The epidemiology of Chronic Non-Communicable Diseases (NCDS) and NCD risk factors in adolescents & youth living with HIV in Cape Town, South Africa

Introduction: South Africa, like many other low- and middle-income countries (LMIC), is currently undergoing an epidemiological transition with a growing burden of noncommunicable diseases (NCDs) co-occurring with an existent burden of infectious diseases like human immunodeficiency virus (HIV). South Africa continues to have the biggest HIV epidemic globally, and adolescents and young people, especially young women, bear a disproportionate burden of HIV in the country. Adolescents and youth living with HIV (AYLHIV) face an elevated NCD risk resulting from chronic immune activation, psychosocial factors and the complications of long-term antiretroviral therapy (ART). However, there is data paucity on the intersection of NCDs and HIV in adolescents in South Africa and Africa. This thesis aims to contribute to the limited evidence base in LMIC settings by investigating NCD multimorbidity and risk factors in AYLHIV within a context of epidemiological transition and urbanisation. Objectives: This aim is achieved by fulfilling the following research objectives: 1. To investigate the extent to which NCD comorbidity (prevention, screening and management) is incorporated within existing adolescent HIV primary healthcare services in Cape Town, South Africa. 2. To estimate the prevalence of common NCDs and their known cardiometabolic, respiratory and behavioural risk factors in AYLHIV residing in peri-urban Cape Town. 3. To determine individual, household, social and neighbourhood level factors associated with obesity in AYLHIV. Methods: I conducted a narrative literature review to inform the development of a conceptual framework for investigating the intersection of adolescence developmental theory with NCDs and HIV. The emergent concepts were explored from an over-arching socioecological viewpoint, drawing on life course epidemiology and epidemiological transition theories. I conducted a cross-sectional quantitative study in nine primary care facilities across peri-urban Cape Town. The study was conducted in two parts. ...