Knowledge, attitudes and practices toward noncommunicable diseases and associated risk factors among people living with HIV in Rwanda: A cross-sectional study

Knowledge, attitudes and practices toward noncommunicable diseases and associated risk factors among people living with HIV in Rwanda: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge, attitudes and practices toward noncommunicable diseases and associated risk factors among people living with HIV in Rwanda: A cross-sectional study Valentine Dushimiyimana, Vivianne U Niyonkuru, Ladislas Nshimiyimana, and 18 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7380637/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The increasing burden of noncommunicable diseases (NCDs) globally poses a significant risk to people living with HIV (PLHIV). However, in Rwanda and other low- and middle-income countries, there is a lack of comprehensive understanding regarding PLHIV knowledge, attitudes, and practices (KAPs) related to NCDs. This study assessed the level of KAPs toward NCDs and related risk factors among PLHIV in Rwanda. Methods We conducted a cross-sectional study nested within an ongoing cohort between March and September 2021. A total of 1,334 PLHIV aged 18 years or older without a prior NCD diagnosis were randomly selected from 12 health facilities across five Rwandan provinces. Data were collected via a standardised KAP questionnaire. The KAP scores were evaluated relative to the maximum achievable scores via Likert scales. Descriptive statistics were used to summarise the findings, and linear regression was used to identify factors influencing KAP outcomes. Results The analysis included 1,170 participants, of which 63.8% were women, including 73.1% in the reproductive age group of 24–54 years. The majority were married (55.1%), nearly half (49.1%) had completed primary education, 39.1% were illiterate, and only 17.4% were unemployed. The study revealed low awareness and suboptimal practices concerning NCDs among PLHIV. While awareness of diabetes was relatively high, large proportions of participants were unaware of stroke (79.1%), heart disease (70.3%), or hypertension (54.7%). Furthermore, 21.9% lacked awareness of NCD risk factors, and 37.2% lacked knowledge of metabolic risk factors. The attitudes reflected misconceptions, with 36.3% believing that NCDs are inevitable and with 71.0% showing no concern about the quantity of salt intake. With respect to practices, 57.1% of the participants reported no routine health check-ups, and 47.9% did not maintain a healthy weight. Education, occupation, and BMI significantly influenced knowledge scores. Participants with above-secondary education scored 16.1 points higher, and those with obesity scored 3.6 points higher than their counterparts with no formal education or normal BMI (p = 0.002, 95% CI: 1.3–6.1). Conclusion Our findings highlight significant gaps in KAPs related to NCDs among PLHIV in Rwanda. Evidence-based and context-appropriate interventions, including health education, are needed to improve awareness and promote preventive behaviours among PLHIV, contributing to reducing NCD risk and fostering a healthier and more sustainable quality of life for PLHIV. Noncommunicable diseases (NCDs) HIV knowledge attitudes practices Rwanda Figures Figure 1 Background The global burden of diseases is shifting from communicable to noncommunicable diseases (NCDs) due to demographic and epidemiological changes in low- and middle-income countries (LMICs) ( 1 ). Globally, NCDs are the leading cause of mortality, accounting for 41 million deaths annually, with over 86% of these cases occurring in LMICs ( 2 ). Rwanda is no exception; 44% of deaths in the country are attributed to NCDs, with cardiovascular diseases (CVDs) accounting for 14% of these fatalities( 3 ). Furthermore, individuals living with HIV (PLHIV) face an elevated risk of developing noncommunicable diseases (NCDs) and experiencing premature mortality ( 4 ). Research indicates a strong association between HIV and NCDs, highlighting greater vulnerability among PLHIV, particularly in sub-Saharan Africa ( 4 ). Conditions such as diabetes, cardiovascular disease (CVD), and other NCDs are notably prevalent within this population. In addition to the risk factors associated with major NCD risk factors, such as tobacco smoking, harmful alcohol consumption, physical inactivity, unhealthy diets, high blood pressure and diabetes, PLHIV face an increased risk of NCDs due to potential side effects of antiretroviral therapy (ART) and chronic inflammation due to viral persistence ( 5 , 6 ). Consequently, compared with people without HIV, PLHIV are at a 1.5 to 2 times greater risk of experiencing CVD manifestations ( 7 ). While data remain scarce, the profound consequences of chronic noncommunicable CVD, mainly CVD, in PLHIV in LMICs are significant, especially given that more than 70% of PLHIV live in these regions( 8 , 9 ). Furthermore, 28% of PLHIV are diagnosed with high blood pressure one year after the initiation of ART( 10 ). In Tanzania, PLHIV were reported to experience 2.2 times greater odds of systolic blood pressure than their counterparts without HIV, and the incidence of stroke was found to be 2.5 times greater in HIV-positive individuals than in their noninfected peers ( 11 – 13 ). Although the link between noncommunicable diseases (NCDs) and HIV is increasingly recognised worldwide, significant research gaps persist in Rwanda. In particular, little is known about the knowledge, attitudes, and practices (KAPs) of people living with HIV (PLHIV) regarding NCDs and their drivers. Addressing this gap is crucial for developing targeted interventions, improving healthcare services, and ultimately enhancing the well-being of PLHIV in Rwanda. This study aims to assess their level of awareness, perceptions, and behaviours related to NCDs, providing valuable insights for more effective and responsive healthcare strategies. Methods Study design and setting We conducted an observational study with a cross-sectional design to measure the KAPs toward NCDs and related risk factors among PLHIV in Rwanda. This study was nested within an ongoing cohort study of health determinants for major NCDs among PLHIV in Rwanda (NCOHIRWA Cohort Study) ( 14 ). The participants in the NCORHIRWA cohort were selected randomly from 12 health facilities in five provinces across Rwanda, as shown in Fig. 1 . Study participants The participants recruited were those 18 years of age or older, engaged in clinical care in an HIV care and treatment program, were free from NCDs and were committed to providing informed consent for participation in the NCOHIRWA cohort study. At each study site, eligible PLHIV were identified and stratified by sex and age, and proportionate random sampling was used to enrol participants to ensure representativity of the general HIV population in Rwanda. Participants from the NCOHIRWA cohort study (total of 1334) were included in the present study if they had available data for the KAP survey; 164 participants were eliminated, and 1170 participants remained. Data collection tool and procedure Data were collected via Research Electronic Data Capture (REDCap) by trained nurses working in HIV clinics at the selected health facilities. The questionnaire was adapted to the standard questionnaire to measure the KAP related to NCDs. Furthermore, the questionnaire was translated into Kinyarwanda, the local language understandable by the study population. Anthropometric measurements (height and weight) were taken via a scale. The nurses were trained in data collection for quality data. The training program for the nurse data collectors emphasised the utilisation of the data collection tool and proficiency with the REDCap software. During the training sessions, the nurses conducted pretests of the questionnaire among themselves to become familiar with the questions. Additionally, the pretest allowed us to estimate the duration of the survey, ensure accurate translation of the questions, and implement any necessary corrections. Measures The research data collection in REDCap consisted of three different tools. The measure of interest is KAP. The data extracted from the KAP questionnaire were separated into three main domains: knowledge, attitudes, and practices. The knowledge assessment domain has a total of 17 questions. Sixteen questions ask about risk factors, symptoms, and preventive measures for NCDs. Responses are scored as 1 for "correct" and 0 for "incorrect." The remaining questions explored awareness levels of major NCDs (hypertension, stroke, heart disease, cancer and diabetes) on a Likert scale ranging from 1 (nothing at all) to 4 (familiar with NCDs). The attitude domain comprises eight statements, with answers using a 4-level Likert scale rated as “Strongly agree,” “Agree,” “Disagree,” and “Strongly disagree.” During the analysis, the attitudes were reclassified as “Favourable” to indicate positive attitudes that can help in the control and prevention of NCDs and “Unfavourable” for negative attitudes. The practices domain assesses lifestyle practices related to NCD prevention and features eleven questions. The answers were binary, with “Yes” for actions that the participants practiced and “No” for those that they did not. Other measurement data, including sociodemographic characteristics and anthropometric measures, were extracted from the centralised database of the NCOHIRWA cohort study. Sociodemographic characteristics included sex, age, education level, marital status, and occupation. Education was measured by the highest level completed, and occupation reflected participants' primary income source during data collection. These characteristics served as independent variables in the study. For anthropometric measurements, weight was measured in kilograms (kg), and height was measured in centimetres (cm). Body mass index (BMI) was calculated by dividing weight (kg) by height (m) squared, with the results expressed in kg/m². The following BMI classifications were applied: underweight (< 18.5 kg/m²), normal (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), and obese (≥ 30 kg/m²)( 15 ). Statistical analysis Descriptive analysis was performed to summarise sociodemographic characteristics, anthropometric measures and KAP scores. KAP scores were calculated against the highest possible scores. Associations between sociodemographic and anthropometric variables of interest (independent variables) and KAP scores (dependent variables) were modelled via uni- and multivariable linear regression models. For all analyses, alpha was set at a two-sided p value less than 0.05. The data were analysed via R version 4.3. Results Sociodemographic characteristics of the participants We included 1,170 PLHIV with complete KAP and demographic data, including 747 females (63.8%) and 423 males (36.2%). The most represented age group was 35–44 years, with 349 participants (29.8%). The majority of the respondents were married, comprising 644 (55.1%) of the participants. Nearly half of the participants, 575 (49.1%), reported primary education as their highest educational attainment. Unemployment was reported by 203 participants (17.4%), whereas self-employment and farming were the most common occupations, each representing 382 participants (33.1%). The body mass index (BMI) was within the normal range: 58.5% (685) and 9.5% (111) were obese, and 10.1% ( 9 ) were underweight (Table 1 ). Table 1 Sociodemographic characteristics and anthropometric measurements of the participants at baseline Demographics Frequency Percentage Sex Female 747 63.8% Male 423 36.2% Age category 55 245 20.9% Marital status Single 181 15.5% Married 644 55.1% Divorced 119 10.2% Widow(er) 226 19.3% Education level No formal education 465 39.7% Primary level 575 49.1% Secondary level 100 8.5% Higher than Secondary 30 2.6% Occupation category Employed 159 13.8% Self-employed 382 33.1% Farmer 382 33.1% Student 37 3.2% Retired 7 0.6% Unemployed 203 17.4% Anthropometry BMI Category Underweight (< 18.5) 9 10.1% Normal (18.5–24.9) 685 58.5% Overweight (25.0-29.9) 256 21.9% Obese (≥ 30.0) 111 9.5% General knowledge of major noncommunicable diseases (NCDs) Stroke was the least known disease, with 917 (79.1%) of the participants reporting no knowledge of it at all. Similarly, the majority of the participants (n = 785, 70.3%) lacked knowledge about heart disease. Almost half of the participants, 580 (49.8%), reported having no knowledge of cancer, whereas 381 (32.7%) knew little about it. Diabetes was fairly well known as NCD, with 629 (53.9%) of the participants knowing little about the disease and 166 (14.2%) having heard the condition before (Table 2 ). Table 2 General knowledge of major NCDs NCDs Level of information n (%) Nothing at all I have heard the term only I know little I am very familiar Hypertension 639 (54.7%) 155 (13.3%) 363 (31.1%) 12 (1.0%) Heart diseases 785 (70.3%) 145 (13.0%) 180 (16.1%) 6 (0.5%) Stroke 917 (79.1%) 144 (12.4%) 97 (8.4%) 2 (0.2%) Cancer 580 (49.8%) 200 (17.2%) 381 (32.7%) 3 (0.3%) Diabetes 359 (30.8%) 166 (14.2%) 629 (53.9%) 12 (1.0%) Knowledge of the risk factors and prevention measures for NCDs The participants identified various risk factors and prevention measures for NCDs. Tobacco smoking was the most recognised behavioural risk factor among 650 participants (56.1%), followed by harmful alcohol consumption (596, 51.4%). The most recognised metabolic risk factor was being overweight or obese (474, 42.1%), whereas increased cholesterol was the least known factor 143 (12.7%). A total of 418 (37.2%) participants were unaware of any metabolic or behavioural risk factors 254 (21.9%). For prevention measures, avoiding tobacco smoking was noted by 651 (56.0%) participants, followed