Noncommunicable Diseases Burden and Risk Factors in a Cohort of HIV+ Elderly Patients in Malawi

Ciccacci, Fausto; Tolno, Victor Tamba; Altan, Aanna Maria Doro; Liotta, Giuseppe; Orlando, Stefano; Palombi, Leonardo; Marazzi, Maria Cristina

doi:10.1089/aid.2019.0125

Cited by 36 publications

(32 citation statements)

References 36 publications

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“…Although chronic immune activation contributes to increased hypertension among PLHIV, the inflammatory milieu is poorly understood [33]. ART associated endothelial dysfunction [34], increasing age and longevity on ART treatment have also been associated with increased prevalence of NCDs among PLHIV [23,30,32]. In this study, close to two thirds of KPs living with HIV who had an NCD diagnosis, were either obese or overweight.…”

Section: Plos Onementioning

confidence: 77%

“…pressure readings [28,29], several others point to an increased prevalence of hypertension and obesity [5,7,30]. There are mixed associations with ART use on the prevalence of NCDs with some studies suggesting no associations with hypertension [23,31] while others finding an increased odds for hypertension, dyslipidemia and other cardiovascular conditions [29,30,32]. Although chronic immune activation contributes to increased hypertension among PLHIV, the inflammatory milieu is poorly understood [33].…”

Section: Plos Onementioning

confidence: 99%

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High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

et al. 2020

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Introduction People Living with HIV (PLHIV) bear a disproportionate burden of non-communicable diseases (NCDs). Despite their significant toll across populations globally, the NCD burden among key populations (KP) in Kenya remains unknown. The burden of four NCD-categories (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) was evaluated among female sex workers (FSWs) and men who have sex with men (MSM) at the Sex Workers Outreach Program (SWOP) clinics in Nairobi Kenya. Methods A retrospective medical chart review was conducted at the SWOP clinics among KP clients �15 years living with HIV enrolled between October 1, 2012 and September 30, 2015. The prevalence of the four NCD-categories were assessed at enrollment and during subsequent routine quarterly follow-up care visits as per the Ministry of Health guidelines. Prevalence at enrollment was determined and distributions of co-morbidities assessed using Chi-square and t-tests as appropriate during follow-up visits. Univariate and multivariate analysis were conducted to identify factors associated with NCD diagnoses. Results Overall, 1,478 individuals' records were analyzed; 1,392 (94.2%) were from FSWs while 86 (5.8%) were from MSM over the three-year period. FSWs' median age was 35.3 years (interquartile range (IQR) 30.1-41.6) while MSM were younger at 26.8 years (IQR 23.2-32.1). At enrollment into the HIV care program, most KPs (86.6%) were at an early WHO clinical stage (stage I-II) and 1462 (98.9%) were on first-line anti-retroviral therapy (ART). A total of 271, 18.3% (95% CI: 16.4-20.4%), KPs living with HIV had an NCD diagnosis in

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Section: Plos Onementioning

confidence: 77%

Section: Plos Onementioning

confidence: 99%

High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

et al. 2020

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“…DREAM is a public health program run by the Community of Sant'Egidio in 11 SSA (sub-Saharan African) countries that focuses on HIV prevention, care and retention strengthening, TB, and other diseases [12][13][14][15]. Each patient accessing the centres managed by the DREAM program has access to routine haematologic tests (in addition to molecular and biochemistry analyses) from the baseline of ART through follow-up according to national and/or international guidelines.…”

Section: Patient Populationmentioning

confidence: 99%

Hematologic alterations and early mortality in a cohort of HIV positive African patients

