Journal Article Ahead of print
PubMed: 42860566 DOI: 10.1111/hiv.70318
Gaps in diabetes care among people living with HIV and hypertension in Botswana: A cross-sectional analysis of the InterCARE study.
HIV Med
Authors: Onkabetse Julia Molefe-Baikai, Tshepo B Leeme, Moagedi K Mawi, Kago Kebotsamang, Thato Moshomo, Edwin Mogaetsho, Tendani Gaolathe, Kesaobaka Molebatsi, Matlhogonolo Kelepile, Keonayang Kgotlaetsile, Pooja Gala, Duolao Wang, Shabbar Jaffar, Laura M Bogart, Lisa R Hirschhorn, Mosepele Mosepele
Affiliations
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
- Botswana Harvard Health Partnership, Gaborone, Botswana.
- Department of Statistics, University of Botswana, Gaborone, Botswana.
- Department of Environmental Science, Faculty of Science, University of Botswana, Gaborone, Botswana.
- Department of Medicine, NYU Langone Grossman School of Medicine, New York, New York, USA.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- University College London, London, UK.
- RAND, Santa Monica, California, USA.
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA.
- Department Medical Social Sciences and Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
- Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA.
Abstract
OBJECTIVES
Data on diabetes screening and monitoring, within HIV care programmes in sub-Saharan Africa, remain limited. This study describes the quality of diabetes screening and management among people living with HIV with comorbid hypertension receiving care at facilities participating in the InterCARE trial in Botswana.
METHODS
We conducted a cross-sectional analysis of adults aged 20-75 years with a documented diabetes diagnosis at enrolment in InterCARE (January-September 2023). All participants were people living with HIV with hypertension receiving routine HIV clinic care. Descriptive statistics were used to summarize baseline characteristics and key diabetes care indicators, including glycated haemoglobin (HbA1c), low-density lipoprotein (LDL) cholesterol and blood pressure (BP), and their level of control.
RESULTS
Of 4655 InterCARE participants, 138 (3.0%) had a prior diabetes diagnosis. In this diabetes subgroup, 69.6% were female (n = 99), and the median age was 58 years (IQR 52-64). Among the 87 participants receiving diabetes treatment, 80.0% (n = 70) were on oral agents and 20.0% (n = 17) on insulin-based therapy. Glycaemic and LDL monitoring had been performed in only 5.1% and 2.2% of participants, respectively. Blood pressure control (BP <130/80 mmHg) was achieved in 60.9%. Among those with HbA1c results (n = 75.1%), only 28.6% (n = 2) had glycaemic control (HbA1c <7%); however, interpretation is limited by the small number of HbA1c measurements. Lipid control could not be assessed due to insufficient data. Among participants without diabetes, documented screening was rare (17/4517; 0.3%).
CONCLUSION
Diabetes care among people living with HIV ith hypertension in Botswana is suboptimal with major gaps in screening and metabolic monitoring. These findings highlight broader challenges in the delivery of integrated chronic disease care within HIV services. Strengthening the integration of non-communicable disease care into HIV programmes, including routine diabetes screening and cardiometabolic risk management, is urgently needed to improve health outcomes and reduce the burden of cardiovascular and other chronic complications among people living with HIV.
MeSH
Diabetes Mellitus, Hypertension, Cross-Sectional Studies, Risk Management, Diagnosis, Therapeutics