NCD Epidemiology in Adolescents Living with HIV
Investigating NCDs and NCD risk factors in adolescents and youth living with HIV in peri-urban Cape Town, South Africa.
South Africa is facing a double burden of disease with an increase in non-communicable diseases (NCDs) like obesity and an existing burden of infectious diseases, including human immunodeficiency virus (HIV). Adolescents and youth bear a disproportionate burden of HIV, and youth living with HIV have an increased risk of NCDs in part due to psychosocial challenges and the complications of antiretroviral therapy (ART).
To better understand the interlinkages between HIV and NCDs when they co-exist (also known as co-morbidity) in adolescents and youth living with HIV (AYLHIV) in peri-urban South Africa, we explored:
- The extent to which NCD prevention, screening and management are already part of existing adolescent HIV primary healthcare services.
- The prevalence of NCDs and their risk factors in AYLHIV.
- Individual, household, social and neighbourhood level factors associated with abdominal obesity in AYLHIV.
We initially reviewed the medical records of 491 AYLHIV accessing HIV care across nine primary care health facilities in Cape Town.
We then conducted interviews and clinical observations on a sample of 92 adolescents to ascertain their health profile, environmental exposures, and NCD risk factors during routine clinic visits between March and December 2019.
Key findings / Progress
Despite high NCD comorbidity, our patient records review showed limited attention to NCD prevention, screening and treatment within adolescent HIV primary care.
For example, only 62% of patient folders had documented height and weight, measurements necessary to calculate body mass index, an indicator of obesity. This evidence suggests inadequate integration of NCDs within HIV health services, a missed opportunity to identify those at risk and to prevent NCDs before they occur.
We found a significant burden of common NCDs – hypertension (5%), abdominal obesity (determined using waist circumference) (37%), depression (43%) and psychological distress (44%). AYLHIV reported high levels of household food insecurity (70%) and economic deprivation (44%). They reported low daily fruit and vegetable consumption; while unhealthy food consumption, including fast-foods and sugar-sweetened beverages, was high. Furthermore, they had low nutritional knowledge especially with respect to how diets relate to disease. Encouragingly, two-thirds had sufficient weekly levels of physical activity, primarily from walking. Considering the relatively high burden of NCDs and NCD risk factors in urban AYLHIV, healthy behaviours should be promoted in this population.
We also found that various individual, household and environmental factors were associated with abdominal obesity. At the individual level, skipping breakfast, low wholegrain consumption, absence from school or work and not engaging in weekly physical activity were associated with an increased risk of obesity. Within households, living in a home with an uncomfortable temperature was associated with increased odds of obesity. At the environmental level, having access to a diversity of neighborhood-level destinations and recreational places, good pedestrian facilities, traffic safety, and having a non-fast-food restaurant within walking distance were all associated with a reduced risk of abdominal obesity in this population group.
Our findings highlight that for a more comprehensive approach to keeping AYLHIV healthy, it is vital that care is integrated, incorporating physical, socio-cultural and environmental factors that influence health behaviours and outcomes in order to prevent disease in young people. As many of these factors lie outside healthcare systems, multisectoral interventions are needed to prevent NCDs in adolescents and youth living with HIV.
- Kamkuemah M, Gausi B, Oni T. Missed opportunities for NCD multimorbidity prevention in adolescents and youth living with HIV in urban South Africa. BMC Public Health. 2020 Dec; 20:1-1.
- Kamkuemah M, Gausi B, Oni T. High prevalence of NCD multimorbidity in South African Adolescents and Youth Living with HIV: Implications for Integrated Prevention (Under peer review).
- International Workshop on HIV & Adolescence, November 2020. Mental health and substance use in adolescents and youth living with HIV in a context of violence.
- International Workshop on HIV & Adolescence, November 2020 Epidemiology of non-communicable Diseases (NCDs) and risk factors in South African adolescents and youth living with HIV in an urban setting.
- 17th European AIDS Conference, Basel, Switzerland, November 2019. Non-communicable disease screening and prevention in adolescents and youth living with HIV in the context of rapid urbanisation in South Africa.
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