Factors associated with chronic comorbidity among adult ART patients of the public hospital in South Ethiopia, 2022
Factor variable
Chronic comorbidity
COR (95% CI)
AOR (95% CI)
Yes (n)
No (n)
Age
18–34®
6
155
1
1
35–54
42
283
3.83 (1.59, 9.22)
3.54 (1.46, 8.74)*
≥ 55
7
27
6.69 (2.09, 21.46)
7.66 (2.29, 25.50)*
Income level
Low®
22
240
1
1
High
33
225
1.60 (0.91, 2.83)
1.11 (0.59, 2.06)
BMI
Underweight (< 18.5)®
5
73
1
1
Normal weight (18.5–24.9)
25
279
1.31 (0.48, 3.54)
1.02 (0.36, 2.84)
Overweight (≥ 25)
25
113
3.23 (1.18, 8.82)
2.82 (1.00, 7.93)*
Household food security
Food secured®
19
98
1
1
Food insecure
36
367
1.98 (1.09, 3.59)
1.94 (0.99, 3.78)
Dietary diversity score
Low®
26
259
1
1
High
29
206
1.40 (0.80, 2.46)
1.27 (0.68, 2.38)
Self-management
Low®
37
368
1
1
High
18
97
1.85(1.01, 3.38)
1.39 (0.69, 2.80)
* Statistically significant variables in multiple logistic regressions at p-value ≤ 0.05; ® reference category. ART: antiretroviral therapy; COR: crude odds ratio; CI: confidence interval; AOR: adjusted odds ratio; BMI: body mass index
Declarations
Acknowledgments
We thank Hawassa University, College of Medicine and Health Sciences, for providing funds for the study. We would also like to thank the data collectors and the study participants.
Author contributions
YTW: Conceptualization, Data curation, Formal analysis, Investigation, Writing—original draft, Writing—review & editing. SMB, RT, BS, AT, and MS: Conceptualization, Writing—review & editing. MRU and KTB: Writing—review & editing. All authors read and approved the final draft of the manuscript.
Conflicts of interest
The authors declare that they have no conflicts of interest.
Ethical approval
To comply with the Helsinki Declaration (2013) and the Population Screening Act, the study received ethical approval from the Hawassa University, College of Medicine and Health Sciences Institutional Review Board (IRB/216/2019) on May 7, 2019. Permission was obtained from the hospital management. Participation was determined by the person without any external influence to participate or not. Before the data collection, informed written consent (signed or verified by fingerprint) was taken from the study subjects. The data was collected and analyzed anonymously.
Consent to participate
The informed consent to participate in the study was obtained from all participants.
Consent to publication
Not applicable.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Funding
This research work was financed by the research office of Hawassa University, College of Medicine and Health Sciences, Ethiopia. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Parker E, Judge MA, Macete E, Nhampossa T, Dorward J, Langa DC, et al. HIV infection in Eastern and Southern Africa: Highest burden, largest challenges, greatest potential.South Afr J HIV Med. 2021;22:1237. [DOI] [PubMed] [PMC]
Joint United Nations Programme on HIV/AIDS (UNAIDS). Seizing the moment: tackling entrenched inequalities to end epidemics. Geneva: UNAIDS; 2020.
Mirkuzie AH, Ali S, Abate E, Worku A, Misganaw A. Progress towards the 2020 fast track HIV/AIDS reduction targets across ages in Ethiopia as compared to neighboring countries using global burden of diseases 2017 data.BMC Public Health. 2021;21:285. [DOI] [PubMed] [PMC]
Teeraananchai S, Kerr SJ, Amin J, Ruxrungtham K, Law MG. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis.HIV Med. 2017;18:256–66. [DOI] [PubMed]
Bernell S, Howard SW. Use Your Words Carefully: What Is a Chronic Disease?Front Public Health. 2016;4:159. [DOI] [PubMed] [PMC]
Guo F, Hsieh E, Lv W, Han Y, Xie J, Li Y, et al. Cardiovascular disease risk among Chinese antiretroviral-naïve adults with advanced HIV disease.BMC Infect Dis. 2017;17:287. [DOI] [PubMed] [PMC]
World Health Organization. Global status report on noncommunicable diseases 2010. World Health Organization; 2011.
