Diabetes mellitus among adults on highly active anti-retroviral therapy and its associated factors in Ethiopia: Systematic review and meta-analysis

Belay, Demeke Mesfin; Bayih, Wubet Alebachew; Alemu, Abebaw Yeshambel; Mekonen, Demewoz Kefale; Aynew, Yeshambaw Eshetie; Jimma, Melkamu Senbeta; Chanie, Ermias Sisay; Hailemeskel, Habtamu Shimels; Necho, Worku; Kassaw, Amare; Teshome, Diriba; Hailemichael, Wasihun; Getu, Sisay; Kiros, Mulugeta; Arage, Getachew; Henok, Andualem; Birhane, Binyam Minuye

doi:10.1016/j.diabres.2021.109125

Cited by 7 publications

(2 citation statements)

References 53 publications

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“…Independent variables were categorised into three groups: socio-economic, behavioural, and biological factors based on the literature review [ 17 , 23 – 25 , 30 – 34 ]. Socioeconomic factors included age (coded as 1 for ≥ 30 and 0 for < 35), marital status (coded as 1 = married, 2 = single, and 3 = widow/divorced), education (coded as 1 = primary or less, 2 = secondary education, and 3 = tertiary education), employment status (coded as 1 = unemployed, 2 = self-employed, and 3 = formally employed), and gender (coded as 1 = male and 0 = female).…”

Section: Methodsmentioning

confidence: 99%

Diabetes mellitus and associated factors among HIV-positive patients at primary health care facilities in Harare, Zimbabwe: a descriptive cross-sectional study

Chireshe,

Manyangadze,

Naidoo

2024

BMC Prim. Care

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Background Highly active antiretroviral therapy (HAART) has improved the life expectancy of people living with HIV (PLWH) and has increased the risk of chronic non-communicable diseases. Comorbid HIV and diabetes mellitus (DM) significantly increase cardiovascular disease and mortality risk. This study aimed to determine the prevalence of type 2 diabetes mellitus among HIV-positive patients receiving HAART in Zimbabwe and its associated risk factors. Methods This cross-sectional study was conducted at eight primary healthcare facilities in Harare, Zimbabwe, between January 2022 and March 2023. Non-probability convenience sampling was used to recruit adult HIV-positive patients undergoing HAART attending the facilities. Data were captured on clinical history and socio-demographic and behavioral characteristics, and analyzed using descriptive statistics to determine DM prevalence rates. Additionally, bivariate and multivariate logistic regression models were employed to examine factors associated with HIV and DM comorbidities. Results A total of 450 participants were included in this study, of which 57.6% (n = 259) were female. The majority were married (73.8%) and older than 35 years (80.2%). Most participants had completed high school (87.6%) and 68.9% were employed either formally or self-employed. The prevalence of diabetes mellitus (DM) was 14.9%. HIV/DM comorbidity was more prevalent in patients who were female, self-employed, and smoked (p < 0.05). Multivariate logistic regression analysis revealed that the factors associated with DM-HIV comorbidity were gender, age, education, marital status, employment status, smoking, physical activities, duration of HAART, and diet. Age, level of education, marital status, and occupation were not associated with HIV-DM comorbidity. Obesity (body mass index > 30 kg/m2), smoking, and alcohol consumption were associated with an increased risk of DM. Regular physical activity is associated with a reduced risk of DM. Conclusion A substantial burden of DM was found in PLWH. The intersectoral integration approach is advocated, and active screening for DM is recommended. Gender-specific interventions are necessary to target diseases and health behaviors that differ between men and women. These interventions should be customized to the specific diseases and behaviors of each group.

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Section: Methodsmentioning

confidence: 99%

Diabetes mellitus and associated factors among HIV-positive patients at primary health care facilities in Harare, Zimbabwe: a descriptive cross-sectional study

Chireshe,

Manyangadze,

Naidoo

2024

BMC Prim. Care

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“…The increased risk of hypertension among PLHIV has been intensi ed by the combination of HIV-associated immune dysregulation, microbial translocation to the systemic circulation, altered lipid metabolism, and chronic systemic in ammation (26). Highly Active Antiretroviral Therapy (HAART) has been attributed to the incidence of diabetes among PLHIV through altering glucose and lipid metabolism, impaired insulin sensitivity, and increasing insulin resistance (27)(28)(29)(30)(31)(32)(33). Family history of diabetes, weight gain, lipodystrophy syndrome, systemic in ammation, advance in age, and hepatitis C infection have also been a rmed as risk factors for the development of diabetes among PLHIV (4,34,35).…”

Section: Introductionmentioning

confidence: 99%

Cost analysis of integrating hypertension and diabetes management into routine HIV care in Mbarara and Ibanda districts, Uganda

