Knowledge, attitudes, and practices in cardiometabolic health among adolescents and adults in HIV care in Dar es Salaam, Tanzania.

BACKGROUND: Although integration of cardiometabolic conditions (CMC) prevention into HIV care is increasingly prioritized, limited evidence exists on the CMC knowledge, attitudes, and practices (KAP) of people living with HIV (PLWH). We examined cardiometabolic KAP among PLWH to inform age-appropriate interventions aimed at improving KAP and reducing CMC risk. METHODS: A facility-based cross-sectional survey was conducted from April to May 2025 among adolescents (13-19 years) and adults (≥20 years) living with HIV attending six randomly selected HIV care and treatment clinics in Dar es Salaam, Tanzania. Participants were recruited consecutively. Knowledge, attitudes, and practices were assessed using a questionnaire adapted from the WHO STEPwise approach and the Global Physical Activity Questionnaire. KAP scores were categorized using modified Bloom's cut-off criteria. Factors associated with KAP were assessed using generalized Poisson mixed-effects regression models accounting for clustering by health facility. RESULTS: We enrolled 488 participants: 51.0% (249) were female; 20.1% (98) were adolescents (median age 17 years, IQR 14-19), and 79.9% (390) were adults (median age 41 years, IQR 32-49). Adolescents demonstrated higher knowledge of CMC risk factors than adults (75.3% vs. 55.9%, p < 0.001). Compared with participants with secondary education or higher, those with no formal education (aPR = 2.08, 95% CI: 1.52-2.84) and primary education (aPR = 1.60, 95% CI: 1.22-2.09) had a higher prevalence of low CMC knowledge. Negative attitudes towards CMC prevention were more prevalent among participants attending clinics in Kigamboni Municipality than Ubungo Municipality (aPR = 1.39, 95% CI: 1.25-1.54) and among divorced, separated or widowed participants than those who were married or cohabiting (aPR = 1.45, 95% CI: 1.10-1.90). Adolescents reported higher physical activity (94.9% vs. 85.1%, p = 0.01) but poorer dietary practices and lower uptake of blood glucose screening than adults (all p < 0.001). Poor CMC-related practices were more prevalent among participants attending dispensaries than hospitals (aPR = 1.97, 95% CI: 1.67-2.32) and among adolescents than adults (aPR = 1.73, 95% CI: 1.11-2.69). CONCLUSION: Sociodemographic factors were associated with differing KAP for CMCs risk reduction. Strengthening HIV services with age-specific strategies to improve cardiometabolic knowledge, attitudes, and preventive practices may support healthier behaviours and strengthen integrated cardiometabolic prevention within HIV care.