Correlates of physical activity among people living with and without HIV in rural Uganda

Epidemiology of Coronary Atherosclerosis Among People Living With HIV in Uganda : A Cross-Sectional Study

BACKGROUND

Data on the prevalence of coronary atherosclerotic disease (CAD) in the African region among people with and without HIV are lacking.

OBJECTIVE

To estimate the prevalence of CAD in Uganda and determine whether well-controlled HIV infection is associated with increased presence or severity of CAD.

DESIGN

Cross-sectional study.

SETTING

Southwestern Uganda.

PARTICIPANTS

Ambulatory people living with HIV (PWH), aged older than 40 years, taking antiretroviral therapy for 3 or more years, and population-based, age- and sex-similar people without HIV (PWoH).

MEASUREMENTS

Participants had cardiovascular (CV) disease (CVD) risk profiling and computed tomography scanning for detection of CAD, defined as the presence of calcified or noncalcified plaque.

RESULTS

Of 630 screened, 586 (93%) met criteria and had evaluable images. Of these, 287 (49.0%) were PWH and nearly all (272 of 287 [95%]) were virologically suppressed. Mean age (57.9 vs. 57.4 years), proportion female (49%), and median CVD risk score (4.1 vs. 3.4) did not differ by HIV serostatus. The prevalence of CAD was low overall (45 of 586 [7.7%]) and among both PWH (26 of 287 [9.1%]) and PWoH (19 of 299 [6.4%]; absolute prevalence difference, 2.7% [95% CI, -1.6% to 7.0%]). Results were similar after adjustment for CVD risk factors.

LIMITATIONS

Our findings may not generalize to symptomatic populations or those with greater predicted CVD risk. The study was not powered to detect small differences in CAD prevalence between HIV subgroups. Both PWH and PWoH had similar CV risk factor profiles, but residual confounding between HIV and CAD cannot be excluded.

CONCLUSION

The prevalence of CAD in Uganda was low compared with population-based cohorts from the Global North with similar CVD risk profiles and was similar between HIV serostatus subgroups. Our results suggest that CAD may not be a major cause of morbidity in Uganda.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Longitudinal Trends in Physical Activity Among Older Adults With and Without HIV in Uganda

INTRODUCTION

Physical Activity (PA) and its links to frailty, quality of life (QoL), and other comorbidities in older Ugandans living with HIV remain under-explored.

METHODS

We analyzed data from three annual assessments of older people living with HIV (PLWH) and age- and sex-similar people not living with HIV (PnLWH). We fitted linear generalized estimating equations (GEE) regression models to estimate the correlates of PA, including demographics, frailty, QoL, HIV, and other comorbidities.

RESULTS

We enrolled 297 PLWH and 302 PnLWH. Older age (b = -157.34, 95% CI [-222.84, -91.83]), living with HIV (b = -979.88 [95% CI: -1878.48, -81.28]), frailty (b = -3011.14 [95% CI: -4665.84, -1356.45]), and comorbidities (b = -2501.75 [95% CI: -3357.44, -1646.07]) were associated with lower overall PA. Higher general QoL (b = 89.96 [95% CI: 40.99, 138.94]) was associated with higher PA.

CONCLUSION

PA interventions may support wellbeing of older people in the region, and tailored interventions should be explored.

The impact of sociocultural contexts on the knowledge, attitudes, and practices of adults living with HIV/AIDS in Ethiopia towards metabolic syndrome risks: A descriptive phenomenology study using the PEN-3 model

INTRODUCTION

The global HIV/AIDS initiative in Africa aims for eradication by 2030 and treatment for 95% of HIV-positive adults by 2025. Adult People living with HIV (PLWHs) face health complications, including metabolic syndrome (MS), which heightens the risk of non-communicable diseases (NCDs) and cardiovascular problems. WHO and UNAIDS advocate for the integration of NCDs into primary healthcare, yet addressing MS remains a significant challenge in Africa. The WHO's Global Action Plan aims to reduce chronic diseases by managing risk factors and promoting healthy lifestyles within this population. However, effectively promoting healthy lifestyles necessitates an understanding of the sociocultural contexts that influence behaviors related to MS. Therefore, this study investigates how sociocultural contexts influences on knowledge, attitudes, and practices of PLWHs in Ethiopia regarding MS prevention and associated lifestyle risks, utilizing the PEN-3 model as a sociocultural framework.

