| dc.description.abstract | Background: Successful rollout of highly active antiretroviral therapy has improved survival and ageing among persons living with HIV. Opportunistic infections are declining as the leading cause of morbidity and mortality among persons living with HIV. Though comprehensive data are lacking, concern has been raised about the high burden of non-communicable diseases among persons living with HIV. Several factors such as effects of antiretroviral therapy, increased life expectancy and survival to old age among persons living with HIV, environmental risk factors that affect the general population, overweight and obesity, unhealthy diet, physical inactivity, and subsistence abuse contribute greatly to this burden. The high burden of non-communicable diseases among persons living with HIV increases polypharmacy and drug interactions, increases the use of healthcare resources, increases morbidity and mortality, and negatively impact the quality of life of HIV patients.
This study aimed to estimate the prevalence and factors associated with selected non-communicable diseases (diabetes, hypertension, and depression) as well as explored health systems challenges in managing HIV patients with the selected non-communicable diseases (hypertension, diabetes, and depression) at Kalisizo Hospital. This may help health care managers and the Ministry of Health officials to design interventions to control as well as improve care and management of HIV patients with the selected non-communicable diseases. Methods: A cross-sectional study utilizing mixed methods was conducted at Kalisizo Hospital. A sample of 290 HIV patients attending the HIV Clinic was randomly selected from 8th to 24th August 2020. Quantitative data were collected on socio-demographic characteristics, height, weight, blood pressure, blood sugar, physical activity, depression, smoking, and alcohol use. These data were collected using the following tools: an adapted WHO steps questionnaire, patient Health Questionnaire-9, and an extraction form for the data extracted from medical records. The qualitative data were collected using key-informant-interviews with 10 health workers managing HIV patients and were audio recorded. Quantitative data were entered in excel and exported to STATA Version 15.0 for analysis. Descriptive analyses were performed, and descriptive data were presented using mean (standard deviation) and frequencies and percentages. Factors associated with selected non-communicable diseases were measured using bivariate and multivariable modified Poisson regression, reporting prevalence ratios with their 95% Confidence interval and
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p-value. Key informant interview recordings were transcribed verbatim. The transcriptions were analyzed manually, where categories were identified and merged into themes.
Results: The mean age of the participants was 43.4 (standard deviation 8.7) years. Of the 290 respondents, 193/290 (66.6%) were females, 139/290 (47.9%) were married, 113/290 (39.0%) had lower primary education, 209/290 (72.1%) were catholics, 122/290 (42.2%) engaged in agricultural occupation and 100/279 (35.8%) earned greater than 100000 Uganda shillings but less than or equal to 500000 Uganda shillings. The overall prevalence of selected non-communicable diseases was 39.7% (95% CI=34.2%-45.4%). The prevalence of selected non-communicable diseases was significantly higher among participants who; had tertiary education (APR=1.55, 95% CI=1.05-2.77, P=0.026), were obese (APR=2.01, 95% CI=1.40-2.87, p<0.001), were in WHO clinical staging 3 and 4 of HIV (APR=1.45, 95% CI=1.02-2.05 p=0.037) and had unhealthy diets (APR=1.61, 95% CI=1.20-2.16 p=0.002).
Health systems challenges in managing HIV patients with non-communicable diseases as observed from key-informant-interviews included difficulty managing adverse events, inadequate communication from specialists to lower cadre health workers especially nurses and clinical officers following referral, limited financial and human resources, unsupportive clinical guidelines which did not incorporate non-communicable disease management in HIV care and treatment and inadequate knowledge and skills required to appropriately manage non-communicable diseases. Conclusion and recommendation: Prevalence of the selected non-communicable diseases was high among persons living with HIV. It is therefore important for the policy makers in the Ministry of Health in collaboration with appropriate institutions to promote health and lifestyle changes especially physical activity and dietary modification and to incorporate NCD management in routine HIV care and treatment and this will help to improve the health and wellbeing of persons living with HIV in rural Uganda. | en_US |
