Sleep health epidemiology in adults with and without HIV in Mwanza, Tanzania: Baseline results from an ongoing cohort study

• People living with HIV (PLWH) reported a longer habitual sleep duration (>9 hours) compared to people without HIV (PWoH) • Based on actigraphy, PLWH were more likely to take >30 minutes to fall asleep and spend more time awake after sleep onset compared to PWoH • These differences remained statistically significant after adjusting for potential confounders Poor sleep health is a growing public health concern worldwide and may disproportionately affect people living with HIV (PLWH). This study compared subjectively and objectively quantified sleep parameters in PLWH and people without HIV (PWoH) in Tanzania. We conducted a cross-sectional analysis of the baseline assessment of participants enrolled in the Mwanza HIV&CVD Cohort in Tanzania. The cohort enrolled 500 PLWH and 500 PWoH between 2021-2023. Participants completed the Pittsburgh Sleep Quality Index, together with 24-hour actigraphy. The median age was 46 and 43 in PLWH and PWoH, respectively. We observed modest but statistically significant differences in subjective and objective sleep measures. Subjective sleep duration and objectively measured sleep latency and wake after sleep onset (WASO) differed between PLWH and PWoH, indicating worse sleep health among PLWH. These differences persisted after adjustment for potential confounders. Long sleep duration (>9 hours), as measured by subjective report, was more common among PLWH than PWoH (15% vs 10%; adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI): 1.08–2.60). Prolonged sleep latency, as assessed by objective measures, was also more prevalent among PLWH (41% vs 34%; aOR = 1.37, 95% CI: 1.05–1.78). Similarly, extended WASO was more common among PLWH (18% vs 13%; aOR = 1.46, 95% CI: 1.02–2.08). PLWH and PWoH have important differences in sleep health parameters, with PLWH experiencing worse sleep on average, underscoring the value of incorporating sleep assessment into routine HIV care. Longitudinal research using multiple-night objective sleep measurements is needed to confirm these findings and assess the impact of poor sleep on health outcomes in PLWH and PWoH in Africa.