Key result
HIV status is not associated with differences in untreated hypertension or diabetes rates.
Why the study?
Hypertension and diabetes are increasingly important contributors to morbidity and mortality in African countries, including among people living with HIV, but local HIV care programs have historically not included management of noncommunicable diseases.
Does HIV status impact the risk of having untreated hypertension or untreated diabetes among individuals receiving care in African health facilities?
Cohort (n=4,114)
Yes
Does HIV status impact the risk of having untreated hypertension or untreated diabetes among individuals receiving care in African health facilities?
Relative Risk: 0.93 (95% CI 0.84–1.04)
Absolute Event Rate: 58.4% vs 70.3%
There is a high burden of untreated hypertension and diabetes among individuals in African care programs regardless of HIV status, highlighting the urgent need for integrated non-communicable disease management within primary healthcare systems.
Hypertension and diabetes are increasingly important contributors to morbidity and mortality in African countries, including among people living with HIV (PLWH) who are on lifelong antiretroviral therapy. However, local HIV care programs have historically not included management of noncommunicable diseases. The African Cohort Study enrolls PLWH and people living without HIV (PLWoH) aged 15 years and older who are receiving clinical care at 12 PEPFAR-supported health facilities in Kenya, Nigeria, Tanzania, and Uganda. Participants undergo clinical assessments and medical record review every six months. We defined hypertension as a persistently elevated systolic and/or diastolic blood pressure ≥140/90 mmHg at two consecutive 6-monthly visits or receipt of hypertension medication. We defined diabetes as a single study visit with a fasting plasma glucose ≥7.0 mmol/L and/or non-fasting plasma glucose ≥11.1 mmol/L or receipt of diabetes medication. We computed descriptive statistics for hypertension/diabetes prevalence and treatment and used random intercept models adjusted for demographic and clinical characteristics to examine predictors of untreated hypertension and diabetes. From 2013 through 2023, among 3617 participants, 692 (19.1%) met our definition of hypertension, with a prevalence of 19.5% among PLWH and 17.3% among PLWoH; 276 (39.9%) received hypertension treatment. No significant difference in untreated hypertension was found comparing PLWH with PLWoH (adjusted risk ratio [aRR] 0.93, 95% confidence interval [CI]: 0.84-1.04). Among 3995 participants, 253 (6.3%) met our definition of diabetes, with a prevalence of 6.6% among PLWH and 4.7% among PLWoH; 51 (20.2%) received diabetes treatment. No significant difference in untreated diabetes was found comparing PLWH with PLWoH (aRR 1.01, 95% CI: 0.91-1.12). The high burden of untreated hypertension and diabetes among PLWH and PLWoH highlight the need for integrated non-communicable disease management within existing HIV services and strengthening of primary healthcare systems.
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Romo et al. (2025) conducted a cohort in Hypertension and diabetes (n=4,114). HIV infection vs. Living without HIV was evaluated on Untreated hypertension (aRR 0.93, 95% CI 0.84-1.04). Living with HIV was not significantly associated with the risk of untreated hypertension (aRR 0.93) or untreated diabetes (aRR 1.01) compared to living without HIV, revealing severe treatment gaps in both groups.
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