Cytomegalovirus (CMV) has been linked with increased cardiovascular risk and monocyte activation in people living with HIV (PLWH). This cross-sectional study aimed to compare CMV immunoglobulin G (IgG) levels between combined antiretroviral therapy (cART)-treated PLWH versus ART-naïve PLWH and those without HIV, and to investigate their associations with biomarkers of endothelial injury and carotid atherosclerosis, in Gaborone, Botswana. All participants were between 30 and 50 years old. Carotid intimal media thickness (cIMT) and biomarkers of endothelial injury and monocyte activation were also assessed. The association between quantitative CMV IgG and cardiovascular disease risk was assessed in multivariate logistic regression analysis. The results showed that the mean CMV IgG level among ART-naïve participants was significantly higher than both the cART group and controls. However, CMV IgG levels did not differ significantly between the controls and cART groups. Among PLWH, CMV IgG levels were associated with ICAM-1 levels and cIMT. Increases in CMV IgG among ART-naïve participants were significantly associated with increases in log VCAM-1. In conclusion, CMV IgG levels are elevated among PLWH in sub-Saharan Africa, and higher levels are associated with biomarkers of endothelial injury and cIMT. Future research should investigate the long-term impact of elevated CMV IgG among PLWH.

Treated human immunodeficiency virus (HIV) is associated with persistent systemic inflammation, even after many years of sustained viral suppression following initiation of antiretroviral therapy (ART). Albuminuria is common among people living with HIV (PLWH), but the impact of persistent systemic inflammation on outcome of albuminuria is not well understood. Thawed serum samples from PLWH who participated in an albuminuria prevalence study in Gaborone, Botswana, between January 2020 and March 2022, were selected randomly for a cross-sectional study of the link between inflammation and albuminuria. Systemic inflammation (interleukin [IL] 1β, IL 6, and soluble cluster of differentiation-163 [sCD163]) was assessed using enzyme linked immunosorbent assay, and albuminuria was reported as urinary albumin–creatinine ratio (ACR) (mg/g), as obtained from the parent study. The association between systemic inflammation and albuminuria was first explored by ACR quartiles, graphically using simple linear models, and then using general additive models for the adjusted analysis. The study population comprised 715 ART treated PLWH, with a mean age of 49.9 (SD 10.7) years, median HIV disease duration of 13.5 (IQR 8.7–16.7) years, and 398/715 (55.7%) were male. The relationship between log transformed ACR and sCD163 was linear, with regression coefficient β = 0.10, P-value = .02 but was nonlinear for log transformed IL-1β and IL-6, β = 0.10, P -value = .82 and β = ‐0.04, P-value = .36, respectively. In the final adjusted general additive models, sCD163 was not associated with ACR, P-value = .137. IL-1β, IL-6, and sCD163 were not associated with ACR among ART treated PLWH. Novel strategies to identify inflammatory pathways that may promote albuminuria among PLWH should consider other innovative and sensitive markers of both systemic and organ specific inflammation.

Due to the success of HIV treatment, people living with HIV (PWH) have aged to develop chronic conditions. InterCARE is evaluating the integration of hypertension treatment into HIV care in Botswana. This involves adapting the Electronic Health Records [EHR], health care workers training, and the use of treatment partners. A pilot hybrid type 2 effectiveness implementation trial in two public HIV clinics found high effectiveness, adoption, and fidelity overall but low adoption of EHR. This mixed-methods research aimed to explain mean variation in these outcomes to inform future scale-up. Guided by the Consolidated Framework for Implementation Research, we recruited community members, healthcare workers, patients, and treatment partners to complete surveys ( n = 100), and semi-structured interviews in-person ( n = 10), 12 months after InterCARE implementation. Descriptive statistics and Fischer’s exact tests were calculated for surveys, and a deductive analysis was completed for interviews (Cohen’s Kappa = 0.86). Qualitative analysis found high acceptability of InterCARE compared to standard of care for HIV and hypertension. Integration improved patient experiences by increasing efficiency of care (e.g., reduced visit frequency, less time spent accessing care, reduced out-of-pocket costs). Integration of care and use of treatment partners increased medication adherence. Barriers included insufficient resources, HIV-related stigma (both internalized and perceived), high healthcare workers workload, and need for HIV providers’ training in hypertension. To improve implementation, suggestions included increasing client awareness and understanding of services through education, using various dissemination strategies (e.g., social media, community meetings, handouts), and enhancing provider buy-in. Overall, results showed positive perceptions of the strategies and overall integration. This research provides valuable insight into factors that affect outcomes from bundled implementation strategies supporting integration among chronic diseases and HIV in resource-limited settings.