Chu C, Selwyn PA. An Epidemic in Evolution: An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era.J Urban Health. 2011;88:556–66. [DOI] [PubMed] [PMC]
Gallant J, Hsue PY, Shreay S, Meyer N. Comorbidities Among US Patients With Prevalent HIV Infection—A Trend Analysis.J Infect Dis. 2017;216:1525–33. [DOI] [PubMed]
Hajat C, Stein E. The global burden of multiple chronic conditions: A narrative review.Prev Med Rep. 2018;12:284–93. [DOI] [PubMed] [PMC]
Foo KM, Sundram M, Legido-Quigley H. Facilitators and barriers of managing patients with multiple chronic conditions in the community: a qualitative study.BMC Public Health. 2020;20:273. [DOI] [PubMed] [PMC]
McPhail SM. Multimorbidity in chronic disease: impact on health care resources and costs.Risk Manag Healthc Policy. 2016;9:143–56. [DOI] [PubMed] [PMC]
Grey M, Schulman-Green D, Knafl K, Reynolds NR. A revised Self- and Family Management Framework.Nurs Outlook. 2015;63:162–70. [DOI] [PubMed]
Holman HR. The Relation of the Chronic Disease Epidemic to the Health Care Crisis.ACR Open Rheumatol. 2020;2:167–73. [DOI] [PubMed] [PMC]
Grady PA, Gough LL. Self-Management: A Comprehensive Approach to Management of Chronic Conditions.Am J Public Health. 2014;104:e25–31. [DOI] [PubMed] [PMC]
Bratzke LC, Muehrer RJ, Kehl KA, Lee KS, Ward EC, Kwekkeboom KL. Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature.Int J Nurs Stud. 2015;52:744–55. [DOI] [PubMed] [PMC]
Miller WR, Lasiter S, Bartlett Ellis R, Buelow JM. Chronic disease self-management: a hybrid concept analysis.Nurs Outlook. 2015;63:154–61. [DOI] [PubMed] [PMC]
Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice.PLoS One. 2019;14:e0220116. [DOI] [PubMed] [PMC]
Anekwe TD, Rahkovsky I. Self-Management: A Comprehensive Approach to Management of Chronic Conditions.Am J Public Health. 2018;108:S430–6. [DOI]
O’Connell S, Mc Carthy VJC, Savage E. Frameworks for self-management support for chronic disease: a cross-country comparative document analysis.BMC Health Serv Res. 2018;18:583. [DOI] [PubMed] [PMC]
Elissen A, Nolte E, Knai C, Brunn M, Chevreul K, Conklin A, et al. Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches.BMC Health Serv Res. 2013;13:117. [DOI] [PubMed] [PMC]
Daniel M, Mazengia F, Birhanu D. Nutritional status and associated factors among adult HIV/AIDS clients in Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia.Sci J Public Health. 2013;1:24–31. [DOI]
Mercer S, Furler J, Moffat K, Fischbacher-Smith D, Sanci L. Multimorbidity: technical series on safer primary care. Geneva: World Health Organization; 2016.