by maintaining a healthy diet in 538 (46.0%) participants. However, 239 (20.6%) were unaware of any prevention measures (Table 3 ). Table 3 Knowledge of the risk factors for and prevention measures for NCDs Risk factors Categories Frequency (Yes) n (1170) Percentage (%) Behaviour risk factors Tobacco use 650 56.1% Physical inactivity 316 27.3% Unhealthy diet 481 41.5% Harmful use of alcohol 596 51.4% Nothing at all 254 21.9% Metabolic Risk factors Raised blood pressure 312 27.7% Being overweight/obese 474 42.1% Raised blood glucose 425 37.8% Raised Cholesterol 143 12.7% Nothing at all 418 37.2% Prevention measures Avoid or quit smoking 651 56.0% Healthy diet 535 46.0% Physical activities 432 37.2% Abstain from harmful alcohol consumption 528 45.4% Eating vegetables and fruits/ 198 17.0% Nothing at all 239 20.6% Attitudes toward NCDs The participants' attitudes toward NCDs revealed that 398 (34.8%) perceived themselves as having a healthy body capable of fighting NCDs, whereas 754 (65.2%) did not. A significant proportion, 902 (78.5%), disagreed with the statement that PLHIV do not have NCDs. The majority, 1,006 (87.3%), believe that excessive alcohol consumption is never acceptable, even on an occasional basis. The opinion that a healthy lifestyle is hard to attain was evenly split among participants. Moreover, 719 (65.5%) disagreed with the belief that no matter what you do, you can obtain NCDs. Most participants (1,031, 89.6%) recognised the importance of monitoring salt intake, 628 (55.2%) expressed concern about developing NCDs, and 1036 (89.5%) acknowledged that early detection improved outcomes (Table 4 ). Table 4 Attitudes toward NCDs Variable Favourable Unfavourable Total Perceive that he/she has a healthy body able to fight NCDs 398 (34.8) 745 (65.2) 1143 People living with HIV do not get NCDs 247 (21.5) 902 (78.5) 1149 Drinking much alcohol some occasion is allowed 147 (12.7) 1006 (87.3) 1153 Healthy lifestyle is hard to attainable 570 (49.1) 591 (50.9) 1161 No matter what you can do, you can get NCDs 378 (34.5) 719 (65.5) 1097 Finding NCDs early increase chance for improvement 1039 (89.5) 122 (10.5) 1161 It is important to care about salt to put in food 1031 (89.6) 120 (10.4) 1151 Feeling worried to get NCDs 628 (55.2) 510 (44.8) 1138 Practices toward NCDs Most respondents reported not smoking tobacco (1,078, 92.4%) and abstaining from harmful alcohol consumption (657, 58.4%). Seventy (6.0%) ate fruits and vegetables at least three times per week. Additionally, 401 (34.8%) consumed fatty foods frequently, and 650 (55.8%) liked to add more salt to meals while eating. A total of 442 participants (40.3%) undertook measures to reduce stress, whereas 500 participants (45.5%) engaged in daily physical activities lasting between 30 and 60 minutes. Moreover, 528 (46.6%) participants maintained a healthy weight. Visits to physicians for general checkups were reported by 619 (56.3%) participants, while 919 (78.7%) did not check their blood sugar, and 569 (48.7%) did not check their blood pressure regularly (Table 5 ). Table 5 Practices toward NCDs Variable Yes n(%) No n(%) Total Do you smoke tobacco? 1078 (92.4) 89 (7.6) 1167 Do you drink alcohol? 657 (58.4) 468 (41.6) 1125 Do you eat fruit and vegetables are least three times per week? 70 (6.0) 1093 (94) 1163 Do you consume oftenly fatty foods? 401 (34.8) 750 (65.2) 1151 Do you add more salt when you are eating meals? 650 (55.8) 514 (44.2) 1164 How often do you try do reduce stress? 442 (40.3) 656 (59.7) 1098 Do you do 30–60 mins physical activity daily? 500 (45.5) 598 (54.5) 1098 Do you participate in maintaining your healthy weight? 528 (46.6) 605 (53.4) 1133 Do you visit the physician for general body checkup? 619 (56.3) 480 (43.7) 1099 Do you check your blood pressure regularly? 919 (78.7) 248 (21.3) 1167 Do you check your blood sugar regularly? 569 (48.7) 599 (51.3) 1168 Associations between demographic characteristics, anthropometric measures and knowledge scores The mean overall knowledge score was 38.4. Compared with normal weight individuals, obese individuals scored 3.6 points higher (AβC = 3.6, p = 0.002). The level of education was a significant predictor, with lower education levels being negatively correlated with knowledge scores (p < 0.001). The scores progressively increased from individuals with no formal education (34.71) to those with education beyond the secondary level (52.16). Employment status also demonstrated significant associations: self-employed individuals (AβC = -2.2, p = 0.04), unemployed individuals (AβC = -2.8, p = 0.02), and farmers (AβC = -2.8, p = 0.01) had lower knowledge scores than did the employed group. Other demographic characteristics, such as age and marital status, were not significantly associated with knowledge. Table 6 Association between demographic characteristics and the knowledge score Demographic characteristics Knowledge Mean score AβC P- value CI (95%) Sex Male 39.22 1.2 0.12 [-0.3–2.7] Female 38.04 Ref Age category 55 37.61 -0.6 0.7 [-4.7–3.4] Marital status Single 40.06 0.6 0.6 [-2.3–3.6] Married 38.57 1.1 0.3 [-1.1–3.4] Divorced 36.33 Ref Widow(er) 37.97 1.4 0.3 [-1.3–4.1] Education level No formal education 34.71 -16.1 < 0.001* [-20.4 -11.8] Primary level 39.69 -11.8 < 0.001* [-16.1 -7.6] Secondary level 44.78 -7.6 < 0.001* [-12.2–2.9] Higher than secondary 52.16 Ref Occupation category Employed 42.38 Ref Self-employed 38.73 -2.2 0.04* [-4.3 -0.1] Student 43.83 0.4 0.8 [-4.5–5.3] Retired 46.33 4.9 0.3 [-3.7- 13.5] Unemployed 37.81 -2.8 0.02* [-5.2 -0.4] Farmer 36.53 -2.8 0.01* [-5.1 -0.5] BMI Category Underweight (< 18.5) 37.7 -0.3 0.9 [-2.6-2.0] Normal (18.5–24.9) 38.01 Ref Overweight (25.0-29.9) 38.6 0.6 0.6 [-1.1-2.3] Obese (≥ 30.0) 41.7 3.6 0.002* [1.3–6.1] *Significance level α < 0.05, AβC: adjusted beta coefficients; CI: confidence interval Discussion Evidence-based and context-appropriate interventions, including health education, are needed to improve awareness and promote preventive behaviours among PLHIV, contributing to reducing NCD risk and fostering a healthier and more sustainable quality of life for PLHIV. The study revealed that people living with HIV had low levels of knowledge and awareness about NCDs and their risk factors. The participants' education levels, occupation level, and BMI status were associated with the mean knowledge score of the participants. These findings suggest that highly educated individuals have better access to information, enabling them to understand the disease, its risk factors, and prevention measures more effectively than others do. The results provide insights into the level of awareness and knowledge about NCDs among individuals living with HIV. Notably, participants displayed varying levels of awareness regarding major NCDs, with stroke and heart disease being significantly less known than diabetes is, which has emerged as the most recognised NCD by participants. In a study conducted in Botswana, 97.8% of the enrolled participants reported high awareness of diabetes ( 16 ). A survey conducted in Rwanda revealed that approximately 1 in 6 people live with hyperglycemia or diabetes mellitus, which increases the knowledge of patients and family members about the disease ( 17 – 19 ). Moreover, Rwanda's diabetes management programs were initiated many years before; despite the widespread awareness of NCDs, they have been decentralised to primary healthcare facilities with a focus on increasing community awareness and early detection and treatment( 20 ). This could explain why diabetes is well known compared with other NCDs and highlights the need for investment in all NCDs. Unfortunately, 49.8% of the participants knew nothing about cancer, although PLHIV are much more likely to develop cancer than people who do not have HIV infection ( 21 , 22 ). Typically, cervical cancer is highly prevalent in PLHIV because of human papilloma virus coinfection and the inability to control these infections with a suppressed immune system( 22 , 23 ). The findings of Shiferaw et al. (2016) in Ethiopia were also congruent with the findings of this study, as that study revealed that PLHIV had very low knowledge of cancer ( 24 ). Hence, these findings underscore the imperative of increasing the knowledge of PLHIV, which should help them prevent these diseases. The participants predominantly demonstrated awareness of risk factors such as tobacco smoking and harmful alcohol consumption. These findings resonate with other studies reporting that smoking cigarettes is listed by 65.7% of the respondents, followed by alcohol consumption ( 25 , 26 ). Many respondents were aware of metabolic risk factors such as being overweight, having high glucose levels, and having high blood pressure. However, increased cholesterol is less recognised, and many are unaware of any risk factors. Moreover, a significant portion recognised key preventive measures, such as avoiding tobacco smoking, and a notable percentage expressed uncertainty about specific preventive measures. The assessment of participants' attitudes toward NCDs revealed a mix of positive and negative perceptions. The majority expressed perceived susceptibility to NCDs, emphasising the awareness of potential risks ( 27 ). While a significant portion acknowledged the importance of adopting a healthy lifestyle and monitoring specific health-related behaviours, there was a mix of confidence and concern about personal health. More than half of the respondents believed that luck plays a role in avoiding NCDs and felt that regardless of lifestyle choices, one can still develop NCDs. The belief that NCDs and strokes are caused by supernatural forces hinders efforts to take preventive measures, as some people view them as curses or bewitchments and feel powerless to prevent them ( 28 – 30 ). The population in low-income settings, such as Nepal, has been found to consider health facilities for curative purposes, which hinders the population from seeking preventive services such as general body checkups ( 31 ). A similar gap was observed in this study, particularly in routine health checks, where more than half of the participants did not perform regular check-ups for serum glucose, cholesterol and blood pressure monitoring. Moreover, the insurance packages do not cover the checkups. Although 98% of Rwanda is covered by community-based health insurance, it requires out-of-pocket payments for body checkups, which can be pulling factors for checkups( 32 , 33 ). The findings highlight the gaps in preventive measures that can sometimes be resolved at minimum cost, such as integrating some physical measures, such as blood sugar, blood pressure and body weight, into triage for all patients and providing health education on the basis of the results. The participants who attained a high level of education were found to be associated with high knowledge of NCDs and their practices. A total of 16.1 more knowledge scores were obtained from the participants with higher than secondary education than from those without formal education. In this study, most of the respondents did not have a high level of education, as 39.7% had no formal education and 49.1% had only primary education. Low literacy levels generally affect knowledge of diseases, especially in Africa ( 34 ). A study in Tanzania reported that more educated participants had better knowledge. Another study linked education status with understanding NCD risk factors and service utilisation ( 35 – 37 ). The link between BMI and knowledge scores sheds light on NCD awareness. Compared with normal weight participants, obese participants had higher knowledge scores, indicating greater exposure to health information from healthcare providers focused on lifestyle changes and disease prevention. Obesity is generally seen in wealthier people in low-income countries, contrary to what we see in high-income countries. It is likely that people with obesity in Rwanda are largely wealthier and more educated and are more knowledgeable about NCDs. Additionally, it is plausible that obese individuals might be more motivated to seek information about NCDs and their prevention, driven by personal health concerns, with an effort to manage their weight and improve their overall health. Several studies support the notion that individuals with health-threatening conditions are more likely to receive health education because of their increased risk of comorbidities and more prevention measures to prevent recurrence( 38 ). Healthcare providers frequently focus on health education, especially behaviour change communication, to reduce complications in overweight and obese individuals, likely resulting in higher knowledge scores in this group ( 38 – 40 ). However, public health strategies should aim for the widespread dissemination of information, targeting the general population, which may not perceive themselves at immediate risk but can benefit significantly from preventative knowledge. Policy Implications The significant gaps in knowledge, attitudes, and preventive practices toward NCDs among PLHIV in Rwanda highlight the urgent need to integrate NCD prevention and health education into existing HIV care services. Strengthening routine screening for hypertension, diabetes, and other NCD risk factors in HIV services, combined with tailored health promotion targeting low-literacy populations, could improve early detection and foster healthier behaviours. Leveraging Rwanda’s strong HIV program infrastructure to deliver integrated NCD-HIV services, supported by community-based outreach and health insurance coverage for preventive check-ups, would accelerate progress toward reducing the dual burden of NCDs and HIV, improving long-term health outcomes and lowering future healthcare expenses. Limitations