Prevalence and risk factors of hypertension and diabetes among persons living with HIV in Zambia: results of a national facility-based cross-sectional survey

Introduction: Despite growing evidence on the rising burden of non-communicable diseases (NCDs) in sub-Saharan Africa, the national prevalence of hypertension, prediabetes and diabetes among persons living with HIV (PLHIV) in Zambia is largely unknown. This study aimed to determine the national prevalence of hypertension and diabetes mellitus and their associated risk factors among adult PLHIV in Zambia. Methods: We conducted a cross-sectional study in 149 antiretroviral therapy (ART) clinics located in 52 rural and urban districts in Zambia based on the adapted World Health Organization (WHO) STEPwise approach to NCD risk factor Surveillance (STEPS) and the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) questionnaire. We used proportional to size sampling to select districts and clinics, targeting 5775 PLHIV. Data was collected from 1 October 2023 to 30 November 2023. We estimated the prevalence of hypertension and diabetes mellitus and used robust Poisson regression to analyse associations with socio-demographic, behavioural and HIV-related risk factors, and reported prevalence ratios (PR). Results: In the final analysis, we included a total of 5204 participants from 52 districts and 149 ART clinics countrywide: 67.2% were female, and 71.3% were from urban areas. The prevalence of hypertension, prediabetes and diabetes was 22.5% (95% confidence interval [CI]: 21.3−23.6), 26.7% (CI: 25.5−27.9) and 12.5% (CI: 11.6−13.4), respectively. In the multivariable model, being 30–44 (PR = 2.1; CI: 1.5−2.9), 45–49 (PR = 3.3; CI: 2.4−4.7) and 60 years or older (PR = 4.7; CI: 3.3−6.8) compared to those aged 18–29; widowed, divorced or separated individuals compared to those never married; being overweight (PR = 1.4; CI: 1.2−1.5) and obese (PR = 1.9; CI: 1.6−2.1) compared to normal weight PLHIV was associated with hypertension. College or university-educated PLHIV (PR = 2.1; CI: 1.3−3.4), compared to those with no formal education; and those with high total cholesterol ≥6.2 mmol/l (PR = 2.2; CI: 1.4−3.6), versus desirable total cholesterol (<5.2 mmol/l); being overweight (PR = 1.4; CI: 1.1−1.6) and obese (PR = 1.6; CI: 1.3−2.0), compared to those with normal weight, showed a significant association with diabetes mellitus. Conclusions: The prevalence of hypertension and diabetes mellitus among PLHIV in Zambia was notably high. This underscores the need for immediate and robust intervention strategies to mitigate the high prevalence of hypertension and diabetes mellitus, along with their associated risk factors, particularly within this vulnerable demographic.