Hurst JR, Dickhaus J, Maulik PK, Miranda JJ, Pastakia SD, Soriano JB, et al.; GACD Multi-Morbidity Working Group. Global Alliance for Chronic Disease researchers’ statement on multimorbidity.Lancet Glob Health. 2018;6:e1270–1. [DOI] [PubMed]
Boehmer KR, Abu Dabrh AM, Gionfriddo MR, Erwin P, Montori VM. Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis.PLoS One. 2018;13:e0190852. [DOI] [PubMed] [PMC]
Wilson MG, Lavis JN, Gauvin FP. Designing Integrated Approaches to Support People with Multimorbidity: Key Messages from Systematic Reviews, Health System Leaders and Citizens.Healthc Policy. 2016;12:91–104. [PubMed] [PMC]
Webel AR, Schexnayder J, Cioe PA, Zuñiga JA. A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science.J Assoc Nurses AIDS Care. 2021;32:322–46. [DOI] [PubMed] [PMC]
Ataro Z, Ashenafi W, Fayera J, Abdosh T. Magnitude and associated factors of diabetes mellitus and hypertension among adult HIV-positive individuals receiving highly active antiretroviral therapy at Jugal Hospital, Harar, Ethiopia.HIV AIDS (Auckl). 2018;10:181–92. [DOI] [PubMed] [PMC]
Mohammed AE, Shenkute TY, Gebisa WC. Diabetes mellitus and risk factors in human immunodeficiency virus-infected individuals at Jimma University Specialized Hospital, Southwest Ethiopia.Diabetes Metab Syndr Obes. 2015;8:197–206. [DOI] [PubMed] [PMC]
Sachithananthan V, Loha E, Gose M. Prevalence of Diabetes Mellitus, Hypertension and Lipodystrophy in HAART Receiving HIV Patients in Southern Ethiopia.Int STD Res Rev. 2013;1:1–11.
Aantjes CJ, Ramerman L, Bunders JFG. A systematic review of the literature on self-management interventions and discussion of their potential relevance for people living with HIV in sub-Saharan Africa.Patient Educ Couns. 2014;95:185–200. [DOI] [PubMed]
Kang E, Kim S, Rhee YE, Lee J, Yun YH. Self-management strategies and comorbidities in chronic disease patients: associations with quality of life and depression.Psychol Health Med. 2021;26:1031–43. [DOI] [PubMed]
Swindale A, Bilinsky P. Household Dietary Diversity Score (HDDS) for Measurement of Household Food Access: Indicator Guide (v. 2). Washington, D.C.: FHI 360/FANTA; 2006.
Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide (v. 3). Washington, D.C.: FHI 360/FANTA2007; 2007.
Sabir AA, Balarabe S, Sani AA, Isezuo SA, Bello KS, Jimoh AO, et al. Prevalence of diabetes mellitus and its risk factors among the suburban population of Northwest Nigeria.Sahel Med J. 2017;20:168–72. [DOI]
American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020.Diabetes Care. 2020;43:S14–31. [DOI] [PubMed]
Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, et al. 2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas.Lancet Reg Health Am. 2022;9:100219. [DOI] [PubMed] [PMC]
Webel AR, Asher A, Cuca Y, Okonsky JG, Kaihura A, Dawson Rose C, et al. Measuring HIV Self-Management in Women Living With HIV/AIDS: A Psychometric Evaluation Study of the HIV Self-Management Scale.J Acquir Immune Defic Syndr. 2012;60:e72–81. [DOI] [PubMed] [PMC]
Majumdar U, Nanyonga Clarke R, Moran AE, Doupe P, Gadikota-Klumpers DD, Gidio A, et al. Hypertension screening, prevalence, treatment, and control at a large private hospital in Kampala, Uganda: A retrospective analysis.PLOS Glob Public Health. 2022;2:e0000386. [DOI] [PubMed] [PMC]
Julius H, Basu D, Ricci E, Wing J, Basu JK, Pocaterra D, et al. The Burden of Metabolic Diseases Amongst HIV Positive Patients on HAART Attending the Johannesburg Hospital.Curr HIV Res. 2011;9:247–52. [DOI] [PubMed]
