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Biraguma J.1,2, Mutimura E.3, Frantz J.4
1University of Rwanda, College of Medicine and Health Sciences, Physiotherapy, Kigali, Rwanda, 2University of the Western Cape, Physiotherapy, Cape Town, South Africa, 3Regional for Alliance for Sustainable Development (RASD) and UR-CMHS, College of Medicine and Health Sciences, Kigali, Rwanda, 4University of the Western Cape, Faculty of Community and Health Sciences, Cape Town, South Africa
Background: Throughout the world, specifically in Africa, non-communicable diseases (NCDs) are the main causes of morbidity and deaths. People with HIV infection (PLWHI) live longer due to effective antiretroviral therapy. Associated with improved life expectancy, PLWHI are exposed to various chronic diseases of lifestyle. Thus understanding behavioural and biological determinants of NCDs, motivators and barriers to a healthy lifestyle is quite critical to designing a strategy to prevent chronic diseases of lifestyle in the African continent.
Purpose: We studied associations and distribution patterns for NCD risk factors in HIV-infected on ART and ART-naïve in Rwanda and we identified motivators and barriers to physical activity participation and healthy diets in this population.
Methods: A multistage sampling frame was employed. A cross-sectional study using the WHO STEPwise approach and Motivators and Barriers of Healthy Lifestyle Scale, risk factors for NCDs and motivators and barriers of a healthy lifestyle were analysed for 794 PLWHI, both HIV+ on ART and ART-naïve. Data were analysed using SPSS Statistics 23 to generate frequencies, percentage, mean values and associations of risk factors for NCDs, motivators and barriers to physical activity participation and healthy diets.
Results: Out of 794 total participants: women were 64.6% and the mean age was 37.9 (±10.8) years. About 16.2% reported daily smoking, 31.4% reported harmful alcohol use and 95% reported insufficient consumption of vegetables and fruits, while 26.1% reported being physically inactive. Body mass index (BMI) ≥ 25 Kg/m² was 18.4%. Waist-hip-ratio (WHR) ≥ 0.95 in males was 15.6% and WHR ≥ 0.85 in females was 58.8%. High blood pressure (HBP) i.e. systolic blood pressure (SBP) of ≥140 mmHg, or diastolic blood pressure (DBP) ≥90 mmHg was 24.4%. Old age was associated with tobacco use as well as high blood pressure. Lack of disclosure of HIV+ serostatus was associated with tobacco and alcohol use. Tobacco use and physical inactivity were both associated with high blood pressure. The most frequently barriers to physical activity participation and healthy diet included lack of motivation, affordability, lack of information from healthcare provider, time and just lack of understanding what needs to be done. Additionally, want to be healthy, want to manage my weight, have someone to encourage or help me and believe that God wants me to take care of my body were the commonly reported motivators.
Conclusion(s): A high burden of NCD risk factors was observed in PLWHI. Predictors of NCD risk factors included old age that was associated with tobacco use as well as high blood pressure. Men were more associated with higher rates of alcohol use but more likely to be physically active and fewer men than women had abdominal obesity. The current study may point to the need for advocacy and formulation of prevention strategies for NCDs and their risk factors in PLWHI.
Implications: Policy and strategies are needed in Rwanda to package and monitor modifiable lifestyle risk factors for NCDs in HIV+ population. Policy makers and HIV care providers should consider barriers and motivators discovered when designing strategies to prevent chronic diseases of lifestyle in PLWHI.
Funding acknowledgements: The Government of Rwanda through the Ministry of Education for the scholarship to support principal investigator's PhD studies.
Topic: Non-communicable diseases (NCDs) & risk factors
Ethics approval: From the relevant authorities at the University of the Western Cape and permission was obtained from the relevant Rwandan committees.
All authors, affiliations and abstracts have been published as submitted.