and strengths While our study provides robust evidence on KAPs toward NCDs in Rwanda using a large nationally representative sample of PLHIV, there are potential limitations that should be considered when our findings are interpreted. First, the recruitment of participants from health facilities may introduce selection bias, as those attending clinics may differ in health-seeking behaviour compared with those who do not, potentially affecting the study's conclusions about KAP levels. Second, the cross-sectional nature of the study captures associations at only a single point in time, making it impossible to infer causality between sociodemographic factors and KAP outcomes. Third, the use of self-report questionnaires may introduce response bias, as participants could provide socially desirable answers, particularly concerning sensitive health behaviours. Fourth, while the analysis included sociodemographic characteristics, other potential confounding factors (e.g., comorbid conditions, cultural beliefs) that might influence KAP levels were not accounted for, which could affect the interpretation of the results. Conclusion The identified knowledge, attitudes and practice gaps for the control and prevention of NCDs emphasise the importance of comprehensive health promotion strategies. While knowledge is crucial, interventions should also target attitude formation and address potential barriers to translating knowledge into actionable practices. Tailored approaches that consider the unique circumstances of PLHIV, including their experiences, beliefs, and psychosocial factors, and provide structural support are essential for fostering holistic well-being and effective NCD prevention. Furthermore, integrating preventive measures into routine healthcare services and addressing barriers to health check-ups could further increase the overall well-being of people living with NCDs. Hence, efforts should sustain the impact of the global commitment to achieve a healthier and highly attainable quality of life among PLHIV. Further studies should explore the enabling factors for people living with HIV to effectively control and prevent NCDs while considering their exponential risk of contracting NCDs. Abbreviations ART: antiretroviral therapy BMI: body mass index CI: confidence interval CVD: cardiovascular disease CVDs: cardiovascular diseases LMICs: Low- and middle-income countries KAP: Knowledge, attitudes and practices NCDs: noncommunicable diseases PLHIV: People living with HIV REDCap: Research Electronic Data Capture Declarations Ethics approval and consent to participate The study was conducted in accordance with the Helsinki Declaration and approved by the Rwanda National Ethics Committee, reference numbers 210/RNEC/2020 and 84/RNEC/2021, and aligns with good clinical practice. All participants gave their informed consent for inclusion before they participated in the study. Consent for publication NA Availability of data and materials The datasets generated and/or analysed during the current study are presented in this manuscript. Competing interests The authors declare that they have no competing interests. Funding The study was implemented under funds from the Rwanda National Council for Science and Technology (NCST), Research excellent scheme. Authors' contributions The funder of the study had no role in the design, data collection, data analysis, data, interpretation or writing of the manuscript. The authors confirm the contributions to the paper as follows: All authors (VD, VNU, LN, PK, NG, CI, YDNU, ER, AT, GNR, FU, BAK, MD, NP, CH, LB, KMI, NABN, GK, PN, MT, SC): conceptualisation, design, and read and approved the manuscript. VD, VNU, LN, PK, CI, and YDNU: Material preparation, data collection and analysis VD, VNU: Manuscript draft Acknowledgements We acknowledge all the technical assistance provided to the authors by the NCOHIRWA cohort study team members, research collaborators and anyone who had helpful discussions or contributed fewer tangible concepts. Research assistants from the research sites, research site leaders, and study participants for their time and effort, invested in this study References Lower-Income Countries That Face The Most Rapid Shift. In Noncommunicable Disease Burden Are Also The Least Prepared - PMC [Internet]. [cited 2024 Oct 24]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7705176/ Noncommunicable diseases [Internet]. [cited 2024 Oct 7]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases Sani MU, Ogah OS, Fourie JM, Scholtz W, Scarlatescu O, Nel G, et al. Rwanda Country Report. Cardiovasc J Afr [Internet]. 2020;31(4 Suppl):S27. [cited 2023 Dec 11];. from:/pmc/articles/PMC9562790/ . Achwoka D, Mutave R, Oyugi JO, Achia T. Tackling an emerging epidemic: the burden of noncommunicable diseases among people living with HIV/AIDS in sub-Saharan Africa. Pan Afr Med J [Internet]. 2020 May 1 [cited 2023 Dec 11];36(271):1–9. Available from:/ pmc/articles/PMC7546015/ Hoffmann M, Berger JR, Nath A, Rayens M. Cerebrovascular disease in young, HIV-infected, black Africans in the KwaZulu Natal province of South Africa. J Neurovirol. 2000;6(3):229–36. Achwoka D, Waruru A, Chen TH, Masamaro K, Ngugi E, Kimani M et al. Noncommunicable disease burden among HIV patients in care: A national retrospective longitudinal analysis of HIV-treatment outcomes in Kenya, 2003–2013. BMC Public Health [Internet]. 2019 Apr 3 [cited 2023 Dec 11];19(1):1–10. Available from: https://bmcpublichealth.biomedcentral.com/articles/ 10.1186/s12889-019-6716-2 Shah ASV, Stelzle D, Ken Lee K, Beck EJ, Alam S, Clifford S et al. Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis. Circulation [Internet]. 2018 [cited 2023 Dec 11];138(11):1100–12. Available from: https://pubmed.ncbi.nlm.nih.gov/29967196/ Kansiime S, Mwesigire D, Mugerwa H. Prevalence of noncommunicable diseases among HIV positive patients on antiretroviral therapy at joint clinical research centre, Lubowa, Uganda. PLoS One [Internet]. 2019 Aug 1 [cited 2023 Dec 11];14(8). Available from:/pmc/articles/PMC6688817/ Bloomfield GS, Khazanie P, Morris A, Rabadán-Diehl C, Benjamin LA, Murdoch D, et al. HIV and Non-Communicable Cardiovascular and Pulmonary Diseases in Low- and Middle-Income Countries in the ART Era: What We Know and Best Directions for Future Research. J Acquir Immune Defic Syndr [Internet]. 2014;67(0 1):S40. Sep 9 [cited 2023 Dec 11];. from:/pmc/articles/PMC4133739/ . Mateen FJ, Kanters S, Kalyesubula R, Mukasa B, Kawuma E, Kengne AP et al. Hypertension prevalence and Framingham risk score stratification in a large HIV-positive cohort in Uganda. J Hypertens [Internet]. 2013 [cited 2023 Dec 11];31(7):1372–8. Available from: https://pubmed.ncbi.nlm.nih.gov/23615323/ Hoffmann M, Berger JR, Nath A, Rayens M. Cerebrovascular disease in young, HIV-infected, black Africans in the KwaZulu Natal province of South Africa. J Neurovirol. 2000;6(3):229–36. Dobe I, Manafe N, Majid N, Zimba I, Manuel B, Mocumbi A. Patterns of cardiovascular risk and disease in HIV-positive adults on anti-retroviral therapy in Mozambique. Cardiovasc J Afr. 2020;31(4):190–5. Kavishe BB, Olsen MF, Filteau S, Kitilya BW, Jeremiah K, Krogh-Madsen R et al. Blood Pressure and Body Composition During First Year of Antiretroviral Therapy in People With HIV Compared With HIV-Uninfected Community Controls. Am J Hypertens [Internet]. 2022 Nov 1 [cited 2023 Dec 11];35(11):929. Available from:/pmc/articles/PMC9629436/ Dushimiyimana V, Twagirumukiza M, Durand M, Ntusi NAB, Kateera BA, Bigirimana N et al. Health determinants for major noncommunicable diseases among people living with HIV in Rwanda (NCOHIRWA) cohort study: rationale, protocol and baseline characteristics of participants. 2025 Jul 25 [cited 2025 Jul 29]; Available from: https://www.researchsquare.com Adult BMI. Categories | BMI | CDC [Internet]. [cited 2025 Feb 3]. Available from: https://www.cdc.gov/bmi/adult-calculator/bmi-categories.html Masupe T, Mashalla Y, Seloilwe E, Jibril H, Medhin H. Integrated management of HIV/NCDs: knowledge, attitudes, and practices of health care workers in Gaborone, Botswana. Afr Health Sci [Internet]. 2019 Sep 1 [cited 2023 Dec 11];19(3):2312. Available from:/pmc/articles/PMC7040279/ Bavuma CM, Niyibizi JB, Bitunguhari L, Musafiri S, McQuillan R, Wild S. Prevalence and characteristics associated with diabetes mellitus and impaired fasting glucose among people aged 15 to 64 years in rural and urban Rwanda: secondary data analysis of World Health Organisation surveillance data. PAMJ. 2022; 41:115 [Internet]. 2022 Feb 9 [cited 2023 Dec 11];41(115). Available from: https://www.panafrican-med-journal.com/content/article/41/115/full Legesse E, Nigussie T, Girma D, Geleta LA, Dejene H, Deriba BS et al. Level of Adequate Knowledge of Noncommunicable Diseases and Associated Factors Among Adult Residents of North Shewa Zone, Oromia Region, Ethiopia: A Mixed-Method Approach. Front Public Health [Internet]. 2022 Jun 23 [cited 2023 Dec 11];10:892108. Available from:/ pmc/articles/PMC9260241/ Sitaula D, Shrestha N, Timalsina S, Pokharel B, Sapkota S, Acharya S et al. Knowledge, attitude and practice regarding diabetes and hypertension among school students of Nepal: A rural vs. urban study. PLoS One [Internet]. 2022 Aug 1 [cited 2023 Dec 11];17(8):e0270186. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0270186 National Diabetes Prevention and Control Program - WDF15-1232. | World Diabetes Foundation [Internet]. [cited 2023 Dec 11]. Available from: https://www.worlddiabetesfoundation.org/projects/rwanda-wdf15-1232 Casper C, Crane H, Menon M, Money D. HIV/AIDS Comorbidities: Impact on Cancer, Noncommunicable Diseases, and Reproductive Health. Disease Control Priorities, Third Edition (Volume 6): Major Infectious Diseases [Internet]. 2017 Nov 6 [cited 2023 Dec 11];45–66. Available from: https://pubmed.ncbi.nlm.nih.gov/30212097/ Chen CH, Chung CY, Wang LH, Lin C, Lin HL, Lin HC. Risk of cancer among HIV-infected patients from a population-based nested case–control study: Implications for cancer prevention. BMC Cancer [Internet]. 2015 Dec 12 [cited 2023 Dec 11];15(1):1–9. Available from: https://bmccancer.biomedcentral.com/articles/ 10.1186/s12885-015-1099-y Silverberg MJ, Chao C, Leyden WA, Xu L, Tang B, Horberg MA et al. HIV infection and the risk of cancers with and without a known infectious cause. AIDS [Internet]. 2009 Nov [cited 2023 Dec 11];23(17):2337–45. Available from: https://pubmed.ncbi.nlm.nih.gov/19741479/ Shiferaw N, Brooks MI, Salvador-Davila G, Lonsako S, Kassahun K, Ansel J et al. Knowledge and Awareness of Cervical Cancer among HIV-Infected Women in Ethiopia. Obstet Gynecol Int [Internet]. 2016 [cited 2023 Dec 11];2016. Available from: https://pubmed.ncbi.nlm.nih.gov/27867397/ Legesse E, Nigussie T, Girma D, Adugna Geleta L, Dejene H, Senbeta Deriba B, et al. Does knowledge of noncommunicable diseases risk factors influence screening service utilisation? The finding from North Shewa Zone, Central Ethiopia. Prev Med Rep. 2022;30:102040. Tobacco A. Major Risk Factor for Non-Communicable Diseases | Knowledge Action Portal on NCDs [Internet]. [cited 2023 Dec 11]. Available from: https://www.knowledge-action-portal.com/en/content/tobacco-major-risk-factor-non-communicable-diseases Mahajan M, Naik N, Jain K, Patira N, Prasad S, Mogri S et al. Study of Knowledge, Attitudes, and Practices Toward Risk Factors and Early Detection of Noncommunicable Diseases Among Rural Women in India. J Glob Oncol [Internet]. 2019 [cited 2023 Dec 11];5(5):1–10. Available from:/ pmc/articles/PMC6528727/ Cowan E, D’Ambruoso L, van der Merwe M, Witter S, Byass P, Ameh S et al. Understanding noncommunicable diseases: combining health surveillance with local knowledge to improve rural primary health care in South Africa. Glob Health Action [Internet]. 2021 [cited 2023 Dec 11];14(1). Available from :/pmc/articles/PMC7782313/ Salman A, Tolma E, Chun S, Sigodo KO, Al-Hunayan A. Health Promotion Programs to Reduce Noncommunicable Diseases: A Call for Action in Kuwait. Healthcare 2020, Vol 8, Page 251 [Internet]. 2020 Aug 3 [cited 2023 Dec 11];8(3):251. Available from: https://www.mdpi.com/2227-9032/8/3/251/htm Legesse E, Nigussie T, Girma D, Geleta LA, Dejene H, Deriba BS et al. Level of Adequate Knowledge of Noncommunicable Diseases and Associated Factors Among Adult Residents of North Shewa Zone, Oromia Region, Ethiopia: A Mixed-Method Approach. Front Public Health [Internet]. 2022 Jun 23 [cited 2023 Dec 11];10:892108. Available from:/ pmc/articles/PMC9260241/ Sapkota BP, Baral KP, Berger U, Parhofer KG, Rehfuess EA. Health sector readiness for the prevention and control of noncommunicable diseases: A multimethod qualitative assessment in Nepal. PLoS One [Internet]. 2022 Sep 1 [cited 2023 Dec 11];17(9). Available from:/pmc/articles/PMC9524672/ Nyandekwe M, Nzayirambaho M, Kakoma JB. Universal health insurance in Rwanda: major challenges and solutions for financial sustainability case study of Rwanda community-based health insurance part I. Pan Afr Med J [Internet]. 2020;37(55):1–12. Available from:/. pmc/articles/PMC7648486/ . Woldemichael A, Gurara D, Shimeles A, Mansoor A. The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda 1 Prepared by Andinet Woldemichael, Daniel Gurara, and Abebe Shimeles Authorised for distribution. 2019. Smith-Greenaway E, ARE LITERACY SKILLS ASSOCIATED WITH YOUNG, ADULTS’ HEALTH IN AFRICA? EVIDENCE FROM MALAWI. Soc Sci Med [Internet]. 2015 Feb 1 [cited 2023 Dec 11];127:124. Available from:/ pmc/articles/PMC4297261/ Kagaruki GB, Mahande MJ, Kimaro GD, Ngadaya ES, Mayige MT, Msovela J et al. Knowledge and attitudes towards type 2 diabetes and prevention strategies among regular street food consumers: A cross sectional study in Dar es Salaam, Tanzania. Int J Health Promot Educ. 2022. Biraguma J, Mutimura E, Frantz JM. Knowledge about modifiable risk factors for noncommunicable diseases adults living with HIV in Rwanda. Afr Health Sci [Internet]. 