The burden and determinants of self-reported non-communicable disease comorbidities among HIV positive adults in Tanzania: Insights from the Tanzania HIV Impact Survey 2022-2023

People living with HIV (PLHIV) face an increased risk of developing comorbidities involving HIV and non-communicable diseases (NCDs) caused by a mix of modifiable and non-modifiable risk factors. This study aimed to quantify the burden of NCD-HIV comorbidities and examine their determinants among HIV-positive adults aged ≥ 15 years using data from the 2022– 2023 Tanzania HIV Impact Survey (THIS). The 2022–2023 THIS enrolled 33,663 individuals who underwent HIV testing, of whom 1,850 tested positive. Key variables, including socioeconomic, demographic, and behavioral risk factors and clinical characteristics, were extracted from the main survey database. These variables were modelled as potential determinants of HIV–NCD comorbidities. HIV–NCD comorbidity was defined as being HIV-positive and having at least one non-communicable disease. Chi-square tests and logistic regression analyses were performed to identify the determinants of HIV–NCD comorbidity. Among the 1,850 APLWH included in the analysis, 70.2% were female, 63.0% resided in rural areas, and 70.0% had attained primary education. Hypertension was the most prevalent chronic condition (3.3%), followed by lung disease (1.1%), cancer/tumor (1.0%), and heart disease (1.0%), respectively. The overall prevalence of HIV–NCD comorbidity was 6.7% (95% CI: 5.4–8.3). Female participants had significantly higher odds of HIV–NCD comorbidity (aOR = 1.9; 95% CI: 1.2–3.1; p = 0.010). Age was also strongly linked to comorbidity, with individuals aged 45–54 years (aOR = 9.4; 95% CI: 2.7–33.4; p = 0.001) and those aged ≥ 55 years (aOR = 16.1; 95% CI: 4.4–58.3; p < 0.001) showing higher odds than those aged 15–24 years. HIV–NCD comorbidities are common among APLWH. Female sex and older age significantly increase the risk, emphasizing the importance of tailored interventions for prevention, early detection, and integrated care strategies.