A high prevalence of NCD multimorbidity in South African Adolescents and Youth Living with HIV: Implications for Integrated Prevention

Abstract Background: Adolescents and youth living with HIV (AYLHIV) face an elevated NCD risk resulting from HIV, psychosocial challenges and the complications of antiretroviral therapy (ART). Methods : We conducted a cross-sectional study in six primary care facilities to investigate the prevalence of common NCDs and risk factors among AYLHIV in Cape Town, South Africa between March 2019 and January 2020. We collected socio-demographic information, ascertained behaviours and knowledge and screened for pre-existent and previously unidentified NCDs and risk factors in adolescents and youth enrolled for primary HIV care. Characteristics between sexes and age groups were compared using parametric or non-parametric statistical tests. Results : Three out of four participants were female, and the median age was 20.5 years (IQR 18.9- 22.9). More than a quarter were not in education, employment or training (NEET) and 44% were multidimensionally poor. Our results show an existent burden of hypertension (5%) and central obesity (37%) as well as high levels of depression (43%) and psychological distress symptoms (44%). AYLHIV further self-reported high levels of household food insecurity (70%), low fruit and vegetable consumption, high fast-food and sugar-sweetened beverage intake, low nutritional knowledge and insufficient physical activity. Beyond the NCD risk attributable to HIV and ART, these multiple risk factors further increase NCD risk. Conclusions: Our findings highlight the importance of integrated prevention with NCD risk screening as part of HIV care for AYLHIV and the need for early intervention on social, environmental and economic determinants of NCDs targeting adolescents and youth.