Prevention of cardiovascular disease among people living with HIV in sub-Saharan Africa

Okello, Samson; Almasi‐Hashiani, Amir; Bloomfield, Gerald S.; Kentoffio, Katie; Lugobe, Henry Mark; Reynolds, Zahra; Magodoro, Itai M.; North, Crystal M.; Okello, Emmy; Peck, Robert; Siedner, Mark J.

doi:10.1016/j.pcad.2020.02.004

Cited by 34 publications

(36 citation statements)

References 188 publications

(176 reference statements)

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“…Adequate training of physicians and pharmacists is essential to deal with increasingly complex cases across Africa given the increasing prevalence of diseases and patients with co-morbidities [ 7 , 52 , 53 , 54 , 55 ]. This is seen as particularly important during the COVID-19 pandemic given the extent of misinformation that exists regarding possible medicines for the prevention and treatment of COVID-19 and their consequences [ 9 , 56 ].…”

Section: Introductionmentioning

confidence: 99%

Challenges and Innovations Brought about by the COVID-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future

Etando¹,

Amu²,

Haque

et al. 2021

Healthcare

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Background: Multiple measures introduced early to restrict COVID-19 have dramatically impacted the teaching of medical and pharmacy students, exacerbated by the lack of infrastructure and experience with e-learning at the start of the pandemic. In addition, the costs and reliability of the Internet across Africa pose challenges alongside undertaking clinical teaching and practical programmes. Consequently, there is a need to understand the many challenges and how these were addressed, given increasingly complex patients, to provide future direction. Method: An exploratory study was conducted among senior-level medical and pharmacy educators across Africa, addressing four key questions, including the challenges resulting from the pandemic and how these were dealt with. Results: Staff and student members faced multiple challenges initially, including adapting to online learning. In addition, concerns with the lack of equipment (especially among disadvantaged students), the costs of Internet bundles, and how to conduct practicals and clinical teaching. Multiple activities were undertaken to address these challenges. These included training sessions, developing innovative approaches to teaching, and seeking ways to reduce Internet costs. Robust approaches to practicals, clinical teaching, and assessments have been developed. Conclusions: Appreciable difficulties to teaching arising from the pandemic are being addressed across Africa. Research is ongoing to improve education and assessments.

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Section: Introductionmentioning

confidence: 99%

Challenges and Innovations Brought about by the COVID-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future

Etando¹,

Amu²,

Haque

et al. 2021

Healthcare

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“…The astronomic rise in cardiovascular disease (CVD) burden on the African continent coupled with high infectious disease burden, such as HIV, imposes a considerable burden on the fragile health systems and developing economies in this region [14]. Contemporary data on the rising burden of CVDs such as type 2 DM among PLWH, in particular, are needed to understand its determinants and propose solutions to address this double burden of disease [15].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and incidence of pre‐diabetes and diabetes mellitus among people living with HIV in Ghana: Evidence from the EVERLAST Study

et al. 2020

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Background Available data from high‐income countries suggest that people living with HIV (PLWH) have a four‐fold higher risk of diabetes compared with HIV‐negative people. In sub‐Saharan Africa, with 80% of the global burden of HIV, there is a relative paucity of data on the burden and determinants of prevalent and incident dysglycaemia. Objectives To assess the prevalence and incidence of pre‐diabetes (pre‐DM) and overt diabetes mellitus (DM) among PLWH in a Ghanaian tertiary medical centre. Methods We first performed a cross‐sectional comparative analytical study involving PLWH on combination antiretroviral therapy (cART) (n = 258), PLWH not on cART (n = 244) and HIV‐negative individuals (n = 242). Diabetes, pre‐DM and normoglycaemia were defined as haemoglobin A1C (HBA1c) > 6.5%, in the range 5.7–6.4% and < 5.7% respectively. We then prospectively followed up the PLWH for 12 months to assess rates of new‐onset DM, and composite of new‐onset DM and pre‐DM. Multivariate logistic regression models were fitted to identify factors associated with dysglycaemia among PLWH. Results The frequencies of DM among PLWH on cART, PLWH not on cART and HIV‐negative individuals were 7.4%, 6.6% and 7.4% (P = 0.91), respectively, while pre‐DM prevalence rates were 13.2%, 27.9% and 27.3%, respectively (P < 0.0001). Prevalent DM was independently associated with increasing age [adjusted odds ratio (95% confidence interval) (aOR, 95% CI) = 1.82 (1.20–2.77) for each 10‐year rise], male sex [aOR = 2.64 (1.20–5.80)] and log(triglyceride/HDL cholesterol) [aOR = 8.54 (2.53–28.83)]. Prevalent pre‐DM was independently associated with being on cART [aOR (95% CI) = 0.35 (0.18–0.69)]. There were a total of 12 cases of incident DM over 359.25 person‐years, giving 33.4/1000 person‐years of follow‐up (PYFU) (95% CI: 18.1–56.8/1000), and an rate of incident pre‐DM of 212.7/1000 PYFU (95 CI: 164.5–270.9/1000). The two independent factors associated with new‐onset DM were having pre‐DM at enrolment [aOR = 6.27 (1.89–20.81)] and being established on cART at enrolment [aOR = 12.02 (1.48–97.70)]. Conclusions Incidence rates of pre‐DM and overt DM among Ghanaian PLWH on cART ranks among the highest in the literature. There is an urgent need for routine screening and a multidisciplinary approach to cardiovascular disease risk reduction among PLWH to reduce morbidity and mortality from the detrimental effects of dysglycaemia.

