Non-communicable disease burden among adults with and without HIV in Botswana

Objective: Non-communicable disease (NCD) prevalence has increased as age distributions in populations shift to older ages, including in countries with high HIV burden. We assessed NCD prevalence in Botswana, and its association with human immunodeficiency virus (HIV) and age. Design: We analyzed cross-sectional data from the Fifth Botswana AIDS Impact Survey 2021, a nationally-representative, population-based survey conducted from March to August 2021. Methods: People aged 15–64 years old underwent HIV testing and self-reported NCDs. We assessed weighted prevalence and age-stratified logistic regression regarding the associations between HIV status, age, and reported NCDs. Results: In total, 14,581 respondents were analyzed, of whom 49.2% were male, 20.7% had HIV, 16.4% had ≥1 NCD. People with HIV (PWH) were more likely to be female (64.2% versus 47.3%), 45 years or older (45% vs 17.8%), and report having ≥1 NCD (20.2% vs 15.4%), hypertension (14.2% vs 10.3%), kidney disease (2.6% vs 0.6%), and cancer (1.4% vs 0.3%) compared to people without HIV, respectively. PWH had lower age-adjusted odds of reporting having ≥1 NCD aOR (95% CI): 0.8 (0.6, 0.9), diabetes aOR: 0.6 (0.4, 0.8), hypertension aOR: 0.7 (0.6, 0.8), and heart disease aOR: 0.6 (0.3, 0.9). PWH had higher odds of kidney disease aOR: 3.2 (2.1, 4.8) and cancer aOR: 2.1 (1.3, 3.2). Conclusions : Prevalence of reporting at least one NCD was higher among PWH than the general population but differed by age. Health officials could benefit from considering these trends when designing targeted interventions for PWH.