The aim of the project is to assist in the development of a strategy for the early identification and management of diabetes and impaired glucose tolerance (IGT) occuring in South Africans infected with HIV who receive Highly Active Anti Retroviral Therapy (HAART).
Expected impact
1,932 people with HIV/AIDS will participate in a cross-sectional and prospective studies aimed at developing a strategy for early detection and management of people who develop diabetes and/or IGT on HAART
Reduction in diabetes-related morbidity among HIV-positive people on HAART
Development of a cost-effective tool to identify the HIV-positive people most at risk of developing diabetes
Results to date
The 16 month cross-sectional study was initiated in February 2007 and has now been completed. 1,440 patients have been recruited (HAART-naïve: 436; HAART-regimen 1: 464; HAART-regimen 2: 108; HIV-negative: 46; excluded/non-arrival: 386).
The 24 month longitudinal cohort study was commenced in November 2008, with the purpose of recruiting 200 patients on HAART-regimen 1. Recruitment of patients has been completed and 156 patients are actively participating and thus far 50% of patients have completed their 12 month visit.
Project details
With an estimated 5-6 million HIV-infected people, South Africa is already struggling with an overburdened health care system. An increasing prevalence of diabetes and other chronic diseases threatens to further strain the health care system and result in poorer levels of care for patients.
HAART has been made available to HIV-infected people in the public sector in South Africa. The benefits of HAART are well known, but there are several metabolic problems associated with long-term use, including diabetes and impaired glucose tolerance (IGT) - IGT is a condition of elevated levels of blood glucose and is a significant risk factor for development of diabetes.
In industrialised countries HAART is associated with up to four-fold increased risk of diabetes and IGT, but information is not available from sub-Saharan Africa. Factors specific to the region such as poverty and malnutrition may cause the rate to be even higher.
In recognition of this gap in information for sub-Saharan Africa, the project seeks to assess the prevalence and risk factors of diabetes and IGT in HIV-positive people on HAART in Cape Town, South Africa.
Approach
In order to assist in the development of a strategy for early identification and management of diabetes in HIV-positive people on HAART, this project is concentrated around 4 main tasks:
Firstly, a cross-sectional study will form the basis for assessing the prevalence and risk factors for dysglycaemia in HIV-positive people.
Secondly, a simple cost-effective screening tool to be used in a primary health care setting will be developed. Results from questionnaires about sociodemographic data, diabetes risk factors and medical data will be used to identify the parameters most indicative of an increased risk for developing diabetes due to the use of HAART.
Thirdly, a prospective study will be conducted in order to validate the screening tool. If the tool proves to be effective and time-saving, it is most likely to be incorporated into the regular training of health care workers involved in managing patients on HAART.
Finally, if effective, the screening tool will be presented to the Department of National Health for consideration of including the tool in national guidelines for cost-effective investigation and management of diabetes and IGT.
