Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study
Abstract Background HIV clinical care programs in high burden settings are uniquely positioned to facilitate diabetes diagnosis, which is a major challenge. However, in sub-Saharan Africa, data on the burden of diabetes among people living with HIV (PLHIV) and its impact on HIV outcomes is sparse. M...
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-021-06473-1 |
| _version_ | 1818646518748413952 |
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| author | Rachel W. Kubiak Mario Kratz Ayesha A. Motala Sean Galagan Sabina Govere Elisabeth R. Brown Mahomed-Yunus S. Moosa Paul K. Drain |
| author_facet | Rachel W. Kubiak Mario Kratz Ayesha A. Motala Sean Galagan Sabina Govere Elisabeth R. Brown Mahomed-Yunus S. Moosa Paul K. Drain |
| author_sort | Rachel W. Kubiak |
| collection | DOAJ |
| description | Abstract Background HIV clinical care programs in high burden settings are uniquely positioned to facilitate diabetes diagnosis, which is a major challenge. However, in sub-Saharan Africa, data on the burden of diabetes among people living with HIV (PLHIV) and its impact on HIV outcomes is sparse. Methods We enrolled adults presenting for HIV testing at an outpatient clinic in Durban. Those who tested positive for HIV-infection were screened for diabetes using a point-of-care hemoglobin A1c (HbA1c) test. We used log-binomial, Poisson, and Cox proportional hazard models adjusting for confounders to estimate the relationship of diabetes (HbA1c ≥ 6.5%) with the outcomes of HIV viral suppression (< 50 copies/mL) 4–8 months after antiretroviral therapy initiation, retention in care, hospitalization, tuberculosis, and death over 12 months. Results Among 1369 PLHIV, 0.5% (n = 7) reported a prior diabetes diagnosis, 20.6% (95% CI 18.5–22.8%, n = 282) screened positive for pre-diabetes (HbA1c 5.7–6.4%) and 3.5% (95% CI 2.7–4.6%, n = 48) for diabetes. The number needed to screen to identify one new PLHIV with diabetes was 46.5 persons overall and 36.5 restricting to those with BMI ≥ 25 kg/m2. Compared to PLHIV without diabetes, the risk of study outcomes among those with diabetes was not statistically significant, although the adjusted hazard of death was 1.79 (95% CI 0.41–7.87). Conclusions Diabetes and pre-diabetes were common among adults testing positive for HIV and associated with death. Clinic-based diabetes screening could be targeted to higher risk groups and may improve HIV treatment outcomes. |
| first_indexed | 2024-12-17T00:47:55Z |
| format | Article |
| id | doaj.art-3f2c6f8036ae4311a69c40b93393e2d4 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-17T00:47:55Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-3f2c6f8036ae4311a69c40b93393e2d42022-12-21T22:09:51ZengBMCBMC Infectious Diseases1471-23342021-08-012111910.1186/s12879-021-06473-1Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort studyRachel W. Kubiak0Mario Kratz1Ayesha A. Motala2Sean Galagan3Sabina Govere4Elisabeth R. Brown5Mahomed-Yunus S. Moosa6Paul K. Drain7Department of Epidemiology, Health Sciences Building, University of WashingtonDepartment of Epidemiology, Health Sciences Building, University of WashingtonDepartment of Diabetes and Endocrinology, University of KwaZulu-NatalDepartment of Global Health, University of WashingtonAIDS Healthcare FoundationStatistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research CenterDepartment of Infectious Diseases, University of KwaZulu-NatalDepartment of Epidemiology, Health Sciences Building, University of WashingtonAbstract Background HIV clinical care programs in high burden settings are uniquely positioned to facilitate diabetes diagnosis, which is a major challenge. However, in sub-Saharan Africa, data on the burden of diabetes among people living with HIV (PLHIV) and its impact on HIV outcomes is sparse. Methods We enrolled adults presenting for HIV testing at an outpatient clinic in Durban. Those who tested positive for HIV-infection were screened for diabetes using a point-of-care hemoglobin A1c (HbA1c) test. We used log-binomial, Poisson, and Cox proportional hazard models adjusting for confounders to estimate the relationship of diabetes (HbA1c ≥ 6.5%) with the outcomes of HIV viral suppression (< 50 copies/mL) 4–8 months after antiretroviral therapy initiation, retention in care, hospitalization, tuberculosis, and death over 12 months. Results Among 1369 PLHIV, 0.5% (n = 7) reported a prior diabetes diagnosis, 20.6% (95% CI 18.5–22.8%, n = 282) screened positive for pre-diabetes (HbA1c 5.7–6.4%) and 3.5% (95% CI 2.7–4.6%, n = 48) for diabetes. The number needed to screen to identify one new PLHIV with diabetes was 46.5 persons overall and 36.5 restricting to those with BMI ≥ 25 kg/m2. Compared to PLHIV without diabetes, the risk of study outcomes among those with diabetes was not statistically significant, although the adjusted hazard of death was 1.79 (95% CI 0.41–7.87). Conclusions Diabetes and pre-diabetes were common among adults testing positive for HIV and associated with death. Clinic-based diabetes screening could be targeted to higher risk groups and may improve HIV treatment outcomes.https://doi.org/10.1186/s12879-021-06473-1Diabetes mellitusHIVHyperglycemiaPre-diabetesMortalityTuberculosis |
| spellingShingle | Rachel W. Kubiak Mario Kratz Ayesha A. Motala Sean Galagan Sabina Govere Elisabeth R. Brown Mahomed-Yunus S. Moosa Paul K. Drain Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study BMC Infectious Diseases Diabetes mellitus HIV Hyperglycemia Pre-diabetes Mortality Tuberculosis |
| title | Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study |
| title_full | Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study |
| title_fullStr | Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study |
| title_full_unstemmed | Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study |
| title_short | Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study |
| title_sort | clinic based diabetes screening at the time of hiv testing and associations with poor clinical outcomes in south africa a cohort study |
| topic | Diabetes mellitus HIV Hyperglycemia Pre-diabetes Mortality Tuberculosis |
| url | https://doi.org/10.1186/s12879-021-06473-1 |
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