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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2019

Open Access 01-12-2019 | Care | Research article

Assessing rates and contextual predictors of 5-year mortality among HIV-infected and HIV-uninfected individuals following HIV testing in Durban, South Africa

Authors: Ingrid V. Bassett, Ai Xu, Janet Giddy, Laura M. Bogart, Andrew Boulle, Lucia Millham, Elena Losina, Robert A. Parker

Published in: BMC Infectious Diseases | Issue 1/2019

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Abstract

Background

Little is known about contextual factors that predict long-term mortality following HIV testing in resource-limited settings. We evaluated the impact of contextual factors on 5-year mortality among HIV-infected and HIV-uninfected individuals in Durban, South Africa.

Methods

We used data from the Sizanani trial (NCT01188941) in which adults (≥18y) were enrolled prior to HIV testing at 4 outpatient sites. We ascertained vital status via the South African National Population Register. We used random survival forests to identify the most influential predictors of time to death and incorporated these into a Cox model that included age, gender, HIV status, CD4 count, healthcare usage, health facility type, mental health, and self-identified barriers to care (i.e., service delivery, financial, logistical, structural and perceived health).

Results

Among 4816 participants, 39% were HIV-infected. Median age was 31y and 49% were female. 380 of 2508 with survival information (15%) died during median follow-up of 5.8y. For both HIV-infected and HIV-uninfected participants, each additional barrier domain increased the HR of dying by 11% (HR 1.11, 95% CI 1.05–1.18). Every 10-point increase in mental health score decreased the HR by 7% (HR 0.93, 95% CI 0.89–0.97). The hazard ratio (HR) for death of HIV-infected versus HIV-uninfected varied by age: HR of 6.59 (95% CI: 4.79–9.06) at age 20 dropping to a HR of 1.13 (95% CI: 0.86–1.48) at age 60.

Conclusions

Independent of serostatus, more self-identified barrier domains and poorer mental health increased mortality risk. Additionally, the impact of HIV on mortality was most pronounced in younger persons. These factors may be used to identify high-risk individuals requiring intensive follow up, regardless of serostatus.

