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.
Other UrbanBetter projects you might be interested in…
Global Diet and Activity Research (GDAR)
The Global Diet and Activity Research Group and Network (GDAR) is funded through the NIHR Global Health Research initiative. The goal is to help prevent non-communicable diseases (NCDs), such as type 2 diabetes, heart disease, and cancers, in low and middle income countries (LMICs).
Our work involves finding solutions that are affordable and created in partnership with local communities. GDAR builds on the expertise and knowledge of research in Cameroon, the Caribbean, Kenya, South Africa and the UK.
Integrating health into human settlements policy (LIRA study)
The LIRA study explores the knowledge, attitudes and practices of intersectoral collaboration between health and human settlements sectors among policymakers in Cape Town and Douala.
Using Cape Town, South Africa, and Douala, Cameroon, as case studies, this LIRA project (2018–2020), led by Tolullah Oni, seeks to develop a practical health and housing-integrated collaboration model that will improve urban policymaking and governance for the planning of African cities.
UrbanBetter project outputs
The fourth annual International Day of Clean Air for Blue Skies (07 September 2023) focusses on the theme, ‘Together for Clean Air’. The theme aims to highlight the urgent need for stronger partnerships, increased investment, and shared responsibility for overcoming air pollution. The CLEAN-Air Africa
The Africa Community of Practice of the International Society for Urban Health hosted another webinar, on “Age-friendly Public Spaces in African Cities: Opportunities and Challenges”. This is part of the Urban Health in Africa Networking and Webinar Series held on 22nd June 2023. The speakers,
Safe public transport can support climate action and public health….Here’s how both governments and citizens can play a role
Olasumbo Olaniyi, UrbanBetter Disruptor and Cityzen, is an environmental advocate on a mission. She says: “My journey as an environmental advocate took a radical turn when I began to work with the team at UrbanBetter. It made me more sensitive to my environment and overall
The Cityzens for Clean Air campaign, part of the UrbanBetter Cityzens initiative, aims to amplify youth voices with advocacy on air pollution, climate and health using citizen scientist data generated by young people. The report is based on PM2.5 and NO2 air quality data collected
Urban Health Data in Africa and Latin America: Experiences, Challenges and Opportunities – ISUH Community of Practice Webinar Report
Hosted by the Africa Community of Practice of the International Society for Urban Health, the webinar “Urban Health Data in Africa and Latin America: Experiences, Challenges and Opportunities”, is part of the Urban Health in Africa Webinar Series and was held on 23rd February 2023.
Urban Health Data in Africa and Latin America: Experiences, Challenges and Opportunities -ISUH Africa Community of Practice webinar
Hosted by the Africa Community of Practice of the International Society for Urban Health, the webinar “Urban Health Data in Africa and Latin America: Experiences, Challenges and Opportunities”, is part of the Urban Health in Africa Webinar Series and will be held on 23rd February
In this blog #UrbanBetter Disruptor, Waziri Mainasara Abubakar writes about his recent visit to a park in Lagos and what he discovered about the air quality at the park. “We spoke and he’ll be more than delighted to host you guys. He said to me that he
On the 25th of September 2022, Lagos held its first ever Car-Free day. To commemorate this event, Cityzens4CleanAir Run Leaders organised and led a run through the streets of Lagos, using the opportunity to advocate for clean air and healthy public spaces. We asked #UrbanBetter Disruptor, Olasumbo Olaniyi,
Appropriation of public space and urban infrastructure for leisure physical activity (ALPhA) -Second Lagos and Yaoundé stakeholder workshop reports
The research project “Informal Appropriation of Public Space for Leisure Physical Activity in Lagos and Yaoundé (ALPhA)”, led by the University of Cambridge, in collaboration with the Universities of Lagos and Yaoundé, aims to re-imagine urban space for healthy, safe leisure physical activity in Lagos,
Advancing participatory air quality management for urban health in Lagos:
Inaugural knowledge sharing and co-creation workshop
Air pollution – largely from industrial sources, motor vehicles, burning biomass and desert dust – kills more Africans than unsafe water, unsafe sanitation or childhood malnutrition, with significant implications for human development. Despite this, air quality monitoring remains inadequate across most of the continent. This highlights the
The second webinar hosted by the Africa Community of Practice of the ISUH on the 28th of April 2022 centered around “Urban Health Governance”. This was a sequel to the inaugural webinar which is part of the Urban Health in Africa Webinar Series. The speakers
