Browsing by Author "Oni, Tolullah"
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- ItemOpen AccessAssessing the effectiveness of integrated non-communicable disease and antiretroviral adherence clubs in Cape Town, South Africa(2020) Gausi, Blessings; Oni, Tolullah; Jacob, NishaThe growing burden of HIV and non- communicable disease (NCD) syndemic in Sub Saharan Africa, has necessitated introduction of integrated models of care in order to leverage existing HIV care infrastructure for NCDs. However, there is paucity of literature on long term treatment outcomes for multimorbid patients attending integrated care. We describe long term treatment outcomes among multimorbid patients who attended integrated ART and NCD clubs (IC), a novel model of care piloted in 2014 by the Western Cape Government in South Africa. We followed up multimorbid patients for 12 months, who enrolled for IC at Matthew Goniwe and Town II clinics before September 2016. Median adherence proportions, HIV viral suppression and retention rates were calculated at 12 months before and after IC enrolment. Rates for achieving targets for blood pressure and glycosylated haemoglobin were determined at 12 months prior, at IC enrolment and at 12 months post IC enrolment. We describe demographic and clinical variables among all patients at IC enrolment and used multivariable logistic regression to evaluate for predictors of NCD control 12 months post IC enrolment. As of 31 August 2017, 247 patients in total had been enrolled into IC for at least 12 months. Of these, 221 (89.5%) had hypertension, 4 (1.6%) had diabetes mellitus and 22 (8.9%) had both in addition to HIV. Adherence was maintained before and after IC enrolment with median adherence proportions of 1 (IQR 1-1) and 1 (IQR 1-1) respectively. HIV viral suppression rates were 98.6%, 99.5% and 99.4% at the three time points respectively. Retention in care was high with 6.9% lost to follow up at 12 months post IC enrolment. Optimal blood pressure control was achieved in 43.1%, 58.9% and 49.4% of participants whereas optimal glycaemic control was achieved in 47.4%, 87.5% and 53.3% of diabetic participants at the three time points respectively. Multivariable logistic analyses showed no independent variables significantly associated with NCD control. Multi-morbid people living with HIV achieved high levels of HIV control in integrated HIV and NCD clubs. However, intensified interventions are needed to maintain NCD control in the long term.
- ItemOpen AccessEffect of diabetes and HIV on radiographic manifestations of pulmonary tuberculosis(2017) Berkowitz, Natacha; Oni, TolullahDue to the epidemiological transition, diabetes prevalence in South Africa is increasing, while HIV prevalence remains high. Diabetes, along with HIV, has been found to be a significant risk factor for the development of tuberculosis. Early detection and treatment of tuberculosis is essential to prevent unwarranted morbidity and mortality. This hinges on efficient diagnostic methods and tools. The chest radiograph remains a cornerstone in pulmonary tuberculosis diagnosis, especially in those where microbiological evidence of disease is lacking. A study was conducted to investigate the chest radiographic presentation of pulmonary tuberculosis in patients with diabetes, as well as to analyse the effect of HIV comorbidity on this association. The study was conducted in Khayelitsha, Cape Town, an area with a high tuberculosis, HIV and diabetes burden. A literature review was conducted to identify the key features of pulmonary tuberculosis on chest radiograph for patients with diabetes and HIV. We found that patients with diabetes were more likely to have lower lung field infiltrates and increased cavitation, with glycaemic control affecting the presence of these findings. Patients with HIV presented more often with features of primary tuberculosis on chest radiograph, namely hilar and/or mediastinal adenopathy, diffuse reticulonodular infiltrate, and lower lung field (LLF) infiltrates and cavities. These features were influenced by degree of immunosuppression. This review also found that there was no literature describing the influence of HIV on the chest radiographic features of tuberculosis in patients with diabetes. This study was conducted between June 2013 - October 2015, where 377 patients with pulmonary tuberculosis, from Ubuntu and Site B primary care clinics in Khayelitsha, underwent posterior-anterior chest radiography. Chest radiographs were read using a CRRS tool. Participants with diabetes and tuberculosis (TBDM) had a higher proportion of lower lung field opacification (76,2%: 95% CI: 56,3 – 