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Changing contextual factors from baseline to 9-months post-HIV diagnosis predict 5-year mortality in Durban, South Africa.

ABSTRACT: Changes in an individual's contextual factors following HIV diagnosis may influence long-term outcomes. We evaluated how changes to contextual factors between HIV diagnosis and 9-month follow-up predict 5-year mortality among HIV-infected individuals in Durban, South Africa enrolled in the Sizanani Trial (NCT01188941). We used random survival forests to identify 9-month variables and changes from baseline predictive of time to mortality. We incorporated these into a Cox proportional hazards model including age, sex, and starting ART by 9 months a priori, 9-month social support and competing needs, and changes in mental health between baseline and 9 months. Among 1,154 participants with South African ID numbers, 900 (78%) had baseline and 9-month data available of whom 109 (12%) died after 9-month follow-up. Those who reported less social support at 9 months had a 16% higher risk of mortality. Participants who went without basic needs or healthcare at 9 months had a 2.6 times higher hazard of death compared to participants who did not. Low social support and competing needs at 9-month follow-up substantially increase long-term mortality risk. Reassessing contextual factors during follow-up and targeting interventions to increase social support and affordability of care may reduce long-term mortality for HIV-infected individuals in South Africa.

SUBMITTER: Bassett IV

PROVIDER: S-EPMC8088454 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Changing contextual factors from baseline to 9-months post-HIV diagnosis predict 5-year mortality in Durban, South Africa.

Bassett Ingrid V IV Xu Ai A Giddy Janet J Bogart Laura M LM Boulle Andrew A Millham Lucia L Losina Elena E Parker Robert A RA

AIDS care 20201102 12

Changes in an individual's contextual factors following HIV diagnosis may influence long-term outcomes. We evaluated how changes to contextual factors between HIV diagnosis and 9-month follow-up predict 5-year mortality among HIV-infected individuals in Durban, South Africa enrolled in the Sizanani Trial (NCT01188941). We used random survival forests to identify 9-month variables and changes from baseline predictive of time to mortality. We incorporated these into a Cox proportional hazards mode ...[more]

PMID: 33138630

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Project description:BackgroundPopulation 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.MethodsWe 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.ResultsThe 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.DiscussionThe 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.

Project description:ObjectiveInfections are common in systemic lupus erythematosus (SLE), with tuberculosis (TB) being important in an endemic environment. We studied the prevalence and spectrum of TB in SLE in Durban, South Africa.MethodsA medical records review of SLE patients seen over 13-year period, and the demographic data, clinical manifestations, laboratory findings, treatment and outcome were noted.ResultsThere were 512 SLE patients and 72 (14.1%) had TB. Thirty (41.7%) had pulmonary TB (PTB) and 42 (58.3%) had extra-pulmonary TB (EPTB). The prevalence of TB among the different ethnic groups was 36/282 (12.8%) for Indian people, 29/184 (15.8%) Black African people, 7/26 (26.9%) admixed African people and none among the 18 White people. Comparison of the 72 SLE-TB patients with 72 SLE controls showed no difference in gender, age at SLE diagnosis and disease duration. The SLE-TB patients had a significant increase in the clinical and laboratory features of disease activity (arthritis, mucocutaneous lesions, renal involvement, vasculitis, low complement, raised ds-DNA antibodies), and cumulative prednisone use over the preceding 3 months.Compared to PTB, the EPTB patients were significantly younger, developed TB earlier after SLE diagnosis, and had higher disease activity. The EPTB patients also had increase in features of disease activity (renal, thrombocytopenia, ds-DNA antibodies), and increase in ever use of intravenous methylprednisolone (IV-MP) and mycophenolate mofetil (MMF). On multivariate analysis, the independent risk factors for EPTB were ever use of MMF (p = 0.003) and IV-MP (p = 0.027). Analysis of the cumulative SLE criteria showed renal involvement was an independent risk factor for EPTB. The outcome was similar in both groups.ConclusionWe show an increased prevalence of TB (14.1%) and EPTB (58.3%) in SLE in an endemic area and confirm that features of disease activity and use of immunosuppressive therapy are the major risk factors. Renal involvement (as a cumulative criterion) is an independent risk factor for EPTB.

Dataset Information

Changing contextual factors from baseline to 9-months post-HIV diagnosis predict 5-year mortality in Durban, South Africa.

Publications

Changing contextual factors from baseline to 9-months post-HIV diagnosis predict 5-year mortality in Durban, South Africa.

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