{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T16:44:41Z","timestamp":1778949881608,"version":"3.51.4"},"reference-count":27,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T00:00:00Z","timestamp":1605657600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The rapidly growing epidemic of non\u2010communicable diseases (NCDs) including mental health among aging people living with HIV (PLWH) has put a significant strain on the provision of health services in many HIV clinics globally. We constructed care cascades for specific NCDs and mental health among PLWH attending our centre to identify potential areas for programmatic improvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a follow\u2010up study of participants recruited in the Malaysian HIV &amp; Aging study (MHIVA) from 2014 to 2016 at the University Malaya Medical Centre (n\u00a0=\u00a0336). PLWH on suppressive antiretroviral therapy (ART) for a minimum of 12\u00a0months were invited to participate. At study entry, all participants underwent screening for diabetes (DM), hypertension (HTN) and dyslipidaemia; and completed assessments using the depression, anxiety and stress scale (DASS\u201021). Screening results were recorded in medical charts and clinical management provided as per standard of care. A subsequent review of medical records was performed at 24\u00a0months following study completion among participants who remained on active follow\u2010up. Treatment pathways for NCD treatment and psychiatric referrals were assessed based on local practice guidelines to construct the care cascade.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 329 participants (median age\u00a0=\u00a043\u00a0years, 83% male, 100% on ART) completed follow\u2010up at 24\u00a0months. The prevalence of diabetes was 13%, dyslipidaemia 88% and hypertension 44%, whereas 23% presented with severe\/extremely severe symptoms of depression, anxiety and\/or stress. More than 50% of participants with dyslipidaemia and hypertension were not diagnosed until study screening, whereas over 80% with prevalent psychiatric symptoms were not previously recognized clinically. Suboptimal control of fasting lipids, sugar and blood pressure were found in the majority of participants despite optimal HIV treatment outcomes maintained over this same period. Only 32% of participants with severe\/extremely severe mental health symptoms received psychiatric referrals and 83% of these attended their psychiatry clinic appointments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Systematic screening must be introduced to identify NCDs and mental health issues among PLWH followed by proper linkage and referrals for management of screen\u2010positive cases. Assessment of factors associated with attrition at each step of the care cascade is critically needed to improve health outcomes in our aging patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25638","type":"journal-article","created":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T21:01:48Z","timestamp":1605733308000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["A retrospective analysis of the care cascades for non\u2010communicable disease and mental health among people living with HIV at a tertiary\u2010care centre in Malaysia: opportunities to identify gaps and optimize care"],"prefix":"10.1002","volume":"23","author":[{"given":"Chong","family":"Meng Li","sequence":"first","affiliation":[{"name":"Centre of Excellence for Research in AIDS (CERiA) University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fong","family":"Jie Ying","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dhevann","family":"Raj","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Research in AIDS (CERiA) University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wong","family":"Pui Li","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Research in AIDS (CERiA) University of Malaya Kuala Lumpur Malaysia"},{"name":"Department of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anjanna","family":"Kukreja","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Research in AIDS (CERiA) University of Malaya Kuala Lumpur Malaysia"},{"name":"Department of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharifah FS","family":"Omar","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Research in AIDS (CERiA) University of Malaya Kuala Lumpur Malaysia"},{"name":"Department of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adeeba","family":"Kamarulzaman","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Research in AIDS (CERiA) University of Malaya Kuala Lumpur Malaysia"},{"name":"Department of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3756-0629","authenticated-orcid":false,"given":"Reena","family":"Rajasuriar","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Research in AIDS (CERiA) University of Malaya Kuala Lumpur Malaysia"},{"name":"Department of Medicine University of Malaya Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,18]]},"reference":[{"issue":"8","key":"e_1_2_8_2_1","article-title":"Survival of HIV\u2010positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies","volume":"4","author":"The Antiretroviral Therapy Cohort Consortium A","year":"2017","journal-title":"Lancet HIV"},{"key":"e_1_2_8_3_1","unstructured":"AIDSinfo.UNAIDS 2018 Estimates(internet).2018[cited 2020 15 March 2020]. 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