METHODS

The study utilized a deductive descriptive phenomenological approach, involving 32 voluntarily selected PLWHs who sought routine care at public health institutions from December 29, 2017, to January 22, 2018. Data collection was facilitated by experienced research and task teams using standardized guidelines for focus group discussions and in-depth interviews tailored to the research context. The collected text and survey data were managed with Atlas.ti and SPSS software and analyzed through thematic content analysis. Results were reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist.

RESULTS

A study of 32 HIV-positive adults found that knowledge, attitudes, and health-related behaviors were key factors in their health. Participants learned about metabolic syndrome (MS) risks through mass media, peer discussions, and family education. However, there was a lack of awareness about the impact of HIV medications on MS and limited understanding of lifestyle factors for disease prevention. Attitudes reflect complex challenges for PLWHs in perceiving MS and its management. Health-related behaviors varied, with positive practices like fruit and vegetable consumption, regular exercise, and avoidance of harmful substances. Negative practices included sedentary lifestyles, raw meat consumption, alcohol, smoking, and 'Khat' use, which could negatively affect health outcomes. Addressing these culturally preferred behaviors is crucial for improving health among PLWHs.

CONCLUSION

The study revealed a notable knowledge gap regarding metabolic syndrome (MS) and its risk factors, leading to inadequate health attitudes and practices. Sociocultural factors-such as beliefs, values, family dynamics, and community support-are crucial in shaping the knowledge, attitudes and practice of PLWHs toward the prevention and management of chronic diseases like MS. The finding suggested that addressing the sociocultural factors affecting HIV-positive individuals' knowledge and practices regarding metabolic syndrome requires a comprehensive, inclusive approach that emphasizes education, community involvement, policy reform, and a focus on reducing stigma.

Low-level physical activity predictors among adults living with HIV in Ethiopia's southern region, focusing on work, transportation, and recreation domains: unmatched case-control study

BACKGROUND

Low-level physical activity (LLPA) is crucial for the well-being of adults living with HIV (PLWHs). However, many do not engage in enough physical activity, leading to adverse health outcomes. Identifying the determinants of LLPA can aid in developing effective interventions. Despite this, Ethiopia lacks evidence on this topic. This study aimed to identify predictors of LLPA among PLWHs in the Gedeo zone, located in southern Ethiopia.

METHODS

An unmatched case-control study was conducted on PLWHs in the Gedeo zone who visited two hospitals and healthcare institutions between December 29th, 2017 and January 22nd, 2019. Respondents were classified into three categories based on their total physical activity levels: high, moderate, and low. Cases were defined as those meeting the criteria for LLPA, while controls were those who did not fall under the cases category. Data was collected using the WHO Stepwise surveillance tool and analyzed using Epidata v3.1 templates and SPSS v22. Predictor variables with a P-value < 0.25 in bivariable analysis and < 0.05 with a 95% confidence interval in multivariable analysis were selected.

RESULTS

The study involved 633 HIV-positive adults, with a response rate of 92.41%. Most participants were under 34 years old, with an average age of 36.47±(9.055) for cases and 36.38±(8.389) for controls. The multivariable analysis revealed that educational status (AOR = 4.85, P = 0.02, 95%CI (1.28-18.44)), sex (AOR = 0.24, P = 0.04, 95%CI (0.07-0.90)), duration on ART being exposed for 1-4 Years (AOR = 0.12, P < 0.001, 95%CI (0.03-0.44)) and being exposed for 5-9 Years (AOR = 0.03, P < 0.001, 95%CI (0.01-0.16)), and former alcohol use (AOR = 0.11, P < 0.01, 95%CI (0.02-0.56) were significant predictors of LLPA performance.

CONCLUSIONS

The study concluded that educational status, sex, ART duration, and past alcohol use are key determinants of LLPA performance among PLWHs in southern Ethiopia. This suggests that policymakers should implement public health campaigns to promote healthy habits, particularly low-level physical activity, among PLWHs.