Trial registration

Clinical Trials.​gov Identifier NCT01188941. Registered 26 August 2010.
Appendix
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Literature
1.
Joint United Nations Programme on HIV/AIDS. UNAIDS Data 2017. Geneva, Switzerland: UNAIDS; 2017.
2.
Johnson LF, Mossong J, Dorrington RE, et al. Life expectancies of south African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med. 2013;10(4):e1001418.
3.
Mills EJ, Bakanda C, Birungi J, et al. Life expectancy of persons receiving combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda. Ann Intern Med. 2011;155(4):209–216.
4.
Ingle SM, May M, Uebel K, et al. Outcomes in patients waiting for antiretroviral treatment in the Free State Province, South Africa: prospective linkage study. AIDS. 2010;24(17):2717–2725.
5.
Amuron B, Namara G, Birungi J, et al. Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda. BMC Public Health. 2009;9:290.
6.
Bassett IV, Chetty S, Wang B, et al. Loss to follow-up and mortality among HIV-infected people co-infected with TB at ART initiation in Durban, South Africa. J Acquir Immune Defic Syndr. 2012;59(1):25–30.
7.
Cornell M, Lessells R, Fox MP, et al. Mortality among adults transferred and lost to follow-up from antiretroviral therapy programmes in South Africa: a multicenter cohort study. J Acquir Immune Defic Syndr. 2014;67(2):e67–e75.
8.
Boulle A, Schomaker M, May MT, et al. Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies. PLoS Med. 2014;11(9):e1001718.
9.
Yiannoutsos CT, Johnson LF, Boulle A, et al. Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy. Sex Transm Infect. 2012;88(Suppl 2):i33–43.
10.
Braitstein P, Brinkhof MW, Dabis F, et al. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet. 2006;367(9513):817–824.
11.
Cornell M, Johnson LF, Wood R, et al. Twelve-year mortality in adults initiating antiretroviral therapy in South Africa. J Int AIDS Soc. 2017;20(1):21902.
12.
Haas AD, Zaniewski E, Anderegg N, et al. Retention and mortality on antiretroviral therapy in sub-Saharan Africa: collaborative analyses of HIV treatment programmes. J Int AIDS Soc. 2018;21(2).
13.
Cornell M, Lessells R, Fox MP, et al. Mortality among adults transferred and lost to follow-up from antiretroviral therapy programmes in South Africa: a multicentre cohort study. J Acquir Immune Defic Syndr. 2014;67(2):e67–e75.
14.
Hoffmann CJ, Schomaker M, Fox MP, et al. CD4 count slope and mortality in HIV-infected patients on antiretroviral therapy: multicohort analysis from South Africa. J Acquir Immune Defic Syndr. 2013;63(1):34–41.
15.
Fox MP, Shearer K, Maskew M, et al. Treatment outcomes after 7 years of public-sector HIV treatment. AIDS. 2012;26(14):1823–1828.
16.
Bassett IV, Coleman SM, Giddy J, et al. Barriers to Care and 1-Year Mortality Among Newly Diagnosed HIV-Infected People in Durban, South Africa. J Acquir Immune Defic Syndr. 2017;74(4):432–438.
17.
Mukoswa GM, Charalambous S, Nelson G. The association between social capital and HIV treatment outcomes in South Africa. PLoS One. 2017;12(11):e0184140.
18.
Bassett IV, Regan S, Chetty S, et al. Who starts antiretroviral therapy in Durban, South Africa?... not everyone who should. AIDS. 2010;24(Suppl 1):S37–44.
19.
Walker AS, Prendergast AJ, Mugyenyi P, et al. Mortality in the year following antiretroviral therapy initiation in HIV-infected adults and children in Uganda and Zimbabwe. Clin Infect Dis. 2012;55(12):1707–1718.
20.
Walker AS, Prendergast AJ, Mugyenyi P, et al. Mortality in the year following antiretroviral therapy initiation in HIV-infected adults and children in Uganda and Zimbabwe. Clin Infect Dis. 2012;55(12):1707–18.
21.
Brinkhof MW, Pujades-Rodriguez M, Egger M. Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis. PLoS One. 2009;4(6):e5790.
22.
Coetzee D, Hildebrand K, Boulle A, et al. Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. AIDS. 2004;18(6):887–895.
23.
Flynn AG, Anguzu G, Mubiru F, et al. Socioeconomic position and ten-year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy. PLoS One. 2017;12(12):e0189055.
24.
Antelman G, Kaaya S, Wei R, et al. Depressive symptoms increase risk of HIV disease progression and mortality among women in Tanzania. J Acquir Immune Defic Syndr. 2007;44(4):470–477.
25.
Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, cd4 cell count decline, and depressive symptoms among hiv-seropositive women: longitudinal analysis from the hiv epidemiology research study. JAMA. 2001;285(11):1466–74.
26.
Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients. Cancer. 2009;115(22):5349–61.
27.
van Dooren FEP, Nefs G, Schram MT, Verhey FRJ, Denollet J, Pouwer F. Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PLoS One. 2013;8(3):e57058.
28.
Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48(8):1527–1537.
29.
Burack JH, Barrett DC, Stall RD, Chesney MA, Ekstrand ML, Coates TJ. Depressive symptoms and CD4 lymphocyte decline among HIV-infected men. JAMA. 1993;270(21):2568–2573.
30.
