1.0 INTRODUCTION

1.1 Background Information

With more than 26 million people living with human immunodeficiency virus (PLWH) in sub–Saharan Africa (SSA), the urgency of public health needs ha necessitated the expansion of HIV treatment infrastructure (1). As the beneficial effects of antiretroviral therapy (ART) are increasingly clear (2), the focus has now shifted to expanding the growing health infrastructure to include chronic care for common uncommunicable comorbidities.(3,4).

Non communicable diseases (NCDs), especially cardiovascular diseases (CVD), increasingly affect the general population in SSA (5-7). The effects of urbanization and increased life expectancy have been linked to an increased prevalence of traditional CVD risk factors, including changes in diet and exercise patterns (8), although CVD mortality has decreased in SSA over the past few decades (9-10). Concerns regarding the potential impact of CVD in SSA have focused appropriate and necessary attention on its diagnosis, treatment, and prevention (11, 12), and disparities in CVD prevention and treatment across SSA have been highly recognized (12-14). Interventions in prevention, screening, and treatment have been shown to be effective and cost effective among the general population (15-16)

PLWH are at increased risk for CVD (17-18) and a synergistic effect of these two different epidemics may emerge in SSA (11-19). As access to ART increases, more PLWH are living past 50 years of age (20, 21) and face an increased risk of CVD due to traditional CVD risk factors alone (22). The additional impact of HIV infection with its associated inflammation and prothrombotic state may further increase CVD risk. Data on optimal screening methods for CVD risk factors, primary and secondary prevention, risk stratification, outcomes and management in PLWH living in SSA, and in Tanzania is limited (23-24). Now it’s the time to anticipate and consider this problem in light of increasing morbidity from non-communicable and chronic infectious diseases (25).

Traditional CVD risk factors are common in SSA in the general population and include hypertension (6-22%) (26-28), dyslipidemia (5-70%) (29), diabetes (1-12%) (26, 30) a smoking (males 15%, females 0.6%) (31, 32). Though no data in Tanzania was found. Despite these high prevalence estimates, almost 67% of patients with diabetes and 50% of patients with hypertension are thought to be unaware of their status (14, 33). Tobacco use varies greatly in different regions and is likely under-reported, especially among women (31).

Complementing the previously published estimates of CVD among PLWH in SSA, this study will add on to that knowledge to find the prevalence of these cardiovascular risk factors among people living with HIV (PLWH) in sub Saharan Africa, but specifically in East Africa, Tanzania. The target of this study was in Kahama Town in Shinyanga region. The study assessed the awareness of these cardiovascular risk factors among PLWH in the Kahama town. Among the many cardiovascular risk factors, this study included only 8 risk factors; smoking, alcohol consumption, insufficient fruit & vegetables intake, insufficient physical activity, obesity, hypertension, diabetes and family history of cardiovascular disease.

1.2 Problem Statement

HIV is associated with increased risk of cardiovascular disease. It is important to reduce patient lifestyle associated cardiovascular risk factors to reduce the burden of cardiovascular disease in these patients. This study determined the prevalence of cardiovascular risk factors and awareness of these factors among HIV infected patients at KGH.

1.3 Rationale

Following the introduction of ART, new concerns have risen about drug toxicities, including body fat maldistribution and metabolic abnormalities (e.g. dyslipidemia, diabetes mellitus) and their potential association with cardiovascular disease (3, 4, 6). Data from this study will help to design interventions to reduce patient lifestyle associated risk factors and increase their awareness of these factors.

1.4 Research Question

What is the prevalence of cardiovascular risk factors and awareness among people with HIV at KGH?

1.5 Research Objective

1.5.1 Broad Objective

To determine the prevalence of cardiovascular risk factors and awareness among people with HIV at Kahama Government Hospital.

1.5.2 Specific Objective

1. To determine the prevalence of Cardiovascular risk factors among people living with HIV at Kahama Government Hospital.
2. To assess the awareness of these cardiovascular risk factors among people living with HIV at Kahama Government Hospital.

1.6 Variables

1.6.1 Dependent variables

Cardiovascular risk factors among people living with HIV at KGH.

1.6.2 Independent variables

Age, marital status, level of education, smoking use, alcohol use, fruit and vegetables consumption, physical activity level, weight, height, hypertension history, diabetes history, and familial history of cardiovascular disease.