Date of Award
Spring 2026
Document Type
Open Access Dissertation
Department
Public Health
First Advisor
Mufaro Kanyangarara
Abstract
Background: Zimbabwe’s achievement of the UNAIDS 95‑95‑95 targets and expanded access to antiretroviral therapy (ART) has shifted the clinical burden among people living with HIV (PLWH) from AIDS‑related conditions to chronic non‑communicable diseases. As PLWH live longer, multimorbidity, the co‑occurrence of two or more chronic non- HIV conditions, together with polypharmacy, has emerged as a major challenge, yet evidence from low‑resource settings remains limited. This dissertation examines (1) risk factors for incident multimorbidity, (2) the causal effect of multimorbidity on mortality, and (3) the prevalence and determinants of polypharmacy among adults receiving HIV care at Newlands Clinic in Harare, Zimbabwe, between 2004 and 2024.
Methods: Using a retrospective cohort design, electronic medical records were analyzed for more than 7,500 adults without baseline multimorbidity. Time‑varying Cox models incorporating longitudinal ART regimen, CD4 count, viral load, BMI, and age were used to assess predictors of multimorbidity. Marginal structural models with inverse probability weighting estimated the causal effect of multimorbidity on all‑cause mortality. Generalized estimating equations assessed polypharmacy using multiple medication‑count definitions.
Results: The incidence of multimorbidity was 14.5 per 1,000 person‑years, with hypertension, chronic kidney disease, diabetes, depression, and osteoarthritis being the most frequent conditions. Risk increased with older age, overweight/obesity, lower CD4 counts, and use of non‑dolutegravir regimens, and was lower among men and those initiating ART in more recent calendar periods. Multimorbidity significantly worsened survival. Age‑standardized mortality rates rose from 92.3 (no chronic diseases) to 128.1 deaths per 1,000 person‑years among those with multimorbidity, and marginal structural models showed more than double the risk of death (adjusted hazard ratios 2.57-2.70), consistent across complete‑case and imputed analyses. Polypharmacy prevalence was relatively low (2.3-6.3%) but increased over time and was strongly associated with multimorbidity (aOR 8.24-13.48), older age, low CD4 counts, unsuppressed viral load, and underweight BMI.
Conclusion: Overall, multimorbidity and polypharmacy are rising among PLWH in Zimbabwe, and multimorbidity is associated with increased mortality. These findings underscore an urgent need to integrate chronic disease prevention, screening, and management into HIV care.
Rights
© 2026, Pamela Nyaradzai Magande
Recommended Citation
Magande, P. N.(2026). HIV and Multimorbidity: Longitudinal Insights From a Cohort of Adults Living With HIV in Zimbabwe (2004-2024). (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/8882