Introduction

People Living with HIV (PLHIV) bear a disproportionate burden of non-communicable diseases (NCDs). Despite their significant toll across populations globally, the NCD burden among key populations (KP) in Kenya remains unknown. The burden of four NCD-categories (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) was evaluated among female sex workers (FSWs) and men who have sex with men (MSM) at the Sex Workers Outreach Program (SWOP) clinics in Nairobi Kenya.

Methods

A retrospective medical chart review was conducted at the SWOP clinics among KP clients ≥15 years living with HIV enrolled between October 1, 2012 and September 30, 2015. The prevalence of the four NCD-categories were assessed at enrollment and during subsequent routine quarterly follow-up care visits as per the Ministry of Health guidelines. Prevalence at enrollment was determined and distributions of co-morbidities assessed using Chi-square and t-tests as appropriate during follow-up visits. Univariate and multivariate analysis were conducted to identify factors associated with NCD diagnoses.

Results

Overall, 1,478 individuals’ records were analyzed; 1,392 (94.2%) were from FSWs while 86 (5.8%) were from MSM over the three-year period. FSWs’ median age was 35.3 years (interquartile range (IQR) 30.1–41.6) while MSM were younger at 26.8 years (IQR 23.2–32.1). At enrollment into the HIV care program, most KPs (86.6%) were at an early WHO clinical stage (stage I–II) and 1462 (98.9%) were on first-line anti-retroviral therapy (ART). A total of 271, 18.3% (95% CI: 16.4–20.4%), KPs living with HIV had an NCD diagnosis in their clinical chart records during the study period. Majority of these cases, 258 (95.2%) were noted among FSWs. Cardiovascular disease that included hypertension was present in 249/271, 91.8%, of KPs with a documented NCD. Using a proxy of two or more elevated blood pressure readings taken < 12 months apart, prevalence of hypertension rose from 1.0% (95% CI: 0.6–1.7) that was documented in the charts during the first year to 16.3% (95% CI: 14.4–18.3) in the third year. Chronic respiratory disease mainly asthma was present in 16/271, a prevalence of 1.1% (95% CI: 0.6–1.8) in the study population. Cancer in general was detected in 10/271, prevalence of 0.7% (95% CI: 0.3–1.2) over the same period. Interestingly, diabetes was not noted in the study group. Lastly, significant associations between NCD diagnosis with increasing age, body-mass index and CD4 + cell-counts were noted in univariate analysis. However, except for categories of ≥ BMI 30 kg/m² and age ≥ 45, the associations were not sustained in adjusted risk estimates.

Conclusion

In Kenya, KP living with HIV and on ART have a high prevalence of NCD diagnoses. Multiple NCD risk factors were also noted against a backdrop of a changing HIV epidemic in the study population. This calls for scaling up focus on both HIV and NCD prevention and care in targeted populations at increased risk of HIV acquisition and transmission. Hence, KP programs could include integrated HIV-NCD screening and care in their guidelines.

中文翻译：

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在肯尼亚，参加大型艾滋病毒预防和治疗计划的主要人群中非传染性疾病患病率很高。

介绍

艾滋病毒携带者（PLHIV）承担着非传染性疾病（NCD）过多的负担。尽管肯尼亚对非传染性疾病造成了巨大影响，但肯尼亚关键人群中的非传染性疾病负担仍然未知。在内罗毕的性工作者外展计划（SWOP）诊所中，对女性性工作者（FSW）和与男性发生性关系的男性（MSM）评估了四种非传染性疾病类别（心血管疾病，癌症，慢性呼吸道疾病和糖尿病）的负担肯尼亚。

方法

在2012年10月1日至2015年9月30日期间登记的15岁以上感染HIV的KP客户中，在SWOP诊所进行了回顾性医疗图审查。在登记时以及随后的例行季度随访中评估了四个NCD分类的患病率根据卫生部的指导进行门诊护理。确定入组患病率，并在随访期间酌情使用卡方检验和t检验评估合并症的分布。进行单因素和多因素分析以鉴定与NCD诊断相关的因素。

结果

总共分析了1,478个人的记录；在三年期间，有1,392（94.2％）来自FSW，而86（5.8％）来自MSM。FSW的中位年龄为35.3岁（四分位间距（IQR）30.1–41.6），而MSM的年龄中位数为26.8岁（IQR 23.2–32.1）。在加入HIV护理计划时，大多数KP（86.6％）处于WHO早期临床阶段（I–II期），1462人（98.9％）处于一线抗逆转录病毒疗法（ART）。在研究期间，共有271名18.3％（95％CI：16.4–20.4％）的HIV感染者在其临床图表记录中具有NCD诊断。在这些病例中，FSW中大多数为258（95.2％）。249/271的心血管疾病（包括高血压）存在于有NCD记录的KP中，占91.8％。使用相距小于12个月的两个或多个血压读数的替代值，高血压患病率从第一年图表中记录的1.0％（95％CI：0.6–1.7）上升到第三年的16.3％（95％CI：14.4–18.3）。慢性呼吸系统疾病以哮喘为主，出现在16/271，在研究人群中患病率为1.1％（95％CI：0.6–1.8）。通常在10/271中检测到癌症，同期患病率为0.7％（95％CI：0.3–1.2）。有趣的是，研究组未发现糖尿病。最后，在单变量分析中指出了NCD诊断与年龄，体重指数和CD4 +细胞计数之间的显着相关性。但是，BMI≥30 kg / m的类别除外 在研究人群中的患病率为1.1％（95％CI：0.6-1.8）。通常在10/271中检测到癌症，同期患病率为0.7％（95％CI：0.3–1.2）。有趣的是，研究组未发现糖尿病。最后，在单变量分析中指出了NCD诊断与年龄，体重指数和CD4 +细胞计数之间的显着相关性。但是，BMI≥30 kg / m的类别除外 在研究人群中的患病率为1.1％（95％CI：0.6-1.8）。通常在10/271中检测到癌症，同期患病率为0.7％（95％CI：0.3–1.2）。有趣的是，研究组未发现糖尿病。最后，在单变量分析中指出了NCD诊断与年龄，体重指数和CD4 +细胞计数之间的显着相关性。但是，BMI≥30 kg / m的类别除外²岁以上且年龄≥45岁的患者，在调整后的风险评估中并未保持这种关联。

结论

在肯尼亚，感染艾滋病毒且接受抗逆转录病毒治疗的KP的非传染性疾病诊断率很高。在研究人群中艾滋病流行变化的背景下，还注意到了多种非传染性疾病危险因素。这就要求在艾滋病病毒感染和传播风险增加的目标人群中，加大对艾滋病毒和非传染性疾病预防和护理的关注。因此，KP计划可将HIV-NCD综合筛查和护理纳入其指南。