Factors Associated with Type 2 Diabetes Mellitus (T2DM) in People Living with HIV/ AIDS (PLWHA) attending Primary Health Care Centres in Rwamagana District, Rwanda

Abstract

Sub-Saharan African countries including Rwanda are facing a double burden of communicable and non-communicable diseases (NCDs). As HIV and AIDS management improves, the AIDS related mortality rate is thus reduced, and people living with HIV/AIDS (PLWHA) live longer and have more risk of developing diabetes mellitus. Despite the benefits of screening for T2DM on mortality reduction among PLWHA, this practice is not routinely performed in Rwanda. Therefore, data on the burden of T2DM in PLWHA and associated factors are limited in this country. The aim of this study was to determine factors associated with T2DM: anthropometric (BMI, height, weight, WHR), lifestyles (smoking, excessive alcohol consumption, physical inactivity) and HIV-AIDs associated factors for T2DM (duration of HIV infection, CD4 count, types of ARVs, duration of ARVs taking) in PLWHA attending Primary Health Care Centres in the Rwamagana District, Rwanda. A quantitative approach with a cross-sectional analytical study design was used. The study was conducted in seven randomly selected primary health care centres in Rwamagana district. A total of 315 participants of 18 to 65 years were sampled using a systematic sampling technique. A structured data collection instrument and fasting capillary blood glucose measurement were used to collect data from participants. Some data were obtained from participants’ files including CD4 counts, types of ARVs and WHO HIV clinical stages. The remainder data were reported by the participants. Ethical clearance was sought and granted from the Biomedical Research Ethics Committee (BMREC) at UWC (130416-050) and the University of Rwanda, College of Medicine and Health Sciences Institutional Review Board (No308/CMHSIRB/2018). Participation was voluntary and all ethical principles such as justice, beneficence and non-maleficence were observed. The confidentiality and privacy of the participants were respected throughout the study. http://etd.uwc.ac.za/ iii Results. A total of 292 (92.7%) participants which consisted of 200 (68.5%) females completed the survey. Of the participants, 108 (37%) were aged between 36-45 years. Furthermore, 61 (20.9%) and 88 (30.1%) had an unhealthy waist circumference and waist-to-hip ratio respectively. The prevalence of T2DM risk in PLWHA in Rwamagana district was 5.8% (n=17). Although bivariate analysis has shown that age (χ2 =15.536, df:4, p=0.014), longer duration of HIV/AIDS infection (χ2=10.056,df:1, p=0.002), longer duration on ARVs (χ2=11.573,df:1, p ≤0.001) and types of ARVs (χ2=9.882, df:4, p=0.042) were associated with T2DM, the results of the multivariate analysis have shown that none of these abovementioned factors [Age (OR: 1.034, 95% CI: 0.971-1.001, p=0.298), duration of HIV/AIDS infection (OR: 0.764, 95% CI: 0.480- 1.215, p=0.255) and duration on ARVs (OR: 1.508, 95%CI: 0.944-2.411, p=0.086)] were associated with T2DM. Conclusion: The study has shown that prevalence of T2DM in PLWHA attending PHCs in Rwamagana district was 5.8%. Although bivariate analysis indicated that age, duration of HIV and AIDS, types of ARVs and duration of ARVs taking were associated with T2DM, none of the sociodemographic, lifestyle, anthropometric and HIV/AIDS related factors were associated with T2DM in PLWHA in multivariate analysis. The presence of T2DM in PLWHA supports the need to integrate regular screening of T2DM services into HIV and AIDS healthcare programs within primary health care centres in Rwamagana district, Rwanda.