et al. 2020

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Introduction Infection with Human Immunodeficiency Virus (HIV) is highly prevalent worldwide, especially in Sub-Saharan Africa, where anaemia is also widespread. HIV infection is known to be associated with anaemia and various other haematologic alterations, but little data on correlation with immunological and virologic conditions in treatment-naïve patients and impact on mortality are available. Our study aims to investigate hematologic features in HIV-infected individuals in Malawi and Mozambique and assesses possible correlations with early morality. Material and methods We conducted a retrospective analysis of baseline data (general details, nutritional status, full blood count and HIV infection progress data) and 12 months follow-up status for HIV+ adult patients in 22 health facilities in Malawi (11 sites) and Mozambique (11 sites) run by DREAM program. Anagraphic details, anthropometric characteristics, full blood count, CD4+ count and Viral Load data were collected from electronical medical records (EMR) for all the HIV-positive, treatment-naïve patients starting care in the sites in the period January 2007 –December 2016. Follow-up status after one year since enrolment in care was also considered. All the data extracted from the EMR were included in a dataset and then analysed. Univariate and multivariate analysis were conducted through logistical regression to investigate associations, and survival analysis analysed in a Cox regression model. Results On the whole, 22.657 patients were included; severe and moderate anaemia were observed in 1.174 (8,2%) and 4.703 (21,9%) patients respectively. Gender, nutritional status, CD4+ count, and viral load (VL) were associated with anaemia, leukopenia, and thrombocytopenia. Among 21.166 fully evaluable patients, 8.494 (40,1%) had at least one cytopenia. Any cytopenia was present in 1/3 of patients with normal nutritional status and less advanced HIV infection, and it wouldn’t be diagnosed in a basic HIV care setting. During the first year of treatment, 1.725 subjects (7,6% of the entire sample) died. Anaemia, lower Red blood cells and platelets counts correlated with mortality in the first year of care, independently by body mass index, haemoglobin, CD4+ count and VL. Conclusions Notwithstanding anaemia is known to be associated with HIV infection at diagnosis, full blood count is not routinely performed in many African countries. Our results emphasize that including the study of a broader set of parameters in the routine HIV care services in Sub-Saharan Africa would provide significant clinical information able to predict other alterations and poor outcomes.

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“…These health facilities are part of the DREAM (Disease Relied through Excellent and Advanced Means) programme sub recipient of Global Fund, a public health program run by the Community of Sant'Egidio in 11 African Countries. This program focuses on HIV/AIDS, TB and NCDs [19][20][21]. The facilities are located in Blantyre (urban), Machinjiri (peri-urban), Chileka (peri-urban) and Balaka (rural).…”

Section: Study Population and Settingmentioning

confidence: 99%

Social determinants of male partner involvement in women's Prevention of Mother to Child Transmission care Program in Malawi

Triulzi

Keiser

Somerville

et al. 2020

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Background Male partners are rarely present during PMTCT (Prevention-Mother-To-Child-Transmission) services in Sub-Saharan Africa (SSA). Men’s involvement is increasingly recognised as an important element of women’s access to care. This study aims to identify the socio-demographic characteristics, HIV-Knowledge, Attitude and Practice (KAP) among women accompanied and not accompanied by their male partners. Methods We included pregnant women enrolled in PMTCT programme between August 2018 and November 2019 in the Southern Region of Malawi. Eligible women were aged 18 years or older, living with a male partner, enrolled for the first time in one of the four selected facilities. We provided a KAP survey to women and their partners attending the facilities. Our primary objective was to assess and analyse the proportion of women who were accompanied by their partner at least once. We applied descriptive statistics and logistic regressions to study the association between being accompanied and explanatory variables. Results We enrolled 128 HIV-positive women: 82 (64.1%) were accompanied by their male partners and 46 (35.9%) were alone. Women’s unemployment and possession of a vehicle are negatively associated with male attendance (respectively adjusted OR 0.32 [95% CI, 0.13-0.83] and 0.23 [95% CI, 0.07-0.77]), whereas high women’s level of knowledge of HIV is positively associated with male attendance (adjusted OR 2.33 [95% CI, 1.01-5.40]). Level of attitude and practice toward HIV were not significantly associated to our study variable. Conclusions Our study shows a high male involvement in Malawi compared to other studies performed in SSA. This study highlights the factors affecting male attendance which are women’s level of knowledge on HIV, economic condition (employment and means of transport) and healthcare system inequality including geographical accessibility. Moreover, the study points out that gender power relationships and stringent gender norms play a crucial role thus they should be considered to enhance male involvement.

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Noncommunicable Diseases Burden and Risk Factors in a Cohort of HIV+ Elderly Patients in Malawi

Cited by 36 publications

References 36 publications

High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

Hematologic alterations and early mortality in a cohort of HIV positive African patients

Social determinants of male partner involvement in women's Prevention of Mother to Child Transmission care Program in Malawi

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