96,1) and were 3,92 times more likely to have LLF cavitations than patients with TB only. TBDM participants with HbA1c levels over 10% had more frequent LLF involvement overall (90,9% vs 61,9% p=0,052) and isolated LLF involvement (27,3% vs 3,6%; p= 0,019) than TB only participants. Both TBDM and TBDM participants with HIV (TBDMHIV) had higher proportions of isolated LLF lesions as compared to TB only participants (14,3% vs 3,6%; p=0,093 and 15,2% vs 3,6%; p = 0,039, respectively). As CD4 counts increased, there was an upward trend towards an increase in the proportion of cavitations for TBDMHIV participants, but this was not evident in participants with TB and HIV (TBHIV). This study confirms the atypical nature of chest radiograph in persons with TBDM, TBHIV and TBDMHIV, with diabetes driving the presence of lower lung field involvement. These findings can be used in bi-directional screening algorithms for patients with diabetes, with or without HIV and highlights the important role of radiographic examination in pulmonary tuberculosis.
- ItemOpen AccessFidelity and costs of implementing the integrated chronic disease management model in South Africa(2021) Lebina, Limakatso; Alaba, Olufunke; Oni, Tolullah; Kawanga, MaryBackground: The health systems in many low-middle income countries are faced with an increasing number of patients with non-communicable diseases within a high prevalence of infectious diseases. Integrated chronic disease management programs have been recommended as one of the approaches to improve efficiency, quality of care and clinical outcomes at primary healthcare level. The South African Department of Health has implemented the Integrated Chronic Disease Management (ICDM) Model in Primary Health care (PHC) clinics since 2011. Some of the expected outcomes on implementing the ICDM model have not been achieved, and there is a dearth of studies assessing implementation outcomes of chronic care models, especially in low-middle income countries. This thesis aims to assess the degree of fidelity, moderating factors of fidelity and costs associated with the implementation of the ICDM model in South African PHC clinics. Methods: The study was a cross-sectional study design using mixed methods and following the process evaluation conceptual framework. A total of sixteen PHC clinics in the Dr. Kenneth Kaunda (DKK) health district of the North West Province as well as the West Rand (WR) health district of the Gauteng Province, that were ICDM pilot sites were included in the study. The degree of fidelity in the implementation of the ICDM model was evaluated using a fidelity criterion from the four major components of the ICDM model as follows: facility reorganization, clinical supportive management, assisted self-support and strengthening of the support systems. In addition, the implementation fidelity framework was utilized to guide the assessment of ICDM model fidelity moderating factors. The data on fidelity moderating factors were obtained by interviewing 30 purposively selected healthcare workers. The abbreviated Denison Organizational Culture (DOC) survey was administered to 90 healthcare workers to assess the impact of three cultural traits (involvement, consistency and adaptability) on fidelity. Cost data from the provider's perspective were collected in 2019. The costs of implementing the ICDM model current activities for three (facility reorganization, clinical supportive management and assisted self-management) components and additional costs of implementing with enhanced fidelity were estimated. Costs data was collected from budget reviews, interviews with management teams, and other published data. Descriptive statistics were used to describe participants and clinics. Fidelity scores were summarized using medians and proportions and compared by facilities and health districts. Qualitative data were analysed thematically. Pearson correlation coefficient was utilized to assess the association between fidelity and culture. The annual ICDM model implementation costs per PHC clinic and patient per visit were presented in 2019 US dollars. Results: The 16 PHC clinics had comparable patient caseload, and a median of 2430 (IQR: 1685-2942) patients older than 20 years received healthcare services in these clinics over six months. The overall implementation fidelity of the ICDM model median score was 79% (125/158, IQR: 117-132); WR was 80% (126/158, IQR: 123-132) while DKK was 74% (117/158, IQR: 106-130), p=0.1409. The highest clinic fidelity score was 86% (136/158), while the lowest was 66% (104/158). The fidelity scores for the four components of the ICDM model were very similar. A