Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Committee Member

Jennifer R. Pharr

Second Committee Member

Chad L. Cross

Third Committee Member

Francisco S. Sy

Fourth Committee Member

Karl Kingsley

Number of Pages



The human immunodeficiency virus (HIV) infection is a global epidemic, with initial high mortality rates since the first diagnosis over three and a half decades ago. However, the use of antiretroviral therapy (ART) has led to longer, healthier lives for many people living with HIV (PLHIV). Accordingly, aging comes with associated co-morbidities like obesity, diabetes, and cardiovascular diseases. The purpose of this mixed-methods study was to further understand the emergent phenomenon of obesity and overweight among PLHIV who are on treatment with ART, using Nigeria as a case study.

An explanatory sequential mixed-method design was used that involved the analysis of de-identified, quantitative, secondary data from two states in southeastern Nigeria in the first phase, followed by 16 key informant interviews (KIIs) of healthcare providers (HCPs) in the second phase. The quantitative and qualitative strands were integrated at three critical points – in the design, methods, and results presentation phases.

The quantitative study included 3530 participants. The median age at ART commencement was 34 years (IQR: 28.0, 41.0), about 68% were female, and the median BMI at baseline was 21.8 kg/m2 (IQR: 19.4, 24.5). After 24 months on ART, the number of participants who were obese increased by 186%, while those underweight decreased by 59%. The median BMI was 23.6 kg/m2 (IQR: 21.1, 26.6) after 24 months. Overall, the BMI increased in 74.7% of the participants. Further analysis showed that age at ART commencement (p

In conclusion, HCPs should keep in mind the likelihood of excess weight gain among PLHIV and the associated cardio-metabolic effects and have a plan to address it, especially with the universal roll-out of ART for PLHIV. The findings from this study will help HCPs develop services that will aid PLHIV to achieve the highest possible quality of life.


Antiretroviral therapy; Body Mass Index; Human Immunodeficiency Virus; Mixed Methods Research; Nigeria; Obesity


Public Health

File Format


File Size

2.4 MB

Degree Grantor

University of Nevada, Las Vegas




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