{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T03:38:58Z","timestamp":1752550738511,"version":"3.41.2"},"reference-count":54,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1134599"],"award-info":[{"award-number":["OPP1134599"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>As differentiated HIV services provided outside of clinics are scaled up, clients may have fewer interactions with ancillary services for non\u2010communicable disease (NCD) prevention and management traditionally offered within facilities. This study was embedded in the DO ART randomised trial (2016\u22122019), which demonstrated that community\u2010based differentiated service delivery (DSD) improved HIV viral suppression compared with facility\u2010based care. We assessed NCD risk among men and women living with HIV accessing community\u2010based DSD versus facility\u2010based care in KwaZulu\u2010Natal, South Africa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>First, we described lifestyle and clinical NCD risk among DO ART participants in rural and semi\u2010rural KwaZulu\u2010Natal. Next, we compared clinical NCD risk at 12 months by randomisation arm (community\u2010based DSD vs. facility\u2010based care). Finally, we explored the relationship between 12\u2010month viral suppression and clinical NCD risk, overall and stratified by randomisation arm (i.e. service delivery type).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 1010 participants, the median age was 32 years, 245 (24%) smoked, 229 (23%) had hypertension and 502 (50%) were overweight or obese (body mass index [BMI] \u2265\u00a025). Smoking was more common among men than women (43% vs. 6%, <jats:italic>p<\/jats:italic> \u2264\u00a00.001), while overweight\/obesity was more common among women than men (65% vs. 34%, <jats:italic>p<\/jats:italic>\u00a0\u2264\u00a00.001). We found no statistically significant association between service delivery type and clinical NCD risk factors at 1 year. We also found no significant associations between viral suppression at 12 months and blood pressure, haemoglobin A1c or smoking. However, virally suppressed clients had higher mean BMI (+0.93 kg\/m<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic> = 0.004) and higher mean cholesterol (+5.79 mg\/dl, <jats:italic>p<\/jats:italic> = 0.001). These associations were greater in effect size and statistically significant among clients receiving community\u2010based DSD (BMI: <jats:italic>p<\/jats:italic> = 0.003; cholesterol: <jats:italic>p<\/jats:italic> = 0.001), but smaller and not significant for facility\u2010based care (BMI: <jats:italic>p<\/jats:italic> = 0.299; cholesterol: <jats:italic>p<\/jats:italic> = 0.448).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Relatively younger adults accessing HIV treatment in South Africa had substantial NCD risk, which differed by gender and may increase with age. Among clients receiving community\u2010based DSD, viral suppression was associated with modestly higher BMI and cholesterol levels. Community\u2010based DSD programmes should consider integrating NCD risk screening and management that addresses gender\u2010specific needs to prevent premature mortality among people living with HIV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Number<\/jats:title><jats:p>NCT0292999<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26513","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T22:12:37Z","timestamp":1751926357000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Non\u2010communicable disease (NCD) risk among people living with HIV in KwaZulu\u2010Natal, South Africa: evidence from a randomised trial of community\u2010based differentiated service delivery"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1593-0193","authenticated-orcid":false,"given":"Maitreyi","family":"Sahu","sequence":"first","affiliation":[{"name":"Department of Health Metrics Sciences University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam A.","family":"Szpiro","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi","family":"van Rooyen","sequence":"additional","affiliation":[{"name":"Human Sciences Research Council  Western Cape South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Asiimwe","sequence":"additional","affiliation":[{"name":"Integrated Community\u2010Based Initiatives  Kabwohe Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryam","family":"Shahmanesh","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute  KwaZulu\u2010Natal South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3660-6330","authenticated-orcid":false,"given":"D. Allen","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meighan L.","family":"Krows","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kombi","family":"Sausi","sequence":"additional","affiliation":[{"name":"Human Sciences Research Council  Western Cape South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2090-3453","authenticated-orcid":false,"given":"Nsika","family":"Sithole","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute  KwaZulu\u2010Natal South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Torin","family":"Schaafsma","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8242-8438","authenticated-orcid":false,"given":"Jared M.","family":"Baeten","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"},{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"Division of Allergy and Infectious Diseases University of Washington  Seattle Washington USA"},{"name":"Gilead Sciences  Foster City California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3106-1258","authenticated-orcid":false,"given":"Adrienne E.","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"Division of Allergy and Infectious Diseases University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2530-6885","authenticated-orcid":false,"given":"Alastair","family":"van Heerden","sequence":"additional","affiliation":[{"name":"SAMRC\/WITS Developmental Pathways for Health Research Unit Department of Paediatrics School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"},{"name":"Human Sciences Research Council  KwaZulu\u2010Natal South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruanne V.","family":"Barnabas","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Medicine Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"volume-title":"The Path That Ends AIDS: 2023 UNAIDS Global AIDS Update","year":"2023","key":"e_1_2_11_2_1"},{"key":"e_1_2_11_3_1","unstructured":"World Health Organization.Noncommunicable Diseases: Fact Sheet. 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