patient flow analysis indicated long (2-5 hours) waiting times and that acute and chronic care services were combined onto one stream. Interviews with healthcare workers revealed that the moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). Participants also indicated that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads. The overall mean score for the DOC was 3.63 (SD = 0.58), the involvement cultural trait had the highest (3.71; SD = 0.72) mean score, followed by adaptability (3.62; SD = 0.56), and consistency (3.56; SD = 0.63). Although there were no statistically significant differences in cultural scores between PHC clinics, culture scores for all three traits were significantly higher in WR (involvement 3.39 vs 3.84, p= 0.011; adaptability 3.40 vs 3.73, p= 0.007; consistency 3.34 vs 3.68, p= 0.034). The mean annual cost of implementing the ICDM model was $148 446.00 (SD: $65 125.00) per clinic, and 84% ($124 345.00) was for current costs while additional costs for higher fidelity accounted for were 16% ($24 102.00). The mean cost per patient per visit was $6.00 (SD:$0.77). Conclusion: There was some variability of fidelity scores on the components of the ICDM model by PHC clinics, and there are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors influencing implementation fidelity of the ICDM model. Organizational culture needs to be purposefully influenced to enhance adaptability and consistency cultural traits of clinics to enhance the ICDM model's principles of coordinated, integrated, patient-centred care. Small additional costs are required to implement the ICDM model with higher fidelity. Recommendations: Interventions to enhance the fidelity of chronic care models should be tailored to specific activities that have low degree of adherence to the guidelines. Addressing some of the moderating factors like training and mentoring of staff members, role clarification and supply chain management could contribute to enhanced fidelity. Organizational culture enhancements to ensure that the prevailing culture is aligned with the planned quality advancements is recommended prior to the implementation of new innovative interventions. Further research on the cost-effectiveness of the ICDM model in middle-income countries is recommended.
- ItemOpen AccessThe prevalence and determinants of active tuberculosis among diabetes patients attending a primary health care clinic in Cape Town, South Africa(2016) O'Jiaku-Okorie, Adaeze; Oni, TolullahBackground: The number of studies addressing the association between diabetes mellitus (DM) and tuberculosis (TB) in the context of sub - Saharan Africa (SSA) is limited and fewer studies have determined whether DM is associated with TB among patients attending DM c linics. We aimed to assess the prevalence of TB among a population, diagnosed and receiving treatment for DM at a primary care clinic, and to identify significant risk factors of prevalent TB cases. Methods In this cross - sectional study, adult DM patients attending an outpatient clinic at a South African township were evaluated for TB using Xpert MTB/RIF testing (Xpert) and other conventional methods - clinical symptom screening, smear microscopy, chest x - ray, and culture. Socio - demographic and biochemical information were collected using the Who's STEPwise approach to surveillance of chronic disease risk factors. Findings 451 DM patients were screened for TB. 16 DM patients were diagnosed with TB, following screening giving a prevalence rate of 3 · 55% or 35 · 48 per 1000 people [95% CI: 2 · 18 - 5 · 72]. 37 · 50% (n=6) of TB cases reported at least one clinical symptom of TB [95% CI: 17 · 34 - 63 · 11%]. 62 · 5% (n=10; 95% CI :) of TB cases were HIV - positive. In a multivariate analysis, HIV (OR : 14 · 58 , p<0 · 001) and haemoptysis (OR 24 · 48, p<0 · 001) were strongly associated with prevalent TB. Identified associations were not modified by age or gender. There were no significant differences in either fasting plasma glucose or HbA1c levels between TB and non - TB DM participants. Discussion Prevalence of TB among DM population was higher than in the general population based on national estimates, highlighting an important DM - TB association in an SSA setting. HIV as a significant risk factor for TB confirms its position as a major driver in TB epidemic overall and in T2DM patients. Two - thirds of prevalent TB cases reported no TB symptoms, suggesting further research is needed to identify more accurate TB screening strategies for DM patients, particularly in HIV - infected persons, to facilitate early detection and treatment of prevalent TB in this population group.
