Zelalem DebebeDaniel YilmaAyalew AstatkieAgete Tadewos2026-09-232026-09-232025-07-01https://etd.aau.edu.et/handle/123456789/9031Background: Antiretroviral therapy (ART) has significantly improved survival among people living with HIV (PLWH). With increased life expectancy, cardiometabolic risks like obesity, elevated blood pressure, hyperglycemia, dyslipidemia and metabolic syndrome (MetS) are rising in this population. Since the World Health Organization recommended test-and-treat strategy and dolutegravir (DTG) based regimens, they have been widely adopted across sub-Saharan Africa. Ethiopia implemented test-and-treat in 2017 and distribution of DTG-based regimens in 2019. However, their cardiometabolic effects in this population remain unclear. Objective: The objective of this study was to: (1) to assess the prevalence and risk factors of high blood pressure (HBP), hyperglycemia, dyslipidemia, and metabolic syndrome (MetS); (2) evaluate trends in body weight among adults receiving first-line ART over a 24-month period; and (3) evaluate the effect of lifestyle counselling on weight and body composition among adults with overweight and obesity in Hawassa city, Sidama Region. Methods: A mixed-methods design was employed, consisting of a retrospective cohort study (n = 524; February 2017–October 2022), a cross-sectional study (n = 465; January 5, 2023–May 30, 2024) using systematic random sampling, and a randomized controlled trial (RCT; n = 126; January 5, 2023–May 30, 2024). RCT participants were randomly assigned to intervention (n = 63) or control (n = 63) groups. Participants were selected via systematic sampling, and data were collected through semi-structured questionnaires and face-to-face interviews. Blood samples obtained from participants after an overnight fast were used to evaluate glucose and lipid profiles. High blood pressure, hyperglycemia, dyslipidemia, and metabolic syndrome (MetS) were defined according to established guidelines. Data were entered using EPI-Data version 3.1 and analyzed with IBM SPSS version 27.0 and STATA 17.0. Statistical analyses included descriptive statistics, linear mixed-effects models, and binary logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, with p-values < 0.05 considered statistically significant. Results: Over 24 months, adults initiated DTG-based regimens gained significantly more weight than those on non-nucleoside reverse transcriptase inhibitors (NNRTIs) (8.6 kg vs. 4.95 kg, p<0.0001), with DTG initiation associated with ≥10% weight gain (AOR=1.9; 95% CI: 1.19– 3.04). HBP prevalence was 57.9%, including 40.5% prehypertension and 17.3% hypertension; 84.4% of hypertensive cases were newly diagnosed. DTG initiation (AOR=5.9; p=0.01) and switching to DTG (AOR=3.8; p=0.03) were significantly associated with HBP. Hyperglycemia prevalence was 24.4% (16.7% prediabetes, 7.7% diabetes), with 82.3% of diabetes cases newly diagnosed; age >50 (AOR=2.1; p=0.02), alcohol use (AOR=2.1; p=0.04), obesity (AOR=3.2; p=0.01), high waist-hip ratio (AOR=2.6; p=0.002), and elevated LDL-cholesterol (AOR=2.2; p=0.04) were significant associated with hyperglycemia. Dyslipidemia prevalence was 74.0%, most commonly low HDL-cholesterol (66.4%), and dyslipidemia associated with DTG initiation (AOR=4.8; p=0.02) and high waist circumference (AOR=1.06; p=0.01). MetS was present in 36.4% and associated with age >50 (AOR=3.2; p=0.003), alcohol use (AOR=2.7; p=0.02), body mass index ≥25 kg/m² (AOR=2.2; p=0.03), and high waist-height ratio (AOR=3.9; p=0.01). At six months, lifestyle counselling significantly reduced body weight (Δ=–1.4 kg, p=0.002), visceral fat (Δ=–0.53, p=0.006), fat mass (Δ=–2.16 kg, p<0.001), and body fat percentage (Δ=–2.02%, p<0.001), and increased skeletal muscle (Δ=+1.27%, p<0.001). Counselling was associated with achieving ≥3% weight loss (β=0.158, p=0.048). Conclusion: The findings highlight the need to strengthen routine screening, risk stratification, and targeted lifestyle interventions within HIV care to facilitate early identification and management of the growing burden of noncommunicable diseases among PLWH on ARTenHIVAntiretroviral TherapyCardiometabolic RisksDolutegravirDyslipidemiaBlood PressureMetabolic SyndromeObesityLifestyle CounsellingSidama RegionEthiopiaDissertation