2019 Dec 1 [cited 2023 Dec 11];19(4):3181. Available from:/pmc/articles/PMC7040312/ Legesse E, Nigussie T, Girma D, Adugna Geleta L, Dejene H, Senbeta Deriba B, et al. Does knowledge of noncommunicable diseases risk factors influence screening service utilisation? The finding from North Shewa Zone, Central Ethiopia. Prev Med Rep. 2022;30:102040. Jajulwar MB, Meshram PV, Saji DA. To assess the knowledge, attitude and practices of people regarding overweight and obesity: a cross-sectional study. Int J Community Med Public Health. 2017;4(9):3113. Zatońska K, Psikus P, Basiak-Rasała A, Stępnicka Z, Gaweł-Dabrowska D, Wołyniec M et al. Obesity and Chosen Non-Communicable Diseases in PURE Poland Cohort Study. Int J Environ Res Public Health [Internet]. 2021 Mar 1 [cited 2024 Jun 17];18(5):1–10. Available from:/ pmc/articles/PMC7967430/ Singh Gandhar S, Singh MS, Ajinkya M, Jadhav B, Jeelu M, Cheriyan A et al. European Journal of Molecular & Clinical Medicine A study to assess the knowledge regarding the impact of obesity on noncommunicable diseases among adults in selected urban areas of Pune city. Available from: https://www.researchgate.net/publication/350955160 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7380637","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":501582806,"identity":"076c3546-8dd1-47ef-a563-86e55d1aef47","order_by":0,"name":"Valentine Dushimiyimana","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYLACHgaGBDYGBsYHIDYfKVqYDUBsNqK1ACk2CRCHoBaD42cMP7xtq8vjEzt8rPJrjp0MGwPzw0c38Gk5k2MsObftcDGbdFrabdltyUCHsRkb5+DRItmQliDN23YgsU06x+y25DZmoBYeNmm8WvqfJf/mbasDasn/Viy5rZ6wFn6J5GNAW5hBtrAxftx2mBgtj49Zzjl3GKglzViacdtxHjZmAn5h409svvGmrC5x/uzkhx9/bqu252dvfvgYnxYUwMwDJolVDgKMP0hRPQpGwSgYBSMGAADDpkKrAVkHKgAAAABJRU5ErkJggg==","orcid":"","institution":"Rwanda Biomedical Centre","correspondingAuthor":true,"prefix":"","firstName":"Valentine","middleName":"","lastName":"Dushimiyimana","suffix":""},{"id":501582807,"identity":"0a80ee5f-2f7d-471c-8058-2e09912418d8","order_by":1,"name":"Vivianne U Niyonkuru","email":"","orcid":"","institution":"Rwanda Biomedical Centre","correspondingAuthor":false,"prefix":"","firstName":"Vivianne","middleName":"U","lastName":"Niyonkuru","suffix":""},{"id":501582808,"identity":"b3ba8598-f708-4c0a-9c1a-946c06efa190","order_by":2,"name":"Ladislas Nshimiyimana","email":"","orcid":"","institution":"Rwanda Biomedical Centre","correspondingAuthor":false,"prefix":"","firstName":"Ladislas","middleName":"","lastName":"Nshimiyimana","suffix":""},{"id":501582809,"identity":"a69006cc-f482-45da-b22c-6de45222dd2a","order_by":3,"name":"Prosper Karame","email":"","orcid":"","institution":"South Eastern Finland University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Prosper","middleName":"","lastName":"Karame","suffix":""},{"id":501582810,"identity":"2c0e6252-110d-4fb0-9760-5eb125f9c06a","order_by":4,"name":"Noel Gahamanyi","email":"","orcid":"","institution":"Rwanda Biomedical Centre","correspondingAuthor":false,"prefix":"","firstName":"Noel","middleName":"","lastName":"Gahamanyi","suffix":""},{"id":501582811,"identity":"76bcdd9b-26e6-4f54-a8a4-8cbf32b3659c","order_by":5,"name":"Cecile Ingabire","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Cecile","middleName":"","lastName":"Ingabire","suffix":""},{"id":501582812,"identity":"061779bc-4480-4fae-bc60-616c749a8e54","order_by":6,"name":"Yvone Delphine Nsaba Uwera","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Yvone","middleName":"Delphine Nsaba","lastName":"Uwera","suffix":""},{"id":501582813,"identity":"b71f1ead-167b-4868-9a4b-79db8e5ca377","order_by":7,"name":"Eric Remera","email":"","orcid":"","institution":"Rwanda Biomedical Centre","correspondingAuthor":false,"prefix":"","firstName":"Eric","middleName":"","lastName":"Remera","suffix":""},{"id":501582814,"identity":"25fab902-b626-4b47-ac1c-b0d756ddc5d8","order_by":8,"name":"Albert Tuyishime","email":"","orcid":"","institution":"Rwanda Biomedical Centre","correspondingAuthor":false,"prefix":"","firstName":"Albert","middleName":"","lastName":"Tuyishime","suffix":""},{"id":501582817,"identity":"9a8b541b-6586-44f6-b694-63a476f40ef7","order_by":9,"name":"Gallican Nshogoza Rwibasira","email":"","orcid":"","institution":"Rwanda Biomedical Centre","correspondingAuthor":false,"prefix":"","firstName":"Gallican","middleName":"Nshogoza","lastName":"Rwibasira","suffix":""},{"id":501582818,"identity":"113803df-f1ed-4902-ba53-528dc5e6568c","order_by":10,"name":"Francois Uwinkindi","email":"","orcid":"","institution":"Rwanda Biomedical Centre","correspondingAuthor":false,"prefix":"","firstName":"Francois","middleName":"","lastName":"Uwinkindi","suffix":""},{"id":501582819,"identity":"4a846cb9-5965-48e0-a4f9-ddcf9105fcf6","order_by":11,"name":"Brenda A. Kateera","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Brenda","middleName":"A.","lastName":"Kateera","suffix":""},{"id":501582820,"identity":"6df261be-c145-43c7-8218-c4529b03c023","order_by":12,"name":"Madeleine Durand","email":"","orcid":"","institution":"Centre Hospitalier de l’Université de Montréal","correspondingAuthor":false,"prefix":"","firstName":"Madeleine","middleName":"","lastName":"Durand","suffix":""},{"id":501582821,"identity":"18b81502-37a3-42b3-adfe-0886b40ef9eb","order_by":13,"name":"Pacifique Ndishimye","email":"","orcid":"","institution":"African Institute of Mathematical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Pacifique","middleName":"","lastName":"Ndishimye","suffix":""},{"id":501582822,"identity":"9424f486-3219-4c9f-aebe-4dabcb40b8ca","order_by":14,"name":"Celestin Hategeka","email":"","orcid":"","institution":"Boston University","correspondingAuthor":false,"prefix":"","firstName":"Celestin","middleName":"","lastName":"Hategeka","suffix":""},{"id":501582823,"identity":"0d6e449b-3e18-449a-94d3-2ebea6545e8b","order_by":15,"name":"Leopold Bitunguhari","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Leopold","middleName":"","lastName":"Bitunguhari","suffix":""},{"id":501582824,"identity":"47107547-5998-4ca5-ade6-d7e0fd942a51","order_by":16,"name":"KM Monirul Islam","email":"","orcid":"","institution":"Augusta University","correspondingAuthor":false,"prefix":"","firstName":"KM","middleName":"Monirul","lastName":"Islam","suffix":""},{"id":501582825,"identity":"7bdd7297-c3c1-45d9-b2ba-a9bcadbca506","order_by":17,"name":"Ntobeko A. B. Ntusi","email":"","orcid":"","institution":"University of Cape Town and South African Medical Research Council","correspondingAuthor":false,"prefix":"","firstName":"Ntobeko","middleName":"A. B.","lastName":"Ntusi","suffix":""},{"id":501582826,"identity":"8c991ba7-6469-4bf4-8078-8f734ea9f631","order_by":18,"name":"Godfrey Katende","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"Godfrey","middleName":"","lastName":"Katende","suffix":""},{"id":501582827,"identity":"05473916-096a-4d0c-9040-d4b14470f5e5","order_by":19,"name":"Marc Twagirumukiza","email":"","orcid":"","institution":"Ghent University","correspondingAuthor":false,"prefix":"","firstName":"Marc","middleName":"","lastName":"Twagirumukiza","suffix":""},{"id":501582828,"identity":"72a56bd5-6f42-4d74-a1ef-f4e1e98c5d0f","order_by":20,"name":"Steven Callens","email":"","orcid":"","institution":"Ghent University","correspondingAuthor":false,"prefix":"","firstName":"Steven","middleName":"","lastName":"Callens","suffix":""}],"badges":[],"createdAt":"2025-08-15 10:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7380637/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7380637/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89386761,"identity":"cf13b9df-882b-4076-b123-48b95ccfa9a2","added_by":"auto","created_at":"2025-08-19 12:36:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":150797,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Rwanda presenting research sites composed of health centersand hospitals (districts, provinces and referrals)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7380637/v1/2234b39404ed2e86f4a2b14f.png"},{"id":89390927,"identity":"db65ece0-53b6-497a-a2ca-4677a2ffbc98","added_by":"auto","created_at":"2025-08-19 13:00:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1452169,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7380637/v1/941689a6-c0e6-44b1-89a2-cd20671e28ad.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Knowledge, attitudes and practices toward noncommunicable diseases and associated risk factors among people living with HIV in Rwanda: A cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe global burden of diseases is shifting from communicable to noncommunicable diseases (NCDs) due to demographic and epidemiological changes in low- and middle-income countries (LMICs) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Globally, NCDs are the leading cause of mortality, accounting for 41\u0026nbsp;million deaths annually, with over 86% of these cases occurring in LMICs (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Rwanda is no exception; 44% of deaths in the country are attributed to NCDs, with cardiovascular diseases (CVDs) accounting for 14% of these fatalities(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, individuals living with HIV (PLHIV) face an elevated risk of developing noncommunicable diseases (NCDs) and experiencing premature mortality (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Research indicates a strong association between HIV and NCDs, highlighting greater vulnerability among PLHIV, particularly in sub-Saharan Africa (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Conditions such as diabetes, cardiovascular disease (CVD), and other NCDs are notably prevalent within this population.\u003c/p\u003e\u003cp\u003eIn addition to the risk factors associated with major NCD risk factors, such as tobacco smoking, harmful alcohol consumption, physical inactivity, unhealthy diets, high blood pressure and diabetes, PLHIV face an increased risk of NCDs due to potential side effects of antiretroviral therapy (ART) and chronic inflammation due to viral persistence (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Consequently, compared with people without HIV, PLHIV are at a 1.5 to 2 times greater risk of experiencing CVD manifestations (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile data remain scarce, the profound consequences of chronic noncommunicable CVD, mainly CVD, in PLHIV in LMICs are significant, especially given that more than 70% of PLHIV live in these regions(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Furthermore, 28% of PLHIV are diagnosed with high blood pressure one year after the initiation of ART(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In Tanzania, PLHIV were reported to experience 2.2 times greater odds of systolic blood pressure than their counterparts without HIV, and the incidence of stroke was found to be 2.5 times greater in HIV-positive individuals than in their noninfected peers (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough the link between noncommunicable diseases (NCDs) and HIV is increasingly recognised worldwide, significant research gaps persist in Rwanda. In particular, little is known about the knowledge, attitudes, and practices (KAPs) of people living with HIV (PLHIV) regarding NCDs and their drivers. Addressing this gap is crucial for developing targeted interventions, improving healthcare services, and ultimately enhancing the well-being of PLHIV in Rwanda. This study aims to assess their level of awareness, perceptions, and behaviours related to NCDs, providing valuable insights for more effective and responsive healthcare strategies.\u003c/p\u003e\n\n\n\n"},{"header":"Methods","content":"\u003ch3\u003eStudy design and setting\u003c/h3\u003e\u003cp\u003eWe conducted an observational study with a cross-sectional design to measure the KAPs toward NCDs and related risk factors among PLHIV in Rwanda. This study was nested within an ongoing cohort study of health determinants for major NCDs among PLHIV in Rwanda (NCOHIRWA Cohort Study) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The participants in the NCORHIRWA cohort were selected randomly from 12 health facilities in five provinces across Rwanda, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch2\u003eStudy participants\u003c/h2\u003e\u003cp\u003e The participants recruited were those 18 years of age or older, engaged in clinical care in an HIV care and treatment program, were free from NCDs and were committed to providing informed consent for participation in the NCOHIRWA cohort study.\u003c/p\u003e\u003cp\u003eAt each study site, eligible PLHIV were identified and stratified by sex and age, and proportionate random sampling was used to enrol participants to ensure representativity of the general HIV population in Rwanda. Participants from the NCOHIRWA cohort study (total of 1334) were included in the present study if they had available data for the KAP survey; 164 participants were eliminated, and 1170 participants remained.\u003c/p\u003e\u003ch3\u003eData collection tool and procedure\u003c/h3\u003e\u003cp\u003eData were collected via Research Electronic Data Capture (REDCap) by trained nurses working in HIV clinics at the selected health facilities. The questionnaire was adapted to the standard questionnaire to measure the KAP related to NCDs. Furthermore, the questionnaire was translated into Kinyarwanda, the local language understandable by the study population. Anthropometric measurements (height and weight) were taken via a scale. The nurses were trained in data collection for quality data. The training program for the nurse data collectors emphasised the utilisation of the data collection tool and proficiency with the REDCap software. During the training sessions, the nurses conducted pretests of the questionnaire among themselves to become familiar with the questions. Additionally, the pretest allowed us to estimate the duration of the survey, ensure accurate translation of the questions, and implement any necessary corrections.