Prevalence and perceptions of physical activity and healthy diet for the prevention and control of hypertension among HIV-positive clients at the Infectious Diseases Institute in Kampala, Uganda.

Abstract

Introduction: There is a rising burden of hypertension among PLHIV in Uganda, with the estimated prevalence in HIV care settings ranging from 15% to 32.3%. To address this challenge, the Ministry of Health has incorporated hypertension care including preventive lifestyles such as physical activity (PA) and healthy diet in the Consolidated Guidelines for the prevention and treatment of HIV and AIDS in Uganda. However, there is a paucity of evidence on the prevalence and perceptions of PA and healthy diet for the prevention and control of hypertension among PLHIV in Uganda. Objective This study aimed to assess the prevalence of adequate PA and healthy diet consumption for the prevention of hypertension and associated factors among HIV-positive clients accessing care at the Infectious Diseases Institute in Kampala, Uganda. Methods: This cross-sectional quantitative study was conducted at the Infectious Diseases Institute (IDI) HIV clinic located in Kampala, Uganda. An adapted World Health Organization STEPwise questionnaire was administered with Open Data Kit (ODK) to a random sample of 431 PLHIV clients aged 18 years and above to obtain data on levels and perceptions of PA and healthy diet. Data obtained was retrieved from ODK into a Microsoft CSV file, cleaned, and exported to Stata version 17 for analysis. The prevalence and perceptions of the healthy diet and PA for hypertension were summarized using descriptive statistics. The Robust Poisson Regression model was used for bivariable analysis to determine the independent factors associated with engaging in adequate PA and consuming a healthy diet (fruits and/or vegetables). Results: More than three quarters (76.8%, 331/431)) of the respondents met the WHO PA recommendations. The attainment of the recommended level PA per week was majorly through the domain of work (84.6%, 280/331). Overall, the perceptions of respondents about PA were favourable (mean=3.6, SD=0.5), with the constructs of perceived susceptibility to hypertension (mean = 3.2, SD = 1.6) and perceived barriers to PA (mean = 3.1, SD = 0.7) having the least favourable perceptions. Being unemployed was significantly associated with a lower likelihood of engagement in adequate physical activity (APR:0.8, 95% CI :0.7-1.0, p<0.034). Pertaining to consumption of a healthy diet, only 10.6% (44/417) of the respondents met the WHO recommendations. Overall, the perceptions of respondents about consumption of a healthy diet were favourable (mean=3.7, SD=0.5), with the construct of perceived barriers to eating a healthy diet (mean = 3.2, SD = 1.6) having the least favourable perceptions. Being unemployed (APR:0.1, 95% CI :0.0-0.8, p<0.027), having a higher household income (APR:1.0, 95% CI :0.9-1.0, p<0.039) and having a longer duration on Antiretroviral Therapy (ART) (APR:0.9, 95% CI :0.9-1.0, p<0.046) were significantly associated with consumption of an unhealthy diet. Conclusion: Most PLHIV at IDI engaged in adequate PA and attained the WHO PA recommendations through work-related PA, and the likelihood of engagement in adequate PA was low among unemployed PLHIV. Despite overall perceptions of PA being positive, low perceived susceptibility to HTN and high perceived barriers to PA were the biggest challenges to engaging in PA. Consumption of a healthy diet was low. Being unemployed, having a longer duration of ART, and a higher average monthly household income were significantly associated with the low consumption of a healthy diet. The overall perceptions of healthy diet where positive, with the low perceived susceptibility to HTN and high perceived barriers to healthy dieting being the biggest hinderances to consuming a healthy diet. Therefore, there is an urgent need for strategies and interventions to promote PA and healthier diets and address the high perceived barriers to PA and healthier diets and low perceived susceptibility to HTN among PLHIV.