Non-communicable disease (NCD) risk among people living with HIV in KwaZulu-Natal, South Africa: evidence from a randomised trial of community-based differentiated service delivery

IF 4.9 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2025-07-07 DOI:10.1002/jia2.26513

Maitreyi Sahu, Adam A. Szpiro, Heidi van Rooyen, Stephen Asiimwe, Maryam Shahmanesh, D. Allen Roberts, Meighan L. Krows, Kombi Sausi, Nsika Sithole, Torin Schaafsma, Jared M. Baeten, Adrienne E. Shapiro, Alastair van Heerden, Ruanne V. Barnabas

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引用次数: 0

Abstract

Introduction

As differentiated HIV services provided outside of clinics are scaled up, clients may have fewer interactions with ancillary services for non-communicable disease (NCD) prevention and management traditionally offered within facilities. This study was embedded in the DO ART randomised trial (2016−2019), which demonstrated that community-based differentiated service delivery (DSD) improved HIV viral suppression compared with facility-based care. We assessed NCD risk among men and women living with HIV accessing community-based DSD versus facility-based care in KwaZulu-Natal, South Africa.

Methods

First, we described lifestyle and clinical NCD risk among DO ART participants in rural and semi-rural KwaZulu-Natal. Next, we compared clinical NCD risk at 12 months by randomisation arm (community-based DSD vs. facility-based care). Finally, we explored the relationship between 12-month viral suppression and clinical NCD risk, overall and stratified by randomisation arm (i.e. service delivery type).

Results

Among 1010 participants, the median age was 32 years, 245 (24%) smoked, 229 (23%) had hypertension and 502 (50%) were overweight or obese (body mass index [BMI] ≥ 25). Smoking was more common among men than women (43% vs. 6%, p ≤ 0.001), while overweight/obesity was more common among women than men (65% vs. 34%, p ≤ 0.001). We found no statistically significant association between service delivery type and clinical NCD risk factors at 1 year. We also found no significant associations between viral suppression at 12 months and blood pressure, haemoglobin A1c or smoking. However, virally suppressed clients had higher mean BMI (+0.93 kg/m², p = 0.004) and higher mean cholesterol (+5.79 mg/dl, p = 0.001). These associations were greater in effect size and statistically significant among clients receiving community-based DSD (BMI: p = 0.003; cholesterol: p = 0.001), but smaller and not significant for facility-based care (BMI: p = 0.299; cholesterol: p = 0.448).

Conclusions

Relatively younger adults accessing HIV treatment in South Africa had substantial NCD risk, which differed by gender and may increase with age. Among clients receiving community-based DSD, viral suppression was associated with modestly higher BMI and cholesterol levels. Community-based DSD programmes should consider integrating NCD risk screening and management that addresses gender-specific needs to prevent premature mortality among people living with HIV.

Clinical Trial Number

NCT0292999

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南非夸祖鲁-纳塔尔省艾滋病毒感染者的非传染性疾病风险：来自社区差异化服务提供的随机试验的证据

随着诊所外提供的差异化艾滋病毒服务的扩大，客户与传统上在设施内提供的非传染性疾病预防和管理辅助服务的互动可能会减少。该研究嵌入在DO ART随机试验（2016 - 2019）中，该试验表明，与基于设施的护理相比，基于社区的差异化服务提供（DSD）改善了HIV病毒抑制。我们评估了南非夸祖鲁-纳塔尔省艾滋病毒感染者接受社区DSD与设施护理的非传染性疾病风险。首先，我们描述了夸祖鲁-纳塔尔省农村和半农村DO ART参与者的生活方式和临床非传染性疾病风险。接下来，我们通过随机分组（基于社区的DSD与基于设施的护理）比较了12个月的临床非传染性疾病风险。最后，我们探讨了12个月病毒抑制与临床非传染性疾病风险之间的关系，并按随机分组（即服务提供类型）进行了总体和分层。结果1010名参与者中，年龄中位数为32岁，吸烟245人（24%），高血压229人（23%），超重或肥胖502人（50%）（体重指数[BMI]≥25）。吸烟在男性中比女性更常见（43%比6%，p≤0.001），而超重/肥胖在女性中比男性更常见（65%比34%，p≤0.001）。我们发现服务提供类型和临床非传染性疾病风险因素在1年内没有统计学上的显著关联。我们还发现，12个月时的病毒抑制与血压、血红蛋白A1c或吸烟之间没有显著关联。然而，病毒抑制的患者有较高的平均BMI （+0.93 kg/m2, p = 0.004）和较高的平均胆固醇（+5.79 mg/dl, p = 0.001）。这些关联在效应大小上更大，在接受社区DSD的客户中具有统计学意义(BMI: p = 0.003；胆固醇：p = 0.001)，但在基于设施的护理中较小且不显著(BMI: p = 0.299；胆固醇：p = 0.448)。结论：在南非，接受HIV治疗的相对年轻的成年人有很大的NCD风险，这种风险因性别而异，并可能随着年龄的增长而增加。在接受社区DSD治疗的患者中，病毒抑制与中等较高的BMI和胆固醇水平相关。以社区为基础的疾病和发展规划应考虑整合非传染性疾病风险筛查和管理，以解决针对性别的需求，防止艾滋病毒感染者过早死亡。临床试验编号NCT0292999

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.