- ItemOpen AccessThe prevalence and risk factors of diabetes mellitus among tuberculosis patients at Ubuntu clinic, Khayelitsha(2016) Kubjane, Mmamapudi; Oni, TolullahSummary: There is strong evidence suggesting that diabetes mellitus (DM) triples the risk of tuberculosis (TB) disease and worsens TB outcomes. South Africa carries a heavy burden of TB which is primarily driven by the human deficiency virus (HIV). The burden of non-communicable disease is also growing rapidly in South Africa. There is however lack of up to date data on the burden of DM and the associated risk factors among TB patients. This dissertation is based on a cross-sectional study which sought to assess the prevalence of DM and impaired glucose tolerance (IGT) and determine the risk factors associated with DM among TB patients. Methods: This cross sectional study forms part of a case control study that aimed to assess the association between DM and TB and the population attributable risk of TB due to DM in Khayelitsha, a high HIV and TB setting. The TB patients recruited in the case control study formed the population of this current cross-sectional study. Based on oral glucose tolerance test, fasting blood glucose, glycated haemoglobin and self-report the prevalence of DM was determined. Bivariate and multivariate logistic regression analyses were performed to assess risk factors associated DM among TB patients. Due to significant differences between male and females with respect to various characteristics, we also stratified the data by sex during analysis.
- ItemOpen AccessThe Cape Town Violence and Injury Observatory (VIO) Validity and utility of data sources for a prevention-oriented VIO in urban Cape Town, South Africa(2021) Jabar, Ardil; Matzopoulos, Richard; London, Leslie; Engel, Mark; Oni, TolullahBackground The Cardiff model purports that the true burden of violence within a community can only be quantified by the addition of violence-related data from health services to violence data reported to the police. This thesis describes the conceptualisation, development and implementation of a violence and injury observatory for the routine collection of violence-related data for the City of Cape Town. The observatory model, which was conceptualised in the early 1990s in Colombia, has gone through various iterations as a municipality-level research tool, to a city-level tool and thereafter as a national and transnational tool. Aims of this thesis The thesis aimed to assess the utility of clinical and non-clinical data sources in constituting a prevention-oriented violence and injury observatory (VIO) in urban Cape Town, South Africa. The specific objectives of each study component were as follows: • To describe the objectives of the pilot VIO, potential violence-related datasets for collection, data analysis and research dissemination plan (Study One) • To assess the validity and utility of VIOs in reducing violence and violencerelated harms in adult populations (Study Two) • To identify the optimal data elements for inclusion in a VIO according to expert consensus (Study Three) • To determine the concordance between violent crimes reported to the police with violence-related injuries presenting at health facilities in Khayelitsha (Study Four). Methods The systematic review method was used to determine whether the introduction of violence and injury observatories was associated with a reduction in violence in adult populations (Study Two). A modified two-round Delphi study (Study Three) determined the optimal data elements (including violence and injury indicators, datasets and research priorities) for inclusion in a pilot violence and injury observatory in Cape Town. The Delphi panel of 21 participants included one Provincial Head of Emergency Medicine, one Provincial Head of Disaster Medicine, several Heads of Department of Emergency Medicine across hospitals in Cape Town, and representatives from relevant data stakeholders, including the Forensic Pathology Services (FPS), South African Police Services (SAPS), Health Systems Trust (HST) and the Violence Prevention through Urban Upgrading (VPUU). This was to ensure that decisions were made by persons in senior posts to facilitate subsequent implementation of the recommendations. Khayelitsha, a peri-urban mixed informal township of Cape Town, was the setting for the final study (Study Four), which included a retrospective analysis of secondary cross-sectional health and police data, from three health facilities and three police stations in the community of Khayelitsha, Cape Town. A case-matching study, using personal identifier matching, was employed to determine the concordance between reports of violent crimes to police stations with reports of injuries arising from interpersonal violence at health facilities within the community of Khayelitsha in Cape Town, South Africa. Results and Discussion Subgroup analyses according to the two types of models implemented in the systematic review (Study Two), namely, the VIO and the injury surveillance system (ISS), provided evidence for an association between the implementation of the VIO model and a reduction in homicide count in high-violence settings (incidence rate ratio [IRR]=0.06; 95% CI 0.02 to 0.19; four studies), while the introduction of ISS showed significant results in reducing assault (IRR=0.80; 95% CI 0.71 to 0.91; three studies). Following expert consultation through a Delphi process (Study Three), this study identified 14 violence and injury indicators and 12 violence-related datasets for inclusion in the pilot VIO. Additionally, research priorities within 16 research themes across five different types of violence were identified including: elder abuse, youth violence, intimate partner violence, sexual violence, and armed violence. Key findings from these thematic priorities included: (1) formal methods to define and measure violence, identification of violence-related risk factors; (2) evaluation of the effectiveness of promising programmes that target violence-related risk factors; and (3) evidence-based recommendations on scaling up programmes that were shown to be effective in reducing interpersonal violence. With regard to the key findings around data sharing, the majority of the panelists (>55%) thought that: (1) violence-related data from health services should be shared with Policing Services; (2) the data model employed should go beyond the Cardiff model (policing and health data) and also include violence-related data from the Fire and Rescue Services (FARS) and the Emergency Medical Services (EMS); and (3) the functions of a local observatory should include a civilian spatial data observatory, an information technology division, a predictive analytics division, a historical data repository and a systematic review repository. The expert-identified violence and injury indicators, datasets and research priorities provide a research framework for interpersonal violence and injury prevention work within South Africa. The findings have theoretical implications and build up evidence-based data for the general field, and they have a practical outcome in recommendations that are both general and specific for implementation in South Africa. They may also serve to guide the development of additional VIOs locally. In the final study (Study Four), with regard to concordance between the datasets, among the 708 patients being treated for violence-related injuries at health facilities, only 104 reported the incident to the police which equates to a matching ratio of 14.7%. Combining health and police data revealed an 81.7% increase in potential total violent crimes over the reporting period. Compared to incidents reported to the police, those not reported were more likely to involve male patients (difference: +47.0%; p< 0.001), and sharp object injuries (difference: +24.7%; p< 0.001) and less likely to report blunt trauma i.e., push/kick/punch injuries (difference: -17.5%; p< 0.001). These findings suggest that the majority of injuries arising from interpersonal violence presenting at health facilities in Khayelitsha are not reported to the police. Conclusion This research provides an evidence-based model for the development and implementation of a VIO, and the Cardiff model, to reduce interpersonal violence. It is supported by the evidence from the systematic review of the effectiveness of VIOs in reducing violence outcomes among adults in high-violence settings. This pilot VIO represents the first attempt to collect contemporary and comprehensive data on violence and injury in the Western Cape Province and South Africa. The implementation of VIOs should be considered in high-violence communities where the collation and integration of violence-related data and violence stakeholders, may guide violence reduction. The Delphi study provided indicators, datasets and research priorities to (1) inform the basic research infrastructure of a VIO, and (2) serve as part of a regional standardised data collection framework to guide the development of other local violence and injury observatories. This is consistent with the aims of the South African National Development Plan 2030 to ‘improve the health information system; to prevent and reduce the disease burden and promote health and to improve quality by using evidence'. Finally, the research further shows a clear benefit in combining data on violence from different settings as demonstrated in our analysis of data in the Cape Town suburb of Khayelitsha, where the overwhelming majority of injuries arising from interpersonal violence presenting at health facilities in Khayelitsha are not reported to the police. This study has broader implications regionally and nationally for the surveillance of injuries arising from interpersonal violence, for the police definition and surveillance of community interpersonal violence, for community policing intelligence development (improving the configuration of violence heat maps on a real time basis) and finally for police resource utilisation and distribution, which should, in turn, impact positively on reducing crime and violence in the community, and reduce the burden on the health services. The Western Cape Safety Plan, a policy document developed by the Western Cape Government, advocates the use of data and technology to understand violent crime patterns to inform the deployment of law enforcement resources and investigators accordingly and furthermore acknowledges research and analysis as an important component of its evidence-based policing (EBP) strategy. The policy document and study findings provide support to the implementation of the Cardiff Model locally.