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThe research data collection in REDCap consisted of three different tools. The measure of interest is KAP. The data extracted from the KAP questionnaire were separated into three main domains: knowledge, attitudes, and practices. The knowledge assessment domain has a total of 17 questions. Sixteen questions ask about risk factors, symptoms, and preventive measures for NCDs. Responses are scored as 1 for \"correct\" and 0 for \"incorrect.\" The remaining questions explored awareness levels of major NCDs (hypertension, stroke, heart disease, cancer and diabetes) on a Likert scale ranging from 1 (nothing at all) to 4 (familiar with NCDs).\u003c/p\u003e\u003cp\u003eThe attitude domain comprises eight statements, with answers using a 4-level Likert scale rated as \u0026ldquo;Strongly agree,\u0026rdquo; \u0026ldquo;Agree,\u0026rdquo; \u0026ldquo;Disagree,\u0026rdquo; and \u0026ldquo;Strongly disagree.\u0026rdquo; During the analysis, the attitudes were reclassified as \u0026ldquo;Favourable\u0026rdquo; to indicate positive attitudes that can help in the control and prevention of NCDs and \u0026ldquo;Unfavourable\u0026rdquo; for negative attitudes.\u003c/p\u003e\u003cp\u003eThe practices domain assesses lifestyle practices related to NCD prevention and features eleven questions. The answers were binary, with \u0026ldquo;Yes\u0026rdquo; for actions that the participants practiced and \u0026ldquo;No\u0026rdquo; for those that they did not.\u003c/p\u003e\u003cp\u003eOther measurement data, including sociodemographic characteristics and anthropometric measures, were extracted from the centralised database of the NCOHIRWA cohort study. Sociodemographic characteristics included sex, age, education level, marital status, and occupation. Education was measured by the highest level completed, and occupation reflected participants' primary income source during data collection. These characteristics served as independent variables in the study. For anthropometric measurements, weight was measured in kilograms (kg), and height was measured in centimetres (cm). Body mass index (BMI) was calculated by dividing weight (kg) by height (m) squared, with the results expressed in kg/m\u0026sup2;. The following BMI classifications were applied: underweight (\u0026lt;\u0026thinsp;18.5 kg/m\u0026sup2;), normal (18.5\u0026ndash;24.9 kg/m\u0026sup2;), overweight (25.0\u0026ndash;29.9 kg/m\u0026sup2;), and obese (\u0026ge;\u0026thinsp;30 kg/m\u0026sup2;)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eDescriptive analysis was performed to summarise sociodemographic characteristics, anthropometric measures and KAP scores. KAP scores were calculated against the highest possible scores. Associations between sociodemographic and anthropometric variables of interest (independent variables) and KAP scores (dependent variables) were modelled via uni- and multivariable linear regression models. For all analyses, alpha was set at a two-sided p value less than 0.05. The data were analysed via R version 4.3.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSociodemographic characteristics of the participants\u003c/h2\u003e\u003cp\u003eWe included 1,170 PLHIV with complete KAP and demographic data, including 747 females (63.8%) and 423 males (36.2%). The most represented age group was 35\u0026ndash;44 years, with 349 participants (29.8%). The majority of the respondents were married, comprising 644 (55.1%) of the participants. Nearly half of the participants, 575 (49.1%), reported primary education as their highest educational attainment. Unemployment was reported by 203 participants (17.4%), whereas self-employment and farming were the most common occupations, each representing 382 participants (33.1%). The body mass index (BMI) was within the normal range: 58.5% (685) and 9.5% (111) were obese, and 10.1% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) were underweight (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics and anthropometric measurements of the participants at baseline\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e747\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e423\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e349\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e45\u0026ndash;54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e321\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e644\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidow(er)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e575\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher than Secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAnthropometry\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI Category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderweight (\u0026lt;\u0026thinsp;18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal (18.5\u0026ndash;24.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight (25.0-29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObese (\u0026ge;\u0026thinsp;30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eGeneral knowledge of major noncommunicable diseases (NCDs)\u003c/h3\u003e\n\u003cp\u003eStroke was the least known disease, with 917 (79.1%) of the participants reporting no knowledge of it at all. Similarly, the majority of the participants (n\u0026thinsp;=\u0026thinsp;785, 70.3%) lacked knowledge about heart disease. Almost half of the participants, 580 (49.8%), reported having no knowledge of cancer, whereas 381 (32.7%) knew little about it. Diabetes was fairly well known as NCD, with 629 (53.9%) of the participants knowing little about the disease and 166 (14.2%) having heard the condition before (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGeneral knowledge of major NCDs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNCDs\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eLevel of information n (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNothing at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eI have heard the term only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI know little\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI am very familiar\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e639 (54.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e155 (13.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e363 (31.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e785 (70.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e145 (13.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e180 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (0.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e917 (79.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144 (12.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97 (8.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (0.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e580 (49.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e200 (17.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e381 (32.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (0.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e359 (30.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e166 (14.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e629 (53.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eKnowledge of the risk factors and prevention measures for NCDs\u003c/h3\u003e\n\u003cp\u003eThe participants identified various risk factors and prevention measures for NCDs. Tobacco smoking was the most recognised behavioural risk factor among 650 participants (56.1%), followed by harmful alcohol consumption (596, 51.4%). The most recognised metabolic risk factor was being overweight or obese (474, 42.1%), whereas increased cholesterol was the least known factor 143 (12.7%). A total of 418 (37.2%) participants were unaware of any metabolic or behavioural risk factors 254 (21.9%).\u003c/p\u003e\u003cp\u003eFor prevention measures, avoiding tobacco smoking was noted by 651 (56.0%) participants, followed by maintaining a healthy diet in 538 (46.0%) participants. However, 239 (20.6%) were unaware of any prevention measures (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKnowledge of the risk factors for and prevention measures for NCDs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk factors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (Yes)\u003c/p\u003e\u003cp\u003en (1170)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBehaviour risk factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTobacco use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e650\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical inactivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e316\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnhealthy diet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e481\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHarmful use of alcohol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e596\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNothing at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetabolic Risk factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRaised blood pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBeing overweight/obese\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRaised blood glucose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e425\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRaised Cholesterol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNothing at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e418\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevention measures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAvoid or quit smoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e651\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy diet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37.2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbstain from harmful alcohol consumption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e528\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEating vegetables and fruits/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNothing at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eAttitudes toward NCDs\u003c/h2\u003e\u003cp\u003eThe participants' attitudes toward NCDs revealed that 398 (34.8%) perceived themselves as having a healthy body capable of fighting NCDs, whereas 754 (65.2%) did not. A significant proportion, 902 (78.5%), disagreed with the statement that PLHIV do not have NCDs. The majority, 1,006 (87.3%), believe that excessive alcohol consumption is never acceptable, even on an occasional basis. The opinion that a healthy lifestyle is hard to attain was evenly split among participants. Moreover, 719 (65.5%) disagreed with the belief that no matter what you do, you can obtain NCDs. Most participants (1,031, 89.6%) recognised the importance of monitoring salt intake, 628 (55.2%) expressed concern about developing NCDs, and 1036 (89.5%) acknowledged that early detection improved outcomes (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAttitudes toward NCDs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFavourable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eUnfavourable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceive that he/she has a healthy body able to fight NCDs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e398 (34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e745 (65.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1143\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeople living with HIV do not get NCDs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e247 (21.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e902 (78.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1149\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDrinking much alcohol some occasion is allowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e147 (12.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1006 (87.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1153\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealthy lifestyle is hard to attainable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e570 (49.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e591 (50.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo matter what you can do, you can get NCDs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e378 (34.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e719 (65.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1097\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinding NCDs early increase chance for improvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1039 (89.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e122 (10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIt is important to care about salt to put in food\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1031 (89.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e120 (10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1151\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeeling worried to get NCDs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e628 (55.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e510 (44.