University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, Kenya.
Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada.
PLoS One. 2020 Jul 2;15(7):e0235606. doi: 10.1371/journal.pone.0235606. eCollection 2020.
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.
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.
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.
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.
艾滋病毒感染者（PLHIV）承受着不成比例的非传染性疾病（NCD）负担。尽管这些疾病在全球范围内对人群造成了重大影响，但肯尼亚关键人群（KP）中的 NCD 负担仍不清楚。在肯尼亚内罗毕的性工作者外展计划（SWOP）诊所，对女性性工作者（FSW）和男男性行为者（MSM）中的 KP 进行了四类 NCD（心血管疾病、癌症、慢性呼吸道疾病和糖尿病）的负担评估。
对 2012 年 10 月 1 日至 2015 年 9 月 30 日期间在 SWOP 诊所登记的年龄在 15 岁及以上、艾滋病毒阳性的 KP 患者进行了回顾性病历审查。根据卫生部的指导方针，在登记时评估了这四种 NCD 类别的患病率，并在随后的每季度常规随访护理就诊时进行评估。在随访期间，根据适当情况使用卡方检验和 t 检验确定登记时的患病率，并评估合并症的分布。进行单变量和多变量分析，以确定与 NCD 诊断相关的因素。
总体而言，分析了 1478 个人的记录；在三年期间，1392 人（94.2%）来自 FSW，86 人（5.8%）来自 MSM。FSW 的中位年龄为 35.3 岁（四分位距（IQR）为 30.1-41.6），而 MSM 更年轻，为 26.8 岁（IQR 为 23.2-32.1）。在进入艾滋病毒护理项目时，大多数 KP（86.6%）处于世卫组织早期临床阶段（I 期-II 期），1462 人（98.9%）正在接受一线抗逆转录病毒治疗（ART）。在研究期间，共有 271 人（18.3%（95%置信区间：16.4-20.4%））在他们的临床图表记录中被诊断患有 NCD。这些病例中，258 例（95.2%）发生在 FSW 中。心血管疾病包括高血压，在 271 名有记录的 NCD 患者中，249 名（91.8%）存在。使用 12 个月内两次或两次以上血压读数升高的指标，高血压的患病率从第一年图表记录的 1.0%（95%置信区间：0.6-1.7）上升到第三年的 16.3%（95%置信区间：14.4-18.3）。慢性呼吸道疾病主要是哮喘，在 271 名患者中，患病率为 1.1%（95%置信区间：0.6-1.8）。在研究人群中。一般癌症的检出率为 10/271，患病率为 0.7%（95%置信区间：0.3-1.2）。有趣的是，研究组中未发现糖尿病。最后，在单变量分析中，NCD 诊断与年龄、体重指数和 CD4 + 细胞计数的增加之间存在显著关联。然而，除了 BMI≥30 kg/m2 和年龄≥45 以外，这些关联在调整后的风险估计中并不持续。
在肯尼亚，艾滋病毒阳性并接受抗逆转录病毒治疗的 KP 患有 NCD 的患病率很高。在研究人群中，艾滋病毒流行情况发生变化的背景下，还注意到了多种 NCD 危险因素。这呼吁在高危获得和传播 HIV 的人群中，加强对 HIV 和 NCD 的预防和护理的关注。因此，KP 项目可以在其指南中纳入 HIV-NCD 筛查和护理的综合内容。
