High pre-frailty burden among people living with HIV in Botswana

Frailty is increasingly recognized as a significant aging-related condition in people living with HIV (PLWH), but data from sub-Saharan Africa (SSA) - where the majority of PLWH reside - remain limited. Using standardized Fried frailty criteria, we assessed the prevalence and factors associated with frailty in a well-managed cohort of virally suppressed PLWH in Botswana. Between January 2020 and January 2021, we conducted a cross-sectional study of adults ≥ 39 years on antiretroviral therapy (ART) in Gaborone, Botswana. Frailty status (frail, pre-frail, non-frail) was assessed using Fried’s phenotype criteria. We used modified Poisson regression with robust standard errors to estimate risk ratios for frailty, adjusting for sociodemographic, clinical, and laboratory variables. Among 976 participants (52% male; median age 51 years), 3% were classified as frail and 43% as pre-frail. Higher age, lower income, shorter height, and elevated albumin-creatinine ratio (ACR) were significantly associated with frailty. In adjusted models, income above BWP1000/month (~ USD 75) was protective (aRR = 0.75; 95% CI: 0.64–0.88), while higher ACR was associated with increased frailty risk (aRR = 1.06; 95% CI: 1.01–1.11). In this large cohort of virally suppressed PLWH, frailty prevalence was low but pre-frailty was common - suggesting a window for early intervention. Findings support the integration of frailty screening and inflammation monitoring into HIV care. This study contributes globally comparable data from a high-performing SSA setting and underscores the interplay between biological and socioeconomic determinants of healthy aging in PLWH.