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“…Our ndings appear to contradict previous studies that suggested HIV individuals had a higher CVD burden. (21)(22)(23) However, because of the complete dependence on physician diagnosis and missing diagnoses of prevalent cardiovascular problems frequent in HIV, such as atherosclerotic illnesses, our ndings should be interpreted with caution. Previous needs assessments in public health facilities, particularly regional referral hospitals, revealed a lack of diagnostics capability for screening and diagnosing major NCDS, such as CVDs, which may explain our low incidence in these settings.…”

Section: Discussionmentioning

confidence: 87%

The Burden of Non-Communicable Diseases among Hospitalized HIV Positive Patients at Lira Regional Referral Hospital, Northern Uganda: Retrospective Chart Review 2016-2020

Bernard

Bosco

Bony

et al. 2022

Preprint

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Background: Non-communicable diseases(NCDs) are increasing rapidly in sub-Sahara Africa including Uganda. Knowledge of the effect of long-term antiretroviral therapy(ART) and emergence of NCDs on hospital utilization remain scant. This study aimed to assess the burden of major NCDs and predictors of mortality among hospitalized HIV positive patients in the medical wards at Lira regional referral hospital in Northern Uganda.Method: We conducted a retrospective cross-sectional chart review of hospitalized patients from the male and female medical wards between 2016 and 2020. The prevalence of NCDs was estimated and status at discharge determined. Binary and multi-variable regression analyses were performed to determine predictors of mortality with statistical significance set at 0.05 p-value. Results: A total of 445 patient files were examined, with 49 percent (n=218) of them revealing HIV status. Males made up 53% of the total number of patients studied (n=226). In HIV positive patients, the prevalence of at least one NCD, two NCDs, and three or more NCDs multi-morbidity was 73 percent, 16 percent, and 2 percent, respectively. In HIV negative controls, the prevalence of at least one NCD, two NCDs, and three or more NCDs was 62 percent, 28 percent, and 6 percent, respectively, compared to HIV positive controls. Cardiovascular diseases, diabetes, cancers, chronic lung disease, liver diseases, and mental disorders were found in 19.52 percent (CI: 14.67-25.49) of HIV positive patients versus 36.99 percent (CI: 30.06-44.50), 4.4.65 percent (CI: 02.51-08.51) versus 22.65 percent (CI: 17.57-29.74 p-value= 0.001), 13.55 percent (CI: 09.56-18.87) versus 9. 56 percent (CI: 05.99-14.89), 04.65 percent (02.51-08.47) versus 5.62(03.03-10.18), 27.91 percent (22.27-34.32) versus 29.53 (23.48-36.41), and 26.63 percent (21.10-33.02)versus 06.82 (03.89-11.68,p-value-=<0.001). In HIV patients, being middle-aged (40-50 years) was the sole independent predictor of mortality.Conclusion. HIV positive inpatients had a lower prevalence of major NCDs than HIV negative inpatients, albeit, this was not statistically significant except for diabetes mellitus and mental disorders. Increasing age is a significant predictor of mortality in hospitalized HIV positive patients. Prioritizing screening infrastructure and service capacity to reduce the burden of NCDs in PLHIV is critically important.

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Prevention of cardiovascular disease among people living with HIV in sub-Saharan Africa

Cited by 34 publications

References 188 publications

Challenges and Innovations Brought about by the COVID-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future

Challenges and Innovations Brought about by the COVID-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future

Prevalence and incidence of pre‐diabetes and diabetes mellitus among people living with HIV in Ghana: Evidence from the EVERLAST Study

The Burden of Non-Communicable Diseases among Hospitalized HIV Positive Patients at Lira Regional Referral Hospital, Northern Uganda: Retrospective Chart Review 2016-2020

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