Systematic screening reveals high rates of undiagnosed hypertension and diabetes among people living with HIV in Tanzania: a cross-sectional study

BACKGROUND: In sub-Saharan Africa, most people living with HIV (PLHIV) engage with healthcare regularly but their comorbidity history remains largely unknown. We systematically assessed the blood pressure and glucose levels of clinically stable PLHIV who had not been diagnosed with hypertension or diabetes across large urban HIV clinics in Dar es Salaam, Tanzania. METHODS: We analysed data collected from patients screened for enrolment into a randomised trial, which was testing metformin among patients with HIV and pre-diabetes. Participants attending the HIV clinics were recruited via systematic random and purposive body mass index (BMI)-enriched sampling between 4 November 2019 and 21 July 2020. All adults aged ≥ 18 years on antiretroviral therapy for ≥ 6 months were recruited. Screening procedures included standardised questionnaires, anthropometry, triplicate blood pressure measurements, fasting blood glucose (FBG) testing and a 2-h oral glucose tolerance test (OGTT). We conducted descriptive analyses on all participants who were screened. We used log-binomial regression to explore associations between participants' characteristics and cardiometabolic outcomes. RESULTS: A total of 1,279 individuals were screened, of whom 975 (76.2%) were tested for fasting blood glucose and form the analyses of this study. Their median age was 47 years (interquartile range: 42-54) and 731 (75.0%) were female. An elevated FBG (≥ 6.1 mmol/L) was found in 42.2% (95% confidence interval [CI]: 39.0-45.3%) of participants and 38.8% (95% CI: 35.7-42.0%) had an elevated 2-h oral glucose tolerance test (OGTT) (≥ 7.8 mmol/L). Overall, 54.6% (95% CI: 51.3-57.7%) met the criteria for abnormal glucose levels while diabetes prevalence ranged from 7 to 15%, depending on the diagnostic measure applied. Among the 921 participants who had not been diagnosed with hypertension, 37.7% (95% CI: 34.5-40.9%) had high blood pressure (≥140/90 mmHg) and 3.4% (95% CI 2.3-4.7%) had severe high blood pressure (≥180/120 mmHg). Although the BMI-enriched subgroups differed in anthropometric characteristics, prevalence estimates for dysglycaemia and hypertension were similar across the sampling strata. CONCLUSIONS: This study highlights a substantial burden of previously undiagnosed high blood pressure and elevated fasting blood glucose among PLHIV in Dar es Salaam. While generalisability may be limited by the BMI-enriched sampling structure, these findings highlight the high burden of undetected comorbidities among this population.