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1138\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePractices toward NCDs\u003c/h2\u003e\u003cp\u003eMost respondents reported not smoking tobacco (1,078, 92.4%) and abstaining from harmful alcohol consumption (657, 58.4%). Seventy (6.0%) ate fruits and vegetables at least three times per week. Additionally, 401 (34.8%) consumed fatty foods frequently, and 650 (55.8%) liked to add more salt to meals while eating. A total of 442 participants (40.3%) undertook measures to reduce stress, whereas 500 participants (45.5%) engaged in daily physical activities lasting between 30 and 60 minutes. Moreover, 528 (46.6%) participants maintained a healthy weight. Visits to physicians for general checkups were reported by 619 (56.3%) participants, while 919 (78.7%) did not check their blood sugar, and 569 (48.7%) did not check their blood pressure regularly (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePractices toward NCDs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes n(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo n(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you smoke tobacco?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1078 (92.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89 (7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1167\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you drink alcohol?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e657 (58.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e468 (41.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1125\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you eat fruit and vegetables are least three times per week?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1093 (94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1163\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you consume oftenly fatty foods?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e401 (34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e750 (65.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1151\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you add more salt when you are eating meals?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e650 (55.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e514 (44.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow often do you try do reduce stress?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e442 (40.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e656 (59.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you do 30\u0026ndash;60 mins physical activity daily?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e500 (45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e598 (54.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you participate in maintaining your healthy weight?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e528 (46.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e605 (53.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you visit the physician for general body checkup?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e619 (56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e480 (43.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1099\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you check your blood pressure regularly?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e919 (78.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e248 (21.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1167\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you check your blood sugar regularly?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e569 (48.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e599 (51.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1168\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eAssociations between demographic characteristics, anthropometric measures and knowledge scores\u003c/h2\u003e\u003cp\u003eThe mean overall knowledge score was 38.4. Compared with normal weight individuals, obese individuals scored 3.6 points higher (AβC\u0026thinsp;=\u0026thinsp;3.6, p\u0026thinsp;=\u0026thinsp;0.002). The level of education was a significant predictor, with lower education levels being negatively correlated with knowledge scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The scores progressively increased from individuals with no formal education (34.71) to those with education beyond the secondary level (52.16). Employment status also demonstrated significant associations: self-employed individuals (AβC = -2.2, p\u0026thinsp;=\u0026thinsp;0.04), unemployed individuals (AβC = -2.8, p\u0026thinsp;=\u0026thinsp;0.02), and farmers (AβC = -2.8, p\u0026thinsp;=\u0026thinsp;0.01) had lower knowledge scores than did the employed group. Other demographic characteristics, such as age and marital status, were not significantly associated with knowledge.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between demographic characteristics and the knowledge score\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDemographic characteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAβC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP- value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCI (95%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-0.3\u0026ndash;2.7]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-3.1\u0026ndash;4.3]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-4.1\u0026ndash;3.6]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e45\u0026ndash;54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-3.5\u0026ndash;4.2]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-4.7\u0026ndash;3.4]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-2.3\u0026ndash;3.6]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-1.1\u0026ndash;3.4]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidow(er)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-1.3\u0026ndash;4.1]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-16.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-20.4 -11.8]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-11.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-16.1 -7.6]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-7.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-12.2\u0026ndash;2.9]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigher than secondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.04*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-4.3 -0.1]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-4.5\u0026ndash;5.3]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-3.7- 13.5]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-5.2 -0.4]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.01*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-5.1 -0.5]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI Category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderweight (\u0026lt;\u0026thinsp;18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-2.6-2.0]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal (18.5\u0026ndash;24.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight (25.0-29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[-1.1-2.3]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObese (\u0026ge;\u0026thinsp;30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[1.3\u0026ndash;6.1]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Significance level α\u0026thinsp;\u0026lt;\u0026thinsp;0.05, AβC: adjusted beta coefficients; CI: confidence interval\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eEvidence-based and context-appropriate interventions, including health education, are needed to improve awareness and promote preventive behaviours among PLHIV, contributing to reducing NCD risk and fostering a healthier and more sustainable quality of life for PLHIV.\u003c/p\u003e\u003cp\u003eThe study revealed that people living with HIV had low levels of knowledge and awareness about NCDs and their risk factors. The participants' education levels, occupation level, and BMI status were associated with the mean knowledge score of the participants. These findings suggest that highly educated individuals have better access to information, enabling them to understand the disease, its risk factors, and prevention measures more effectively than others do.\u003c/p\u003e\u003cp\u003eThe results provide insights into the level of awareness and knowledge about NCDs among individuals living with HIV. Notably, participants displayed varying levels of awareness regarding major NCDs, with stroke and heart disease being significantly less known than diabetes is, which has emerged as the most recognised NCD by participants. In a study conducted in Botswana, 97.8% of the enrolled participants reported high awareness of diabetes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). A survey conducted in Rwanda revealed that approximately 1 in 6 people live with hyperglycemia or diabetes mellitus, which increases the knowledge of patients and family members about the disease (\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Moreover, Rwanda's diabetes management programs were initiated many years before; despite the widespread awareness of NCDs, they have been decentralised to primary healthcare facilities with a focus on increasing community awareness and early detection and treatment(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This could explain why diabetes is well known compared with other NCDs and highlights the need for investment in all NCDs.\u003c/p\u003e\u003cp\u003eUnfortunately, 49.8% of the participants knew nothing about cancer, although PLHIV are much more likely to develop cancer than people who do not have HIV infection (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Typically, cervical cancer is highly prevalent in PLHIV because of human papilloma virus coinfection and the inability to control these infections with a suppressed immune system(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The findings of Shiferaw et al. (2016) in Ethiopia were also congruent with the findings of this study, as that study revealed that PLHIV had very low knowledge of cancer (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Hence, these findings underscore the imperative of increasing the knowledge of PLHIV, which should help them prevent these diseases.\u003c/p\u003e\u003cp\u003eThe participants predominantly demonstrated awareness of risk factors such as tobacco smoking and harmful alcohol consumption. These findings resonate with other studies reporting that smoking cigarettes is listed by 65.7% of the respondents, followed by alcohol consumption (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Many respondents were aware of metabolic risk factors such as being overweight, having high glucose levels, and having high blood pressure. However, increased cholesterol is less recognised, and many are unaware of any risk factors. Moreover, a significant portion recognised key preventive measures, such as avoiding tobacco smoking, and a notable percentage expressed uncertainty about specific preventive measures.\u003c/p\u003e\u003cp\u003eThe assessment of participants' attitudes toward NCDs revealed a mix of positive and negative perceptions. The majority expressed perceived susceptibility to NCDs, emphasising the awareness of potential risks (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). While a significant portion acknowledged the importance of adopting a healthy lifestyle and monitoring specific health-related behaviours, there was a mix of confidence and concern about personal health. More than half of the respondents believed that luck plays a role in avoiding NCDs and felt that regardless of lifestyle choices, one can still develop NCDs. The belief that NCDs and strokes are caused by supernatural forces hinders efforts to take preventive measures, as some people view them as curses or bewitchments and feel powerless to prevent them (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe population in low-income settings, such as Nepal, has been found to consider health facilities for curative purposes, which hinders the population from seeking preventive services such as general body checkups (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). A similar gap was observed in this study, particularly in routine health checks, where more than half of the participants did not perform regular check-ups for serum glucose, cholesterol and blood pressure monitoring. Moreover, the insurance packages do not cover the checkups. Although 98% of Rwanda is covered by community-based health insurance, it requires out-of-pocket payments for body checkups, which can be pulling factors for checkups(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The findings highlight the gaps in preventive measures that can sometimes be resolved at minimum cost, such as integrating some physical measures, such as blood sugar, blood pressure and body weight, into triage for all patients and providing health education on the basis of the results.