Manuthu EM, Joshi MD, Lule GN, Karari E. Prevalence of dyslipidemia and dysglycaemia in HIV infected patients.East Afr Med J. 2008;85:10–7. [DOI] [PubMed]
Abebe SM, Getachew A, Fasika S, Bayisa M, Girma Demisse A, Mesfin N. Diabetes mellitus among HIV-infected individuals in follow-up care at University of Gondar Hospital, Northwest Ethiopia.BMJ Open. 2016;6:e011175. [DOI] [PubMed] [PMC]
Getahun Z, Azage M, Abuhay T, Abebe F. Comorbidity of HIV, hypertension, and diabetes and associated factors among people receiving antiretroviral therapy in Bahir Dar city, Ethiopia.J Comorb. 2020;10:2235042X19899319. [DOI] [PubMed] [PMC]
Bailin SS, Gabriel CL, Wanjalla CN, Koethe JR. Obesity and Weight Gain in Persons with HIV.Curr HIV/AIDS Rep. 2020;17:138–50. [DOI] [PubMed] [PMC]
Aberg JA. Aging and HIV infection: focus on cardiovascular disease risk.Top Antivir Med. 2020;27:102–5. [PubMed] [PMC]
Duguma F, Gebisa W, Mamo A, Tamiru D, Woyesa S. Diabetes Mellitus and Associated Factors Among Adult HIV Patients on Highly Active Anti-Retroviral Treatment.HIV AIDS (Auckl). 2020;12:657–65. [DOI] [PubMed] [PMC]
Jayedi A, Khan TA, Aune D, Emadi A, Shab-Bidar S. Body fat and risk of all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies.Int J Obes (Lond). 2022;46:1573–81. [DOI] [PubMed]
Reddon H, Grant C, Nosova E, Fairbairn N, Barrios R, Justice AC, et al. The Veterans Aging Cohort Study (VACS) Index Predicts Mortality in a Community-recruited Cohort of People With Human Immunodeficiency Virus (HIV) Who Use Illicit Drugs.Clin Infect Dis. 2021;73:538–41. [DOI] [PubMed] [PMC]
Mashinya F, Alberts M, Cook I, Ntuli S. Determinants of body mass index by gender in the Dikgale Health and Demographic Surveillance System site, South Africa.Glob Health Action. 2018;11:1537613. [DOI] [PubMed] [PMC]
Webel AR, Cuca Y, Okonsky JG, Asher AK, Kaihura A, Salata RA. The impact of social context on self-management in women living with HIV.Soc Sci Med. 2013;87:147–54. [DOI] [PubMed] [PMC]
Kim SH, Youn CH. Efficacy of Chronic Disease Self-management Program in Older Korean Adults with Low and High Health Literacy.Asian Nurs Res (Korean Soc Nurs Sci). 2015;9:42–6. [DOI] [PubMed]
Yin Y, Yang H, Xie X, Wang H, Nie A, Chen H. Status and associated characteristics of HIV disclosure among people living with HIV/AIDS in Liangshan, China: A cross-sectional study.Medicine (Baltimore). 2019;98:e16681. [DOI] [PubMed] [PMC]
Koetsenruijter J, van Lieshout J, Vassilev I, Portillo MC, Serrano M, Knutsen I, et al. Social support systems as determinants of self-management and quality of life of people with diabetes across Europe: study protocol for an observational study.Health Qual Life Outcomes. 2014;12:29. [DOI] [PubMed] [PMC]
Nyirenda M, Chatterji S, Falkingham J, Mutevedzi P, Hosegood V, Evandrou M, et al. An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa.BMC Public Health. 2012;12:259. [DOI] [PubMed] [PMC]
Cohen S, Wills TA. Stress, social support, and the buffering hypothesis.Psychol Bull. 1985;98:310–57. [PubMed]
Langford CP, Bowsher J, Maloney JP, Lillis PP. Social support: a conceptual analysis.J Adv Nurs. 1997;25:95–100. [DOI] [PubMed]
Yalom ID. The Theory and Practice of Group Psychotherapy. 4th ed. Basic Books; 1995.
Wodajo BS, Thupayagale-Tshweneagae G, Akpor OA. Stigma and discrimination within the Ethiopian health care settings: Views of inpatients living with human immunodeficiency virus and acquired immune deficiency syndrome.Afr J Prim Health Care Fam Med. 2017;9:e1–6. [DOI] [PubMed] [PMC]
