Comparison of central obesity prevalence among adults living with and without HIV in Botswana: a cross-sectional study

Objectives: The aim was to establish the community prevalence of central obesity in Botswana and assess its association with HIV status. Design: We performed a one-time central obesity assessment nested within a community-based cluster-randomised controlled HIV treatment and prevention trial (Botswana Combination Prevention Project (BCPP)) conducted in Botswana. Setting: The BCPP enrolled consenting adults from a random sample of 20% of households in 30 rural/peri-urban communities. Participants: A subset of participants from 22 communities was selected for a nested central obesity study. Primary and secondary outcome measures: Central obesity was defined as a waist-to-hip ratio (WHR)>0.90 for males and >0.85 for females or as a waist circumference (WC) ≥94 cm for males and ≥80 cm for females. A modified Poisson regression model was used to ascertain the association between central obesity and HIV status. Additionally, the same model was used to estimate the adjusted prevalence ratio (aPR) for central obesity among participants with missing waist and hip measurements by applying inverse probability weighting, and then adjusting for sex and age in the final multivariate models. Results: Of the 3981 adults, 2039 (51%) completed central obesity assessment (67% female, 29% people living with HIV and median age 35.4 years (IQR 26.4–48.3 years). Central obesity prevalence was 43.5% (95% CI 41.4% to 45.7%) and 50.8% (95% CI 48.6% to 52.9%) as defined by WHR and WC, respectively, and was higher among females than males by WHR (46.9% (95% CI 44.2% to 49.5%) vs 36.7% (95% CI 33.1% to 40.4%)) and WC 68.5% ((95% CI 65.9% to 70.9%) vs 15.1% (95% CI 12.4% to 17.8%)) and increased with age. In fully adjusted models, there was no difference in central obesity by HIV status for both WHR and WC, aPR 0.99 (95% CI 0.90 to 1.09), p value 0.88, and 0.93 (95% CI 0.85 to 1.01), p value 0.06, respectively. Conclusion: Over two-thirds of adult females in Botswana had central obesity; however, living with HIV was not consistently associated with central obesity. Trial registeration number: NCT01965470.