Abstract:

BACKGROUND: Over the past three decades, the numbers of newly HIV infected people and AIDS-related mortality has sharply reduced following improvements made in limiting HIV transmission. This was due to advancement and easy accessibility of long-term anti-retroviral therapy that have resulted in viral suppression. Today, we are faced with a new challenge where HIV co-exists with non communicable diseases as PLHIV are now aging and able to live longer, with regards to chronic complications following prolonged use of ART. Supplemental non-AIDS related treatment is therefore required to manage these co-morbidities. The information on the prevalence of NCDs among PLHIV and challenges they face in accessing their treatment is scant.

OBJECTIVES: To determine prevalence of non-communicable co-morbidities among HIV-infected individuals and challenges encountered in accessing their treatment at Bugando Medical Centre.

METHODOLOGY: This was a descriptive cross sectional study conducted from October to November 2021. The study population involved all people living with HIV/AIDS aged 18 years and above who attended HIV clinic at Bugando Medical Centre during the study period. Face to face interviews using a semi-structured questionnaire were used during data collection. Additional data were also collected from patients’ medical records to obtain further clinical information. Data was double entered, cleaned and analyzed using Statistical Package for Social Science (SPSS) version 21 in which descriptive statistics data was summarized. Categorical data was depicted as components of pie chart.

RESULTS: Overall, 300 individuals with HIV infection were enrolled in this study. The number of females who participated in this study were 189/300 (63%) making nearly two-thirds of the study sample. Participants aged 40 years and above were 74/300 (24%). About 41% (n = 123) of the study participants were married, 23% (n = 69) were separated, and 3.7% (n = 11) were widows/widowers. Majority of the study participants were primary school leavers (n = 128; 42.6%) Among these, 32.3% (n = 97) were unemployed and the monthly income of most participants was below 100,000 TZS (n = 184; 61.3%). NCDs were prevalent among subjects and hypertension was found in 22.3% (n = 67) of study participants, 80.6% (n = 54) of them aged above 40 years and with female predominance accounting 68.7% (n = 46). More than two-thirds (n = 53; 79.1%) of the study participants were on combined ART for more than 5 years. Diabetes mellitus was found in 2.6% (n = 8) of the 300 subjects with high predominance among female participants who contributed 62.5% (n = 5) and those who aged 40 years and above (n = 6; 75%). Among 75 study participants who had non-communicable diseases of interest, an average of 64.9% of individuals suggested that their greatest challenge was high cost of drugs and supportive investigations followed by 46.7% of individuals who reported of increasing transportation costs due to long distance. About 33.3% of individuals reported of high pill burden as another barrier and 18% of study participants who had NCDs reported of various cultural health beliefs as a barrier in accessing treatment for their chronic medical conditions. Furthermore, 14.7% of individuals reported of their religious beliefs as a reason for not seeking medical intervention at health facilities.

CONCLUSION: Conclusively, the burden NCDs among HIV infected individuals is increasing rapidly as shown by findings of this study in Tanzania and other parts of Africa generally. In addition to the traditional risk factor for NCDs seen in the general population, being on long term ART regimen for more than 5 years and toxicity from using antiretroviral drugs are being implicated in the causation. The majority of hypertensive patients were not controlled, not on regular medications and some were unaware of their medical conditions. This calls for integration to the care and treatment of NCDs among PLHIV.