Mapping the current and future non-communicable disease burden in Kenya by HIV status: a modelling study

Background The non-communicable disease (NCD) burden in Kenya is not well characterised, despite estimates needed to identify future health priorities. We aim to quantify current and future NCD burden in Kenya by HIV status. Methods Original systematic reviews (SRs) and meta-analyses of prevalence/incidence of cardiovascular disease (CVD), chronic kidney disease, depression, diabetes, high total cholesterol, hypertension, human papillomavirus infection and related pre-cancerous stages in Kenya were carried out. An individual-based model was developed, simulating births, deaths, HIV-disease and treatment, aforementioned NCDs and cancers. The model was parameterised using SR, epidemiological national and regional surveillance data. NCD burden was quantified for 2018-2035 by HIV status amongst adults. Findings SRs identified prevalence/incidence data for each NCD, except ischemic heart disease. The model estimates that 51% of Kenyan adults currently suffer from ≥1 NCD, with a higher burden in People Living with HIV (PLHIV) compared to HIV-negative (62% versus 51%), driven by their higher age profile and partly by HIV-related risk for NCDs. Hypertension and high total cholesterol are the main NCD drivers (adult prevalence of 20·5% (5·3 million) and 9·0% (2·3 million)), with CVD and cancers the main causes of death. The burden is projected to increase by 2035 (56% in HIV-negative; 71% in PLHIV), with population growth doubling the number of people needing services (15·4 million to 28·1 million) by 2035. Conclusions NCD services will need to be expanded in Kenya. Guidelines in Kenya already support provision of these amongst both the general and HIV-positive population, however coverage remains low.