The substantial burden of non-communicable diseases and HIV-comorbidity amongst adults: Screening results from an integrated HIV testing services clinic for adults in Soweto, South Africa

• Main Authors: Kathryn L. Hopkins, Khuthadzo E. Hlongwane, Kennedy Otwombe, Janan Dietrich, Mireille Cheyip, Jacobus Olivier, Heidi van Rooyen, Tanya Doherty, Glenda E. Gray
• Format: Article
• Language: English
• Published: Elsevier 2021-08-01
• Series: EClinicalMedicine
• Subjects: HIV; Non-communicable disease; Hypertension; Blood glucose; HbA1c; Cholesterol
• Online Access: http://www.sciencedirect.com/science/article/pii/S2589537021002959

Background: South Africa is disproportionately impacted by non-communicable diseases (NCDs) and HIV/AIDS. We investigated the prevalence of known/unknown NCD risk factors, HIV, and NCD risk factor-HIV comorbidity; and treatment status on known diseases to determine the prevalence of controlled/uncontrolled disease. Methods: This cross-sectional study (June 2018-March 2019) within an integrated testing centre in Soweto, South Africa, screened adults (aged ≥18 years) for body mass index (BMI), hypertension (HT), rapid glucose and cholesterol, and HIV. Results were stratified by age group, sex, HIV-status, and self-reported ART use. Analysis included Fisher's exact, chi-squared, Kruskal Wallis, and Student's T-tests. Findings: Of 780 enrolled participants, 19.2% were HIV-positive, 37.5% were overweight/obese, 18.0% hypertensive, 10.8% hyperglycaemic, and 8.1% had hypercholesterolaemia. Significantly more women had overweight/obese BMI than men (46.8% vs 19.7%; p<0.0001), and women aged 25–34 years had significantly more hypercholesterolaemia than same-aged men (18.2% vs 5.6%; p = 0.02). HIV-positive participants had significantly more hyperglycaemia than HIV-negative participants (16.1% vs 9.6%; p = 0.02), and those on ART (63.9%) had significantly more hypercholesterolaemia than those not on ART (21.7% vs. 4.9%; p = 0.002). Of participants with HT, hyperglycaemia, and hypercholesterolaemia; 72.4%, 96.1%, and 93.3% were newly diagnosed. All participants with previously diagnosed NCDs remained with uncontrolled disease. Interpretation: There is a high burden of HIV, NCD risk factors, and comorbidity in Soweto, and amongst young adults (18–34 years), especially women. Lowering age requirements for glucose/cholesterol screening to 18+ years, regardless of BMI, HIV-status, or ART use, may yield timely NCD diagnosis/management. Funding: This project has been supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the Centres for Disease Control and Prevention (CDC) under the terms of CoAg 1U2GGH001150. JD, TD and GEG are funded by the South African Research Council; and TD and GEG also by the National Research Foundation.