Ninsiima,

Basu,

Husain

et al. 2024

Preprint

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Background In 2016, Uganda initiated integration of services for non-communicable diseases, including hypertension and diabetes, into existing HIV care services. However, this intervention has not been fully implemented yet in most HIV clinics. We evaluated the costs associated with scaling up hypertension and diabetes management services in selected HIV clinics in Mbarara and Ibanda districts, Uganda. Methods In March 2023, we obtained data on costs of providing hypertension and diabetes services in ten randomly selected HIV clinics in Mbarara and Ibanda districts including, healthcare providers’ salaries, time spent offering to these services, training costs, medications, and patient monitoring systems. Using the HEARTS costing tool, we estimated the annual costs of providing hypertension and diabetes services. We disaggregated annual costs by the domains of the HEARTS costing tool. We determined the average annual cost and medication expenses for hypertension and diabetes treatment per enrolled adult patient stratified by type of health facility. Results The total annual cost of hypertension and diabetes management services in ten selected HIV clinics was estimated to be $413,850 (range: $8,386 − 186,973). The annual average clinic-level cost per enrolled patient was estimated at $14 (range: $7 − 31). Of the total annual cost, the cost of provider time for initial and follow-up visits represented the largest cost component in 5/10 clinics (mean: 37%, range [13–58%]). In 4/10 clinics, the major cost components were the costs of medication, diagnostic tests, and related supplies (mean: 37%, range [10–75%]). The average cost per enrolled adult patient was $11 at public facilities and $21 in private not-for-profit facilities. The average medication cost per patient for hypertension was $24 (range: $7 − 97) annually; $13 at public facilities and $50 at private, not-for-profit facilities. For diabetes treatment, the average annual medication cost per patient was estimated at $14 (range: $6 − 35); $11 at public facilities and $22 at private not-for-profit facilities. Conclusion Integrating hypertension and diabetes management into routine HIV care might be feasible based on the estimated annual cost per patient. Hypertension and diabetes treatment was more costly in private not-for-profit facility-based clinics than at public facilities, primarily driven by the higher costs of medications.

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Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis

Gizamba,

Davies,

Africa

et al. 2023

BMC Infect Dis

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Background HIV has become a manageable chronic condition due to the success and scale-up of antiretroviral therapy (ART). Globally, South Africa has the highest number of people living with HIV (PLHIV) and research evidence indicates that countries with the highest burden of PLHIV have a substantial burden of obesity, hypertension (HPT) and type 2 diabetes (T2D). We sought to summarize the burden of these three common NCDs among PLHIV in South Africa. Methods In this systematic review, multiple databases were searched for articles reporting on the prevalence of obesity, HPT, and T2D among PLHIV in South Africa published since journal inception until March 2022. A meta-analysis was conducted using random-effects models to obtain pooled prevalence estimates of the three NCDs. Heterogeneity was assessed using X2 test on Cochran’s Q statistic. Results We included 32 studies, with 19, 22 and 18 studies reporting the prevalence of obesity, HPT, and T2D among PLHIV, respectively. The overall prevalence of obesity, HPT, and T2D was 23.2% [95% CI 17.6; 29.9], 25.5% [95% CI 15.6; 38.7], and 6.1% [95% CI 3.8; 9.7] respectively. The prevalence of obesity was significantly higher among women (P = 0.034) compared to men, however the prevalence of HPT and T2D did not differ by sex. The prevalence of each of the three NCDs did not differ significantly between rural, urban, and peri-urban areas. The prevalence of obesity and T2D was higher in studies conducted between 2013 and 2022 compared to studies conducted between 2000 and 2012, while the prevalence of HPT was higher between 2000 and 2012 compared to between 2013 and 2022. Conclusions These findings suggest that South Africa is experiencing a syndemic of NCDs among people PLHIV highlighting the need to increase cost-effective interventions and management strategies that involve integrated HIV and NCD care in the South African setting.

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Diabetes mellitus among adults on highly active anti-retroviral therapy and its associated factors in Ethiopia: Systematic review and meta-analysis

Cited by 7 publications

References 53 publications

Diabetes mellitus and associated factors among HIV-positive patients at primary health care facilities in Harare, Zimbabwe: a descriptive cross-sectional study

Diabetes mellitus and associated factors among HIV-positive patients at primary health care facilities in Harare, Zimbabwe: a descriptive cross-sectional study

Cost analysis of integrating hypertension and diabetes management into routine HIV care in Mbarara and Ibanda districts, Uganda

Prevalence of obesity, hypertension and diabetes among people living with HIV in South Africa: a systematic review and meta-analysis

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