Determinants of cardiovascular and metabolic noncommunicable diseases among people living with HIV in Rwanda: protocol for the NCOHIRWA prospective cohort study

Noncommunicable diseases (NCDs), particularly cardiovascular diseases (CVDs), hypertension and diabetes, are major contributors to morbidity and mortality globally and in Rwanda, where the dual burden of HIV and NCDs is increasing. Evidence remains limited on how biological, behavioural, social, environmental and health-system determinants influence cardiovascular and metabolic outcomes among people living with HIV (PLHIV) in Rwanda. The NCOHIRWA cohort was established to prospectively investigate determinants associated with CVDs, hypertension, diabetes and related NCD outcomes among PLHIV, newly diagnosed PLHIV and people without HIV (PWoH). This manuscript presents the protocol for the NCOHIRWA cohort study. The NCOHIRWA study is a prospective cohort with a mixed-methods implemented across 12 health facilities providing HIV and NCD services in Rwanda. Adults aged ≥ 18 years, including PLHIV, newly diagnosed PLHIV and PWoH were enrolled beginning in March 2021 and will be followed longitudinally for 10 years. Baseline and follow-up data capture sociodemographic characteristics, behavioural, psychosocial, family history of NCDs, environmental and health-system factors, and clinical, anthropometric and laboratory measures relevant to cardiovascular and metabolic health. A total of 1,546 participants with complete baseline data were included, comprising 1,234 (79.8%) PLHIV and 312 (20.2%) PWoH. The median age was 44 years (range: 18–81) among PLHIV and 42 years (range: 18–75) among PWoH. Women represented 785 (63.6%) PLHIV and 197 (63.1%) PWoH. Baseline determinants relevant to future NCD outcome analyses included overweight [256 (21.0%) PLHIV versus 75 (24.4%) PWoH], obesity [118 (9.7%) versus 39 (12.6%)], ever smoking [260 (21.1%) versus 55 (17.7%)], family history of hypertension [219 (17.8%) versus 84 (26.9%)] and elevated fasting blood glucose [37 (3.0%) versus 28 (9.1%)]. These baseline characteristics define the cohort profile and provide the foundation for longitudinal analyses of incident cardiovascular and metabolic outcomes. This protocol describes the design and baseline profile of the NCOHIRWA cohort study. The cohort is positioned to generate longitudinal evidence on determinants of cardiovascular and metabolic NCDs among PLHIV in Rwanda. As follow-up accrues,the study will support estimation of incident outcomes, identification of risk pathways and development of context-appropriate strategies for integrated HIV and NCD prevention and care. Not applicable.