{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T09:04:49Z","timestamp":1784711089698,"version":"3.55.0"},"posted":{"date-parts":[[2026,7,20]]},"group-title":"Public and Global Health","reference-count":71,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Having achieved the UNAIDS 95\u201395\u201395 targets, Eswatini faces a growing burden of non-communicable diseases which are major contributors to morbidity and mortality. Hypertension-associated cardiovascular disease (CVD) is rising among people living with HIV (PLHIV) as survival improves and metabolic risks \u2013 including those linked to dolutegravir (DTG) \u2013 increase. We projected CVD burden among PLHIV and HIV-negative adults (PLWHIV) through 2045 to inform integrated HIV\u2013CVD planning.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>EMOD-HIV, an agent-based model calibrated to Eswatini\u2019s epidemic, generated HIV prevalence trajectories. These were combined with age-standardized Global Burden of Disease CVD estimates and published relative risks (RRs) to produce HIV-stratified CVD projections. CVD burden trajectories were then projected through 2045 using a logistic generalized additive model with Monte Carlo uncertainty quantification. Five scenarios were evaluated to assess how different assumptions about RR of CVD among PLHIV versus PLWHIV affect projected burden: (1) CVD prevalence under a constant RR; (2) CVD mortality under a constant RR; (3) HTN-attributable CVD mortality under a constant RR; (4) HTN-attributable CVD mortality under a post-DTG RR increase following Eswatini\u2019s 2021 dolutegravir rollout; and (5) HTN-attributable CVD mortality under a gradual RR increase from 2010\u20132045 reflecting cumulative metabolic and demographic shifts.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>PLHIV consistently exhibited higher CVD burden than HIV-negative adults. Scenario 1: CVD prevalence was 11.0% (95% UI: 9.0-13.5%) among PLHIV versus 6.8% (6.0-7.8%) in 2025, stable through 2045. Scenario 2: CVD mortality rate was 0.60% (0.47-0.76%) versus 0.37% (0.31-0.45%) in 2025, declining modestly through 2045 with consistent excess. Scenario 3: HTN-attributable mortality was 73% (70-76%) versus 64% (61-66%) in women and 61% (58-64%) versus 58% (55-60%) in men, stable through 2045. Scenario 4: Following DTG rollout, mortality rose from 73% to 85% in women and 61% to 70% in men by 2022, remaining stable thereafter. Scenario 5: By 2045, mortality reached 85% (82-88%) in women and 67% (64-70%) in men with HIV, versus 60% (57 \u2013 63%) and 55% (53 \u2013 57%) in HIV-negative adults.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>While excess CVD burden among PLHIV is projected to persist even under stable risk conditions, ART-related metabolic trajectories \u2013 particularly those linked to DTG \u2013 may drive substantial widening of this gap through 2045. HTN-attributable CVD mortality is particularly elevated among women with HIV. Strengthening integrated HIV\u2013NCD services, including blood pressure screening, risk-based therapy, and sex-specific DTG counseling, will be essential to sustain long-term health gains.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.07.17.26358301","type":"posted-content","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T15:30:28Z","timestamp":1784561428000},"source":"Crossref","is-referenced-by-count":0,"title":["Projected burden of hypertension-associated cardiovascular disease in people living with HIV versus HIV-negative adults in Eswatini"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6527-1088","authenticated-orcid":false,"given":"Masabho P.","family":"Milali","sequence":"first","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T.","family":"Citron","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7313-7144","authenticated-orcid":false,"given":"Kasturi","family":"Bhamidipati","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nao","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afia","family":"Osei-Ntansah","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrida","family":"Platais","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianna","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cebisile","family":"Ngcamphalala","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sotja G.","family":"Dlamini","sequence":"additional","affiliation":[{"name":"Department of Agricultural Economics and Management, Faculty of Agriculture, University of Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ntombifuthi","family":"Ginindza","sequence":"additional","affiliation":[{"name":"Ministry of Health in Eswatini, Ministry of Justice & Constitutional Affairs Building, Mhlambanyatsi Road, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6604-7093","authenticated-orcid":false,"given":"Anna","family":"Bershteyn","sequence":"additional","affiliation":[{"name":"Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026072201551534000_2026.07.17.26358301v1.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-97180-3"},{"key":"2026072201551534000_2026.07.17.26358301v1.2","doi-asserted-by":"publisher","DOI":"10.5334\/gh.403"},{"key":"2026072201551534000_2026.07.17.26358301v1.3","doi-asserted-by":"publisher","DOI":"10.2989\/16085906.2021.1887301"},{"key":"2026072201551534000_2026.07.17.26358301v1.4","unstructured":"UNAIDS: UNAIDS data 2020. 2025 Nov 3."},{"key":"2026072201551534000_2026.07.17.26358301v1.5","unstructured":"Eswatini Summary Sheet 2021. 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