The other pandemic: social media engagement around non-communicable disease preventive behaviours during Nigeria’s COVID-19 lockdowns
Abstract Given the complexity of global health crises such as the COVID-19 pandemic, it is typical for crisis-focused interventions to have a multiplicity of impacts. Some of these impacts may yield positive or negative externalities for health priorities that do not have the same perceived
Hosted by the Africa Community of Practice of the International Society for Urban Health, the webinar, centred around “Urban Health Governance”, is part of the Urban Health in Africa Webinar Series and will be held on 28th April 2022. The speakers will include actors from
Pairing Academia and Policy for Transdisciplinary Research in Africa – Inaugural webinar of the ISUH Africa Community of Practice
The inaugural webinar of the Africa Community of Practice of the International Society for Urban Health (ISUH) – “Pairing academia and policy for transdisciplinary research in Africa” – was held on the 2nd December 2021. The event brought together over 30 scholars, government and non-government
A Systematic Review Protocol of Opportunities for Noncommunicable Disease Prevention via Public Space Initiatives in African Cities
Abstract Public spaces have the potential to produce equitable improvements in population health. This mixed-methods systematic review aims to understand the components of, determinants, risks, and outcomes associated with public space initiatives in African cities. This study will include quantitative and qualitative study designs that
Appropriation of public space and urban infrastructure for leisure physical activity (ALPhA)
-Lagos and Yaoundé stakeholder workshop reports
As part of the research project on Informal Appropriation of Public Space for Leisure Physical Activity in Lagos and Yaoundé, led by the University of Cambridge, in collaboration with the Universities of Lagos and Yaoundé, the ALPhA research team hosted a first stakeholder workshop on
Health through human settlements: Investigating policymakers’ perceptions of human settlement action for population health improvement in urban South Africa.
In this commentary, we highlight five aspects of the ordinary – known interactions between urban environments and physical activity – that are amplified by the extraordinary – an unprecedented societal response to the ongoing COVID-19 pandemic. Using Lagos, Nigeria as a case study, we illustrate the possibility of re-thinking urban development and the potential for urban (re)form to address health inequalities in African megacities in the context of post-COVID-19 pandemic.
A participatory approach to building a coalition of health and planning sector urban actors in Africa-a Douala case-study
Developing a participatory approach to building a coalition of transdisciplinary actors for healthy urban planning in African cities – a case study of Douala, Cameroon
RICHE | Africa Workshop On Healthy Cities Report: Intersectoral Approaches To Non-Communicable Disease Prevention In Africa
Living in cities can create an urban advantage. They can give residents better access to opportunities such as employment and education, social connections, and services such as healthcare. But, rather than experiencing an urban advantage, residents of African cities are more familiar with an urban
RICHE | Africa Workshop On Healthy Cities: Intersectoral Approaches To Non-Communicable Disease Prevention In Africa
The “Healthy Cities: Intersectoral approaches to non-communicable disease prevention in Africa” workshop presented the opportunity to collaboratively identify opportunities to promote health and wellbeing and prevent non-communicable diseases in African cities through investments that support active living and healthy diets. Workshop participants were policy, civil
Using Cape Town, South Africa, and Douala, Cameroon, as case studies, this LIRA project (2018–2020), led by Tolullah Oni, seeks to develop a practical health and housing-integrated collaboration model that will improve urban policymaking and governance for the planning of African cities. The project brings together academic and non-academic stakeholders representing a range of expertise: public health, health geography, urban planning, and demography. The project contributes to SDG 3 and SDG 11.
A Systematised Review of the Health Impact of Urban Informal Settlements and Implications for Upgrading Interventions in South Africa, a Rapidly Urbanising Middle-Income Country
Informal settlements are becoming more entrenched within African cities as the urban population continues to grow. Characterised by poor housing conditions and inadequate services, informal settlements are associated with an increased risk of disease and ill-health. However, little is known about how informal settlement upgrading impacts health over time. A systematised literature review was conducted to explore existing evidence and knowledge gaps on the association between informal settlement characteristics and health and the impact of informal settlement upgrading on health, within South Africa, an upper-middle-income African country.