- ItemOpen AccessThe epidemiology of Chronic Non-Communicable Diseases (NCDS) and NCD risk factors in adolescents & youth living with HIV in Cape Town, South Africa(2021) Kamkuemah, Monika; Oni, Tolullah; Middelkoop, KerenIntroduction: South Africa, like many other low- and middle-income countries (LMIC), is currently undergoing an epidemiological transition with a growing burden of noncommunicable diseases (NCDs) co-occurring with an existent burden of infectious diseases like human immunodeficiency virus (HIV). South Africa continues to have the biggest HIV epidemic globally, and adolescents and young people, especially young women, bear a disproportionate burden of HIV in the country. Adolescents and youth living with HIV (AYLHIV) face an elevated NCD risk resulting from chronic immune activation, psychosocial factors and the complications of long-term antiretroviral therapy (ART). However, there is data paucity on the intersection of NCDs and HIV in adolescents in South Africa and Africa. This thesis aims to contribute to the limited evidence base in LMIC settings by investigating NCD multimorbidity and risk factors in AYLHIV within a context of epidemiological transition and urbanisation. Objectives: This aim is achieved by fulfilling the following research objectives: 1. To investigate the extent to which NCD comorbidity (prevention, screening and management) is incorporated within existing adolescent HIV primary healthcare services in Cape Town, South Africa. 2. To estimate the prevalence of common NCDs and their known cardiometabolic, respiratory and behavioural risk factors in AYLHIV residing in peri-urban Cape Town. 3. To determine individual, household, social and neighbourhood level factors associated with obesity in AYLHIV. Methods: I conducted a narrative literature review to inform the development of a conceptual framework for investigating the intersection of adolescence developmental theory with NCDs and HIV. The emergent concepts were explored from an over-arching socioecological viewpoint, drawing on life course epidemiology and epidemiological transition theories. I conducted a cross-sectional quantitative study in nine primary care facilities across peri-urban Cape Town. The study was conducted in two parts. The first part of the study was comprised of data collected from 491 medical records of AYLHIV accessing HIV care in these facilities. The second part of the study sought to investigate the epidemiology of NCDs and NCD risk factors and to assess multilevel factors associated with abdominal obesity (the primary outcome). I recruited 176 eligible AYLHIV to participate in the study with primary data (on NCDs and NCD risk factors) collected from 92 participants during routine clinic visits between March and December 2019. Results: The findings from the 491 patient medical records reviewed demonstrated limited attention to NCD comorbidity prevention, screening and treatment within adolescent HIV primary care services. Only 62% of patient folders had documented anthropometric measurements, 59% had documented blood pressure measurements, and less than 11% of patient folders reviewed had any NCD health promotion documented. Among the 92 participants recruited for primary data collection, 76% were female. More than a quarter (27%) were not in education, employment or training; 70% lived in food-insecure households, and 44% were multidimensionally poor. At the individual level, a high prevalence of NCDs was found, particularly elevated blood pressure and hypertension (20% and 5% respectively), overweight/obesity (36%), central obesity (37%), and depressive symptoms (43%). With respect to NCD risk factors, 69% reported engaging in sufficient physical activity (79% of males and 66% of females), and 49% reported three or more hours of sedentary behaviour per day. However, unhealthy dietary practices were common, with only 27% eating fresh fruit, 52% eating vegetables and 33% eating whole grains daily. On the other hand, 29% drank sugar-sweetened beverages, and 33% ate sweets and cakes daily, while 42% skipped breakfast regularly. Furthermore, nutritional knowledge was low, especially