Non-communicable Diseases (NCDS) Burden Among People Living With HIV/AIDS (PLHIV) in Kenya

Abstract

Introduction: People living with HIV (PLHIV) in Kenya are disproportionately affected by non-communicable diseases (NCDs) yet care is suboptimal. Objectives: This study sought to determine burden of NCDs among PLHIVs in Kenya and assess benefit of NCD integrated care within HIV settings. Materials and Methods: This study was nested and involved a component of systematic literature review and use of secondary data. For general population PLHIV data was drawn from the national longitudinal surveillance of treatment study (LSTIK II) derived from 50 comprehensive care clinics in Kenya, while key population PLHIV was drawn from Sex Worker Outreach Program (SWOP) clinics key population program in Nairobi. For LSTIK II (2003-2013), 3,340 patient records were obtained through a multistage sampling design while all 2200 patient records for SWOP (2012-2015) were considered. Statistical Analyses: Among general population clients, we assessed distribution of NCDs by ART status and calculated incidence rate ratios for selected baseline demographic and clinical characteristics and incidence/1000 person years by ART status. We estimated prevalence of four NCD-categories among KPs, assessed distributions of co-morbidities using Chi-square test and conducted multivariate analysis to identify factors associated with NCD diagnoses. Results: General Population PLHIV: We analyzed 3170 patient records; 2115 (66.3%) were from women. Close to two-thirds (63.9%) of PLHIVs were on ART. The proportion of any documented NCD among PLHIV was 11.5% (95% confidence interval [CI] 9.3, 14.1), with elevated blood pressure as the most common NCD (87.5%) among PLHIV with diagnosed NCD. At one year of follow-up 43.8% of PLHIV not on ART had been diagnosed with an NCD compared to 3.7% of patients on ART; at five years the proportions with a diagnosed NCD were 88.8% and 39.2% (p<0.001), respectively. vi HIV-infected Key Populations: Overall, 1,478 individuals’ records were analyzed; 1,392 (94.2%) FSWs and 86 (5.8%) MSMs. A total of 271, 18.3% (95% CI 16.4 -20.4%), HIV-infected KPs had an NCD diagnosis in their clinical records; 258 (95.2%) being from FSWs. Some form of cardiovascular disease (CVD) was present in 249/271, 91.8%, of KPs with a documented NCD. Chronic respiratory disease was present in 16/271, prevalence of 1.1% (95% CI: 0.62 – 1.75). Cancer was in 10/271, prevalence of 0.7% (95% CI: 0.32 -1.24). Diabetes was not reported. Significant associations between NCD diagnosis and increased age, unemployment status, BMI and CD4 of NCD diagnoses ceased on adjusted analyses. Systematic Review: We identified 49 eligible studies. In 23 (46.9%) studies. Twenty-four (49.0%) studies were conducted among HIV-infected individuals at HIV clinics, 16 (32.7%) in general clinics, 6 (12.2%) integrated community-based screening, 2 (4.1%) applied differentiated-care models and 1 (2.0%) was at population level. For NCDs, positive outcomes of early screening and identification that forestalled complications associated with NCD progression were identified. Conclusion: We provide estimates and draw attention to the high prevalence of NCDs among PLHIV – general and key populations living with HIV. We offer recommendations on leveraging on comparably formidable HIV healthcare delivery platforms through NCD/HIV care integration for service delivery to address the high prevalence of NCDs.