Leveraging the ART Advantage: diabetes and hypertension along the HIV care cascade in rural South Africa

Background Participation in antiretroviral therapy (ART) programs has been associated with greater utilization of care for diabetes and hypertension in rural South Africa. However, there is limited data about whether this apparent “ART advantage” translates into improved chronic disease management indicators. Methods The Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) is a cohort of 5,059 adults >40 in Agincourt. The study collects data on demographics, healthcare utilization, height, weight, blood pressure (BP), and blood glucose. HIV infection, HIV-1 RNA viral load (VL) and ART drug levels are tested via dried blood spots. We defined hypertension (HTN) based on measured BP or self-report of diagnosis by a healthcare provider or use of antihypertensive medication and diabetes (DM) by measured glucose or self-report of diagnosis by a healthcare provider or the use of DM medications. Our primary predictor of interest was stage along the HIV care cascade (HIV-, HIV+ not on ART, ART with a detectable VL, and with a suppressed VL). We compared the proportion in each sub-group who were aware of and treated for their hypertension or diabetes diagnosis, and fit adjusted linear regression models to estimate differences in systolic BP and glucose among those with diagnosed HTN or DM. Results Rates of HTN and DM were higher in HIV- than those with a suppressed VL (HTN: 68.4% v. 46.4%, DM: 12.9% vs.. 8.8%, respectively). However, the suppressed VL group had higher crude rates of awareness of HTN diagnosis and treated HTN as compared with the HIV- group (Aware: 69.9% vs.. 65.2%, p = 0.118; Treated: 50.2% vs.. 46.4%, p = 0.002). There were no significant differences in awareness or treatment rates for DM. In adjusted linear regression models among those with diagnosed HTN or DM, having a suppressed VL was associated with lower mean systolic BP (-5.94mm Hg, 95% CI: -9.68 – -2.20) and lower mean glucose (-3.74 mmol/L, 95% CI: -5.95 – -0.58), compared with being ...