\u003c/p\u003e\u003cp\u003eThe participants who attained a high level of education were found to be associated with high knowledge of NCDs and their practices. A total of 16.1 more knowledge scores were obtained from the participants with higher than secondary education than from those without formal education. In this study, most of the respondents did not have a high level of education, as 39.7% had no formal education and 49.1% had only primary education. Low literacy levels generally affect knowledge of diseases, especially in Africa (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). A study in Tanzania reported that more educated participants had better knowledge. Another study linked education status with understanding NCD risk factors and service utilisation (\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The link between BMI and knowledge scores sheds light on NCD awareness. Compared with normal weight participants, obese participants had higher knowledge scores, indicating greater exposure to health information from healthcare providers focused on lifestyle changes and disease prevention. Obesity is generally seen in wealthier people in low-income countries, contrary to what we see in high-income countries. It is likely that people with obesity in Rwanda are largely wealthier and more educated and are more knowledgeable about NCDs. Additionally, it is plausible that obese individuals might be more motivated to seek information about NCDs and their prevention, driven by personal health concerns, with an effort to manage their weight and improve their overall health.\u003c/p\u003e\u003cp\u003eSeveral studies support the notion that individuals with health-threatening conditions are more likely to receive health education because of their increased risk of comorbidities and more prevention measures to prevent recurrence(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Healthcare providers frequently focus on health education, especially behaviour change communication, to reduce complications in overweight and obese individuals, likely resulting in higher knowledge scores in this group (\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). However, public health strategies should aim for the widespread dissemination of information, targeting the general population, which may not perceive themselves at immediate risk but can benefit significantly from preventative knowledge.\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003ePolicy Implications\u003c/h2\u003e\u003cp\u003e The significant gaps in knowledge, attitudes, and preventive practices toward NCDs among PLHIV in Rwanda highlight the urgent need to integrate NCD prevention and health education into existing HIV care services. Strengthening routine screening for hypertension, diabetes, and other NCD risk factors in HIV services, combined with tailored health promotion targeting low-literacy populations, could improve early detection and foster healthier behaviours. Leveraging Rwanda\u0026rsquo;s strong HIV program infrastructure to deliver integrated NCD-HIV services, supported by community-based outreach and health insurance coverage for preventive check-ups, would accelerate progress toward reducing the dual burden of NCDs and HIV, improving long-term health outcomes and lowering future healthcare expenses.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eLimitations and strengths\u003c/h2\u003e\u003cp\u003eWhile our study provides robust evidence on KAPs toward NCDs in Rwanda using a large nationally representative sample of PLHIV, there are potential limitations that should be considered when our findings are interpreted. First, the recruitment of participants from health facilities may introduce selection bias, as those attending clinics may differ in health-seeking behaviour compared with those who do not, potentially affecting the study's conclusions about KAP levels. Second, the cross-sectional nature of the study captures associations at only a single point in time, making it impossible to infer causality between sociodemographic factors and KAP outcomes. Third, the use of self-report questionnaires may introduce response bias, as participants could provide socially desirable answers, particularly concerning sensitive health behaviours. Fourth, while the analysis included sociodemographic characteristics, other potential confounding factors (e.g., comorbid conditions, cultural beliefs) that might influence KAP levels were not accounted for, which could affect the interpretation of the results.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe identified knowledge, attitudes and practice gaps for the control and prevention of NCDs emphasise the importance of comprehensive health promotion strategies. While knowledge is crucial, interventions should also target attitude formation and address potential barriers to translating knowledge into actionable practices. Tailored approaches that consider the unique circumstances of PLHIV, including their experiences, beliefs, and psychosocial factors, and provide structural support are essential for fostering holistic well-being and effective NCD prevention. Furthermore, integrating preventive measures into routine healthcare services and addressing barriers to health check-ups could further increase the overall well-being of people living with NCDs. Hence, efforts should sustain the impact of the global commitment to achieve a healthier and highly attainable quality of life among PLHIV. Further studies should explore the enabling factors for people living with HIV to effectively control and prevent NCDs while considering their exponential risk of contracting NCDs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eART: antiretroviral therapy\u003c/p\u003e\n\u003cp\u003eBMI: body mass index\u003c/p\u003e\n\u003cp\u003eCI: confidence interval\u003c/p\u003e\n\u003cp\u003eCVD: cardiovascular disease\u003c/p\u003e\n\u003cp\u003eCVDs: cardiovascular diseases\u003c/p\u003e\n\u003cp\u003eLMICs: Low- and middle-income countries\u003c/p\u003e\n\u003cp\u003eKAP: Knowledge, attitudes and practices\u003c/p\u003e\n\u003cp\u003eNCDs: noncommunicable diseases\u003c/p\u003e\n\u003cp\u003ePLHIV: People living with HIV\u003c/p\u003e\n\u003cp\u003eREDCap: Research Electronic Data Capture\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Helsinki Declaration and approved by the Rwanda National Ethics Committee, reference numbers 210/RNEC/2020 and 84/RNEC/2021, and aligns with good clinical practice. All participants gave their informed consent for inclusion before they participated in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are presented in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was implemented under funds from the Rwanda National Council for Science and Technology (NCST), Research excellent scheme.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe funder of the study had no role in the design, data collection, data analysis, data, interpretation or writing of the manuscript.\u003c/p\u003e\n\u003cp\u003eThe authors confirm the contributions to the paper as follows: All authors (VD, VNU, LN, PK, NG, CI, YDNU, ER, AT, GNR, FU, BAK, MD, NP, CH, LB, KMI, NABN, GK, PN, MT, SC): conceptualisation, design, and read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003eVD, VNU, LN, PK, CI, and YDNU: Material preparation, data collection and analysis\u003c/p\u003e\n\u003cp\u003eVD, VNU: Manuscript draft\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge all the technical assistance provided to the authors by the NCOHIRWA cohort study team members, research collaborators and anyone who had helpful discussions or contributed fewer tangible concepts. Research assistants from the research sites, research site leaders, and study participants for their time and effort, invested in this study\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLower-Income Countries That Face The Most Rapid Shift. In Noncommunicable Disease Burden Are Also The Least Prepared - PMC [Internet]. [cited 2024 Oct 24]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC7705176/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC7705176/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNoncommunicable diseases [Internet]. [cited 2024 Oct 7]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSani MU, Ogah OS, Fourie JM, Scholtz W, Scarlatescu O, Nel G, et al. Rwanda Country Report. Cardiovasc J Afr [Internet]. 2020;31(4 Suppl):S27. [cited 2023 Dec 11];. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003efrom:/pmc/articles/PMC9562790/\u003c/span\u003e\u003cspan address=\"http://from:/pmc/articles/PMC9562790/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAchwoka D, Mutave R, Oyugi JO, Achia T. Tackling an emerging epidemic: the burden of noncommunicable diseases among people living with HIV/AIDS in sub-Saharan Africa. Pan Afr Med J [Internet]. 2020 May 1 [cited 2023 Dec 11];36(271):1\u0026ndash;9. Available from:/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003epmc/articles/PMC7546015/\u003c/span\u003e\u003cspan address=\"http://pmc/articles/PMC7546015/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoffmann M, Berger JR, Nath A, Rayens M. Cerebrovascular disease in young, HIV-infected, black Africans in the KwaZulu Natal province of South Africa. J Neurovirol. 2000;6(3):229\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAchwoka D, Waruru A, Chen TH, Masamaro K, Ngugi E, Kimani M et al. Noncommunicable disease burden among HIV patients in care: A national retrospective longitudinal analysis of HIV-treatment outcomes in Kenya, 2003\u0026ndash;2013. BMC Public Health [Internet]. 2019 Apr 3 [cited 2023 Dec 11];19(1):1\u0026ndash;10. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcpublichealth.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcpublichealth.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-019-6716-2\u003c/span\u003e\u003cspan address=\"10.1186/s12889-019-6716-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah ASV, Stelzle D, Ken Lee K, Beck EJ, Alam S, Clifford S et al. Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis. Circulation [Internet]. 2018 [cited 2023 Dec 11];138(11):1100\u0026ndash;12. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/29967196/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/29967196/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKansiime S, Mwesigire D, Mugerwa H. Prevalence of noncommunicable diseases among HIV positive patients on antiretroviral therapy at joint clinical research centre, Lubowa, Uganda. PLoS One [Internet]. 2019 Aug 1 [cited 2023 Dec 11];14(8). Available \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003efrom:/pmc/articles/PMC6688817/\u003c/span\u003e\u003cspan address=\"http://from:/pmc/articles/PMC6688817/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBloomfield GS, Khazanie P, Morris A, Rabad\u0026aacute;n-Diehl C, Benjamin LA, Murdoch D, et al. HIV and Non-Communicable Cardiovascular and Pulmonary Diseases in Low- and Middle-Income Countries in the ART Era: What We Know and Best Directions for Future Research. J Acquir Immune Defic Syndr [Internet]. 2014;67(0 1):S40. Sep 9 [cited 2023 Dec 11];. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003efrom:/pmc/articles/PMC4133739/\u003c/span\u003e\u003cspan address=\"http://from:/pmc/articles/PMC4133739/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMateen FJ, Kanters S, Kalyesubula R, Mukasa B, Kawuma E, Kengne AP et al. Hypertension prevalence and Framingham risk score stratification in a large HIV-positive cohort in Uganda. J Hypertens [Internet]. 2013 [cited 2023 Dec 11];31(7):1372\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/23615323/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/23615323/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoffmann M, Berger JR, Nath A, Rayens M. Cerebrovascular disease in young, HIV-infected, black Africans in the KwaZulu Natal province of South Africa. J Neurovirol. 2000;6(3):229\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDobe I, Manafe N, Majid N, Zimba I, Manuel B, Mocumbi A. Patterns of cardiovascular risk and disease in HIV-positive adults on anti-retroviral therapy in Mozambique. Cardiovasc J Afr. 2020;31(4):190\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKavishe BB, Olsen MF, Filteau S, Kitilya BW, Jeremiah K, Krogh-Madsen R et al. Blood Pressure and Body Composition During First Year of Antiretroviral Therapy in People With HIV Compared With HIV-Uninfected Community Controls. Am J Hypertens [Internet]. 2022 Nov 1 [cited 2023 Dec 11];35(11):929. Available \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003efrom:/pmc/articles/PMC9629436/\u003c/span\u003e\u003cspan address=\"http://from:/pmc/articles/PMC9629436/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDushimiyimana V, Twagirumukiza M, Durand M, Ntusi NAB, Kateera BA, Bigirimana N et al. Health determinants for major noncommunicable diseases among people living with HIV in Rwanda (NCOHIRWA) cohort study: rationale, protocol and baseline characteristics of participants. 2025 Jul 25 [cited 2025 Jul 29]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchsquare.com\u003c/span\u003e\u003cspan address=\"https://www.researchsquare.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdult BMI. Categories | BMI | CDC [Internet]. [cited 2025 Feb 3]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/bmi/adult-calculator/bmi-categories.html\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/bmi/adult-calculator/bmi-categories.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasupe T, Mashalla Y, Seloilwe E, Jibril H, Medhin H. Integrated management of HIV/NCDs: knowledge, attitudes, and practices of health care workers in Gaborone, Botswana. Afr Health Sci [Internet]. 2019 Sep 1 [cited 2023 Dec 11];19(3):2312. Available \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003efrom:/pmc/articles/PMC7040279/\u003c/span\u003e\u003cspan address=\"http://from:/pmc/articles/PMC7040279/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBavuma CM, Niyibizi JB, Bitunguhari L, Musafiri S, McQuillan R, Wild S. Prevalence and characteristics associated with diabetes mellitus and impaired fasting glucose among people aged 15 to 64 years in rural and urban Rwanda: secondary data analysis of World Health Organisation surveillance data. PAMJ. 2022; 41:115 [Internet]. 2022 Feb 9 [cited 2023 Dec 11];41(115). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.panafrican-med-journal.com/content/article/41/115/full\u003c/span\u003e\u003cspan address=\"https://www.panafrican-med-journal.com/content/article/41/115/full\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLegesse E, Nigussie T, Girma D, Geleta LA, Dejene H, Deriba BS et al. Level of Adequate Knowledge of Noncommunicable Diseases and Associated Factors Among Adult Residents of North Shewa Zone, Oromia Region, Ethiopia: A Mixed-Method Approach. Front Public Health [Internet]. 2022 Jun 23 [cited 2023 Dec 11];10:892108. Available from:/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003epmc/articles/PMC9260241/\u003c/span\u003e\u003cspan address=\"http://pmc/articles/PMC9260241/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSitaula D, Shrestha N, Timalsina S, Pokharel B, Sapkota S, Acharya S et al. Knowledge, attitude and practice regarding diabetes and hypertension among school students of Nepal: A rural vs. urban study. PLoS One [Internet]. 2022 Aug 1 [cited 2023 Dec 11];17(8):e0270186. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0270186\u003c/span\u003e\u003cspan address=\"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0270186\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Diabetes Prevention and Control Program - WDF15-1232. | World Diabetes Foundation [Internet]. [cited 2023 Dec 11]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.worlddiabetesfoundation.org/projects/rwanda-wdf15-1232\u003c/span\u003e\u003cspan address=\"https://www.worlddiabetesfoundation.org/projects/rwanda-wdf15-1232\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCasper C, Crane H, Menon M, Money D. HIV/AIDS Comorbidities: Impact on Cancer, Noncommunicable Diseases, and Reproductive Health. Disease Control Priorities, Third Edition (Volume 6): Major Infectious Diseases [Internet]. 2017 Nov 6 [cited 2023 Dec 11];45\u0026ndash;66. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/30212097/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/30212097/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen CH, Chung CY, Wang LH, Lin C, Lin HL, Lin HC. Risk of cancer among HIV-infected patients from a population-based nested case\u0026ndash;control study: Implications for cancer prevention. BMC Cancer [Internet]. 2015 Dec 12 [cited 2023 Dec 11];15(1):1\u0026ndash;9. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmccancer.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmccancer.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12885-015-1099-y\u003c/span\u003e\u003cspan address=\"10.1186/s12885-015-1099-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSilverberg MJ, Chao C, Leyden WA, Xu L, Tang B, Horberg MA et al. HIV infection and the risk of cancers with and without a known infectious cause. AIDS [Internet]. 2009 Nov [cited 2023 Dec 11];23(17):2337\u0026ndash;45. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/19741479/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/19741479/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShiferaw N, Brooks MI, Salvador-Davila G, Lonsako S, Kassahun K, Ansel J et al. Knowledge and Awareness of Cervical Cancer among HIV-Infected Women in Ethiopia. Obstet Gynecol Int [Internet]. 2016 [cited 2023 Dec 11];2016. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/27867397/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/27867397/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLegesse E, Nigussie T, Girma D, Adugna Geleta L, Dejene H, Senbeta Deriba B, et al. Does knowledge of noncommunicable diseases risk factors influence screening service utilisation? The finding from North Shewa Zone, Central Ethiopia. Prev Med Rep. 2022;30:102040.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTobacco A. Major Risk Factor for Non-Communicable Diseases | Knowledge Action Portal on NCDs [Internet]. [cited 2023 Dec 11]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.knowledge-action-portal.com/en/content/tobacco-major-risk-factor-non-communicable-diseases\u003c/span\u003e\u003cspan address=\"https://www.knowledge-action-portal.com/en/content/tobacco-major-risk-factor-non-communicable-diseases\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahajan M, Naik N, Jain K, Patira N, Prasad S, Mogri S et al. Study of Knowledge, Attitudes, and Practices Toward Risk Factors and Early Detection of Noncommunicable Diseases Among Rural Women in India. J Glob Oncol [Internet]. 2019 [cited 2023 Dec 11];5(5):1\u0026ndash;10. Available from:/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003epmc/articles/PMC6528727/\u003c/span\u003e\u003cspan address=\"http://pmc/articles/PMC6528727/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCowan E, D\u0026rsquo;Ambruoso L, van der Merwe M, Witter S, Byass P, Ameh S et al. Understanding noncommunicable diseases: combining health surveillance with local knowledge to improve rural primary health care in South Africa. Glob Health Action [Internet]. 2021 [cited 2023 Dec 11];14(1). Available from\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e:/pmc/articles/PMC7782313/\u003c/span\u003e\u003cspan address=\"http://:/pmc/articles/PMC7782313/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalman A, Tolma E, Chun S, Sigodo KO, Al-Hunayan A. Health Promotion Programs to Reduce Noncommunicable Diseases: A Call for Action in Kuwait. Healthcare 2020, Vol 8, Page 251 [Internet]. 2020 Aug 3 [cited 2023 Dec 11];8(3):251. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/2227-9032/8/3/251/htm\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/2227-9032/8/3/251/htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLegesse E, Nigussie T, Girma D, Geleta LA, Dejene H, Deriba BS et al. Level of Adequate Knowledge of Noncommunicable Diseases and Associated Factors Among Adult Residents of North Shewa Zone, Oromia Region, Ethiopia: A Mixed-Method Approach. Front Public Health [Internet]. 2022 Jun 23 [cited 2023 Dec 11];10:892108. Available from:/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003epmc/articles/PMC9260241/\u003c/span\u003e\u003cspan address=\"http://pmc/articles/PMC9260241/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSapkota BP, Baral KP, Berger U, Parhofer KG, Rehfuess EA. Health sector readiness for the prevention and control of noncommunicable diseases: A multimethod qualitative assessment in Nepal. PLoS One [Internet]. 2022 Sep 1 [cited 2023 Dec 11];17(9). Available \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003efrom:/pmc/articles/PMC9524672/\u003c/span\u003e\u003cspan address=\"http://from:/pmc/articles/PMC9524672/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNyandekwe M, Nzayirambaho M, Kakoma JB. Universal health insurance in Rwanda: major challenges and solutions for financial sustainability case study of Rwanda community-based health insurance part I. Pan Afr Med J [Internet]. 2020;37(55):1\u0026ndash;12. Available from:/. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003epmc/articles/PMC7648486/\u003c/span\u003e\u003cspan address=\"http://pmc/articles/PMC7648486/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWoldemichael A, Gurara D, Shimeles A, Mansoor A. The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda The Impact of Community Based Health Insurance Schemes on Out-of-Pocket Healthcare Spending: Evidence from Rwanda 1 Prepared by Andinet Woldemichael, Daniel Gurara, and Abebe Shimeles Authorised for distribution. 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmith-Greenaway E, ARE LITERACY SKILLS ASSOCIATED WITH YOUNG, ADULTS\u0026rsquo; HEALTH IN AFRICA? EVIDENCE FROM MALAWI. Soc Sci Med [Internet]. 2015 Feb 1 [cited 2023 Dec 11];127:124. Available from:/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003epmc/articles/PMC4297261/\u003c/span\u003e\u003cspan address=\"http://pmc/articles/PMC4297261/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKagaruki GB, Mahande MJ, Kimaro GD, Ngadaya ES, Mayige MT, Msovela J et al. Knowledge and attitudes towards type 2 diabetes and prevention strategies among regular street food consumers: A cross sectional study in Dar es Salaam, Tanzania. Int J Health Promot Educ. 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBiraguma J, Mutimura E, Frantz JM. Knowledge about modifiable risk factors for noncommunicable diseases adults living with HIV in Rwanda. Afr Health Sci [Internet]. 2019 Dec 1 [cited 2023 Dec 11];19(4):3181. Available \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003efrom:/pmc/articles/PMC7040312/\u003c/span\u003e\u003cspan address=\"http://from:/pmc/articles/PMC7040312/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLegesse E, Nigussie T, Girma D, Adugna Geleta L, Dejene H, Senbeta Deriba B, et al. Does knowledge of noncommunicable diseases risk factors influence screening service utilisation? The finding from North Shewa Zone, Central Ethiopia. Prev Med Rep. 2022;30:102040.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJajulwar MB, Meshram PV, Saji DA. To assess the knowledge, attitude and practices of people regarding overweight and obesity: a cross-sectional study. Int J Community Med Public Health. 2017;4(9):3113.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZatońska K, Psikus P, Basiak-Rasała A, Stępnicka Z, Gaweł-Dabrowska D, Wołyniec M et al. Obesity and Chosen Non-Communicable Diseases in PURE Poland Cohort Study. Int J Environ Res Public Health [Internet]. 2021 Mar 1 [cited 2024 Jun 17];18(5):1\u0026ndash;10. Available from:/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003epmc/articles/PMC7967430/\u003c/span\u003e\u003cspan address=\"http://pmc/articles/PMC7967430/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh Gandhar S, Singh MS, Ajinkya M, Jadhav B, Jeelu M, Cheriyan A et al. European Journal of Molecular \u0026amp; Clinical Medicine A study to assess the knowledge regarding the impact of obesity on noncommunicable diseases among adults in selected urban areas of Pune city. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/publication/350955160\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/publication/350955160\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Noncommunicable diseases (NCDs), HIV, knowledge, attitudes, practices, Rwanda","lastPublishedDoi":"10.21203/rs.3.rs-7380637/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7380637/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe increasing burden of noncommunicable diseases (NCDs) globally poses a significant risk to people living with HIV (PLHIV). However, in Rwanda and other low- and middle-income countries, there is a lack of comprehensive understanding regarding PLHIV knowledge, attitudes, and practices (KAPs) related to NCDs. This study assessed the level of KAPs toward NCDs and related risk factors among PLHIV in Rwanda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a cross-sectional study nested within an ongoing cohort between March and September 2021. A total of 1,334 PLHIV aged 18 years or older without a prior NCD diagnosis were randomly selected from 12 health facilities across five Rwandan provinces. Data were collected via a standardised KAP questionnaire. The KAP scores were evaluated relative to the maximum achievable scores via Likert scales. Descriptive statistics were used to summarise the findings, and linear regression was used to identify factors influencing KAP outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe analysis included 1,170 participants, of which 63.8% were women, including 73.1% in the reproductive age group of 24\u0026ndash;54 years. The majority were married (55.1%), nearly half (49.1%) had completed primary education, 39.1% were illiterate, and only 17.4% were unemployed. The study revealed low awareness and suboptimal practices concerning NCDs among PLHIV. While awareness of diabetes was relatively high, large proportions of participants were unaware of stroke (79.1%), heart disease (70.3%), or hypertension (54.7%). Furthermore, 21.9% lacked awareness of NCD risk factors, and 37.2% lacked knowledge of metabolic risk factors. The attitudes reflected misconceptions, with 36.3% believing that NCDs are inevitable and with 71.0% showing no concern about the quantity of salt intake. With respect to practices, 57.1% of the participants reported no routine health check-ups, and 47.9% did not maintain a healthy weight. Education, occupation, and BMI significantly influenced knowledge scores. Participants with above-secondary education scored 16.1 points higher, and those with obesity scored 3.6 points higher than their counterparts with no formal education or normal BMI (p\u0026thinsp;=\u0026thinsp;0.002, 95% CI: 1.3\u0026ndash;6.1).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eOur findings highlight significant gaps in KAPs related to NCDs among PLHIV in Rwanda. Evidence-based and context-appropriate interventions, including health education, are needed to improve awareness and promote preventive behaviours among PLHIV, contributing to reducing NCD risk and fostering a healthier and more sustainable quality of life for PLHIV.\u003c/p\u003e","manuscriptTitle":"Knowledge, attitudes and practices toward noncommunicable diseases and associated risk factors among people living with HIV in Rwanda: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 12:36:38","doi":"10.21203/rs.3.rs-7380637/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9e75911c-d477-442e-a519-c57ac4899538","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-19T12:36:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 12:36:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7380637","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7380637","identity":"rs-7380637","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}