with respect to healthy food choices and dietdisease relationships. Risky behaviours were also prevalent with 30% current smokers (48% males and 25% females) and 41% alcohol use in the past month (58% males versus 36% females), with binge drinking most commonly reported in the youngest age group < 18 years (55%). Significantly more malesreported lifetime use of any illicitsubstances(53% versus 30% for females), with cannabis the most frequently reported substance used (23% lifetime prevalence). Beyond individual-level risk factors, household-level factors were also explored. More than half (58%) reported the death of one or both parents, while 47% reported a biological parent as their primary caregiver. Parental level factors were largely positive, with participants reporting high levels of positive parenting and parental supervision. However, 35% lived in informal dwellings, 38% did not have access to piped water inside their dwelling and 62% experienced thermal discomfort in winter. Community experiences revealed a mixed picture, with 61% of participants exposed to high levels of community violence, while participants largely reported high neighbourhood belonging and low levels of stigma. Multilevel regression was conducted to investigate the factors associated with abdominal obesity at different socio-ecological levels. All models were adjusted for sex and age. Statistically significant individual-level risk factors that were associated with higher odds of abdominal obesity were skipping breakfast (OR= 5.42; 95% confidence interval (CI): 1.32 – 22.25) and absence from school or work (OR= 3.06; 95% CI: 1.11 – 8.40), while daily whole grain consumption (OR= 0.20; 95% CI: 0.05 – 0.71) and weekly moderate-intensity physical activity (OR = 0.24; 95% CI: 0.06 – 0.92) were associated with lower odds of abdominal obesity. At the household- and community levels, experiencing thermal discomfort was associated with increased odds of obesity (OR= 4.42; 95% CI: 1.43 – 13.73), while higher anticipated stigma was associated with reduced odds of obesity (OR= 0.58; 95% CI: 0.33 – 1.00). The features of the built and food environment that were associated with reduced odds of abdominal obesity in AYLHIV were land-use mix diversity (OR= 0.52; 95% CI: 0.27 – 0.97), access to recreational places (OR= 0.37; 95% CI: 0.18 – 0.74), higher perceived pedestrian and traffic safety (OR= 0.20; 95% CI: 0.05 – 0.80), and having a non-fast-food restaurant within walking distance (OR= 0.30; 95% CI: 0.10 – 0.93). Conclusion: These results indicate an existent burden of NCDs and NCD risk factors in urban AYLHIV. Beyond the NCD risk attributable to HIV and ART, these multiple risk factors coupled with early initiation of high-risk behaviours like smoking and harmful alcohol use further increase NCD risk. Despite high NCD comorbidity and risk, evidence shows little to no integration of health services and limited responsiveness with regards to NCD health promotion. These findings underscore a missed opportunity in multimorbidity prevention. Overall, these findings highlight the need for a comprehensive, integrated approach for AYLHIV to both prevent and manage NCD multimorbidity within primary care. This integrated approach should include mental health assessment and screening for weight status, abdominal obesity and blood pressure to identify comorbid NCDs early and intervene to improve NCD outcomes. Additionally, risk factor screening should be incorporated into HIV care to prevent NCD multimorbidity. Screening should include early identification of the most common NCD risk factors (insufficient physical activity, poor dietary practices, smoking, alcohol use and binge drinking, particularly in male adolescents and younger age groups). These findings also highlight the need for intervention at various levels of the socio-ecological framework through multisectoral interventions in the social and built environments. Finally, this thesis contributes an evidence base to inform the development of integrated and intersectoral models of care to address the colliding epidemics of HIV and NCDs in young people in LMIC settings.