Dataset Information

Barriers to Care and 1-Year Mortality Among Newly Diagnosed HIV-Infected People in Durban, South Africa.

ABSTRACT: BACKGROUND:Prompt entry into HIV care is often hindered by personal and structural barriers. Our objective was to evaluate the impact of self-perceived barriers to health care on 1-year mortality among newly diagnosed HIV-infected individuals in Durban, South Africa. METHODS:Before HIV testing at 4 outpatient sites, adults (?18 years) were surveyed regarding perceived barriers to care including (1) service delivery, (2) financial, (3) personal health perception, (4) logistical, and (5) structural. We assessed deaths via phone calls and the South African National Population Register. We used multivariable Cox proportional hazards models to determine the association between number of perceived barriers and death within 1 year. RESULTS:One thousand eight hundred ninety-nine HIV-infected participants enrolled. Median age was 33 years (interquartile range: 27-41 years), 49% were females, and median CD4 count was 192/?L (interquartile range: 72-346/?L). One thousand fifty-seven participants (56%) reported no, 370 (20%) reported 1-3, and 460 (24%) reported >3 barriers to care. By 1 year, 250 [13%, 95% confidence interval (CI): 12% to 15%] participants died. Adjusting for age, sex, education, baseline CD4 count, distance to clinic, and tuberculosis status, participants with 1-3 barriers (adjusted hazard ratio: 1.49, 95% CI: 1.06 to 2.08) and >3 barriers (adjusted hazard ratio: 1.81, 95% CI: 1.35 to 2.43) had higher 1-year mortality risk compared with those without barriers. CONCLUSIONS:HIV-infected individuals in South Africa who reported perceived barriers to medical care at diagnosis were more likely to die within 1 year. Targeted structural interventions, such as extended clinic hours, travel vouchers, and streamlined clinic operations, may improve linkage to care and antiretroviral therapy initiation for these people.

SUBMITTER: Bassett IV

PROVIDER: S-EPMC5321110 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Barriers to Care and 1-Year Mortality Among Newly Diagnosed HIV-Infected People in Durban, South Africa.

Bassett Ingrid V IV Coleman Sharon M SM Giddy Janet J Bogart Laura M LM Chaisson Christine E CE Ross Douglas D Flash Moses J E MJ Govender Tessa T Walensky Rochelle P RP Freedberg Kenneth A KA Losina Elena E

Journal of acquired immune deficiency syndromes (1999) 20170401 4

<h4>Background</h4>Prompt entry into HIV care is often hindered by personal and structural barriers. Our objective was to evaluate the impact of self-perceived barriers to health care on 1-year mortality among newly diagnosed HIV-infected individuals in Durban, South Africa.<h4>Methods</h4>Before HIV testing at 4 outpatient sites, adults (≥18 years) were surveyed regarding perceived barriers to care including (1) service delivery, (2) financial, (3) personal health perception, (4) logistical, an ...[more]

PMID: 28060226

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Project description:BackgroundSouth Africa has the largest population of human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART) realising the benefits of increased life expectancy. However, this population may be susceptible to cardiovascular disease (CVD) development, due to the chronic consequences of a lifestyle-related combination of risk factors, HIV infection and ART. We predicted a 10-year cardiovascular mortality risk in an HIV-infected population on long-term ART, based on their observed metabolic risk factor profile.MethodsWe extracted data from hospital medical charts for 384 randomly selected HIV-infected patients aged ≥ 30 years. We defined metabolic syndrome (MetS) subcomponents using the International Diabetes Federation definition. A validated non-laboratory-based model for predicting a 10-year CVD mortality risk was applied and categorised into five levels, with the thresholds ranging from very low-risk (< 5%) to very high-risk scores (> 30%).ResultsAmong the 384 patients, with a mean (± standard deviation) age of 42.90 ± 8.20 years, the proportion of patients that were overweight/obese was 53.3%, where 50.9% had low high-density lipoprotein (HDL) cholesterol and 21 (17.5%) had metabolic syndrome. A total of 144 patients with complete data allowed a definitive prediction of a 10-year CVD mortality risk. 52% (95% CI 44-60) of the patients were stratified to very low risk (< 5%) compared to 8% (95% CI 4-13) that were at a very high risk (> 30%) of 10-year CVD mortality. The CVD risk grows with increasing age (years), 57.82 ± 6.27 among very high risk and 37.52 ± 4.50; p < 0.001 in very low risk patients. Adjusting for age and analysing CVD risk mortality as a continuous risk score, increasing duration of HIV infection (p = 0.002) and ART (p = 0.007) were significantly associated with increased predicted 10 year CVD mortality risk. However, there was no association between these factors and categorised CVD mortality risk as per recommended scoring thresholds.ConclusionsApproximately 1 in 10 HIV-infected patients is at very high risk of predicted 10-year CVD mortality in our study population. Like uninfected individuals, our study found increased age as a major predictor of 10-year mortality risk and high prevalence of metabolic syndrome. Additional CVD mortality risk due to the duration of HIV infection and ART was seen in our population, further studies in larger and more representative study samples are encouraged. It recommends an urgent need for early planning, prevention and management of metabolic risk factors in HIV populations, at the point of ART initiation.

Project description:Background:Population growth at all scales and rapid rates of urbanization, particularly in the global South, are placing increasing pressure on ecosystems and their ability to provide services essential for human well-being. The spatial consideration of threats to ecosystem services related to changes in land use is necessary in order to avoid undue impacts on society due to the loss or reduced supply of ecosystem services. This study assesses the potential threats of land use change from strategic and local development proposals to ecosystem services in the city of Durban. Methods:We analysed the spatial relationship between five categories of ecosystem service hotspots (carbon storage, water yield, sediment retention, nutrient retention and flood attenuation) and urban land use change related to selected strategic planning proposals, development proposals and sand-mining applications in Durban, South Africa (eThekwini Municipality) with a view to determining the consequences for progress towards a more sustainable development path in the city. We identified the potential levels of threat related to habitat destruction or transformation for the five categories of ecosystem services and a subset of 13 ecosystem service hotspots, using GIS spatial analysis tools. Results:The results show that on average, should Durban's strategic development plans be realised, approximately 42% loss of ecosystem service hotspots is expected in the two municipal town-planning regions assessed. With respect to development applications between 2009 and 2012, approximately 36% of all environmental impact assessments and 84% of sand mining applications occurred within ecosystem service hotspots within Durban. Discussion:The findings highlight the tension between short-term development pressures and longer-term sustainability goals and confirm that current planning and development proposals pose a threat to ecosystems and their ability to deliver services that support human well-being in Durban. We suggest practical solutions to include ecosystem services into local government decision-making.

Dataset Information

Barriers to Care and 1-Year Mortality Among Newly Diagnosed HIV-Infected People in Durban, South Africa.

Publications

Barriers to Care and 1-Year Mortality Among Newly Diagnosed HIV-Infected People in Durban, South Africa.

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