Evans DL, Ten Have TR, Douglas SD, et al. Association of depression with viral load, CD8 T lymphocytes, and natural killer cells in women with HIV infection. Am J Psychiatry. 2002;159(10):1752–9.
31.
Gallo JJ, Bogner HR, Morales KH, Post EP, Lin JY, Bruce ML. The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial. Ann Intern Med. 2007;146(10):689–698.
32.
Gallo JJ, Morales KH, Bogner HR, et al. Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. BMJ. 2013;346:f2570.
33.
Bogner HR, Morales KH, Post EP, Bruce ML. Diabetes, depression, and death: a randomized controlled trial of a depression treatment program for older adults based in primary care (PROSPECT). Diabetes Care. 2007;30(12):3005–10.
34.
Bogner HR, Joo JH, Hwang S, et al. Does a depression management program decrease mortality in older adults with specific medical conditions in primary care? An exploratory analysis. J Am Geriatr Soc. 2016;64(1):126–31.
35.
Holt-Lunstad J, Robles TF, Sbarra DA. Advancing social connection as a public health priority in the United States. Am Psychol. 2017;72(6):517–30.
36.
Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316.
37.
Bassett IV, Coleman SM, Giddy J, et al. Sizanani: A randomized trial of health system navigators to improve linkage to HIV and TB care in South Africa. J Acquir Immune Defic Syndr. 2016;73(2):154–160.
38.
Bassett IV, Giddy J, Chaisson CE, et al. A randomized trial to optimize HIV/TB care in South Africa: design of the Sizanani trial. BMC Infect Dis. 2013;13:390.
39.
40.
Cunningham WE, Andersen RM, Katz MH, et al. The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Med Care. 1999;37(12):1270–81.
41.
Craw JA, Gardner LI, Marks G, et al. Brief strengths-based case management promotes entry into HIV medical care: results of the antiretroviral treatment access study-II. J Acquir Immune Defic Syndr. 2008;47(5):597–606.
42.
Hays RD, Sherbourne CD, Mazel RM. The RAND 36-item health survey 1.0. Health Econ. 1993;2(3):217–27.
43.
Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.
44.
Holmes WC. A short, psychiatric, case-finding measure for HIV seropositive outpatients: performance characteristics of the 5-item mental health subscale of the SF-20 in a male, seropositive sample. Med Care. 1998;36(2):237–43.
45.
Johnson LF, Dorrington RE, Laubscher R, et al. A comparison of death recording by health centres and civil registration in South Africans receiving antiretroviral treatment. J Int AIDS Soc. 2015;18(1).
46.
Rosenbaum P, Rubin D. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70:41–55.
47.
Ishwaran H, Kogalur U, Blackstone E, Lauer M. Random survival forests. Ann Appl Stat. 2008;2(3):841–60.
48.
Breiman L. Random forests. Mach Learn. 2001;45(1):5–32.
49.
Cornell M, Schomaker M, Garone DB, et al. Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: a multicentre cohort study. PLoS Med. 2012;9(9):e1001304.
50.
Malaza A, Mossong J, Bärnighausen T, Viljoen J, Newell M-L. Population-based CD4 counts in a rural area in South Africa with high HIV prevalence and high antiretroviral treatment coverage. PLoS One. 2013;8(7):e70126.
51.
Heagerty PJ, Zheng Y. Survival model predictive accuracy and ROC curves. Biometrics. Mar 2005;61(1):92–105.
52.
53.
Alamo ST, Wagner GJ, Ouma J, et al. Strategies for Optimizing Clinic Efficiency in a Community-Based Antiretroviral Treatment Programme in Uganda. AIDS Behav. 2013;17(1).
54.
Wagenaar BH, Gimbel S, Hoek R, et al. Wait and consult times for primary healthcare services in Central Mozambique: a time-motion study. Glob Health Action. 2016;9.
55.
Katirayi L, Chadambuka A, Muchedzi A, et al. Echoes of old HIV paradigms: reassessing the problem of engaging men in HIV testing and treatment through women’s perspectives. Reprod Health. 2017;14(1):124.
56.
Katz IT, Dietrich J, Tshabalala G, et al. Understanding treatment refusal among adults presenting for HIV-testing in Soweto, South Africa: a qualitative study. AIDS Behav. 2015;19(4):704–14.
57.
Kinyanda E, Levin J, Nakasujja N, et al. Major Depressive Disorder: Longitudinal Analysis of Impact on Clinical and Behavioral Outcomes in Uganda. J Acquir Immune Defic Syndr. 1 2018;78(2):136–143.
58.
Ramirez-Avila L, Regan S, Giddy J, et al. Depressive symptoms and their impact on health-seeking behaviors in newly-diagnosed HIV-infected patients in Durban, South Africa AIDS Behav 2012;16(8):2226–2235.
59.
Gaolathe T, Wirth K, Holmes MP, et al. Higher mortality in HIV-infected vs -uninfected adults despite ART, Botswana. CROI; 2018; Boston, Massachusetts.
60.
Walker E, McGee R, Druss B. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015;72(4):334–41.
Metadata
Title
Assessing rates and contextual predictors of 5-year mortality among HIV-infected and HIV-uninfected individuals following HIV testing in Durban, South Africa
Authors
Ingrid V. Bassett
Ai Xu
Janet Giddy
Laura M. Bogart
Andrew Boulle
Lucia Millham
Elena Losina
Robert A. Parker
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2019
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-019-4373-9

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