened. The prevalence of depression was 16.3% (95% CI 11.1%, 22.7%). Mild, moderate, and moderately severe depression was identified in 17 (9.9%), 8(4.7%) and 3(1.7%) of the participants, respectively. One (0.6%) respondent had suicidal ideation. Of PLWH with any depression, 20/28(71.4%) were within the 40-59 years of age range. None of the participants was on antidepressants. The factor most associated with depression was hypertension, with adjusted odd ratios of 9.8(95% CI 3.5-27.3, p < 0.0001). The study highlights the importance of screening for the severity of depression among PLWH in rural hospitals providing ART services in Africa. PLWH with comorbid hypertension were more likely to suffer from some form of depression.