Risk Factors for Late-Stage HIV Disease Presentation at Initial HIV Diagnosis in Durban, South Africa
Identifieur interne : 002377 ( Main/Merge ); précédent : 002376; suivant : 002378Risk Factors for Late-Stage HIV Disease Presentation at Initial HIV Diagnosis in Durban, South Africa
Auteurs : Paul K. Drain [États-Unis] ; Elena Losina [États-Unis] ; Gary Parker [Afrique du Sud] ; Janet Giddy [Afrique du Sud] ; Douglas Ross [Afrique du Sud] ; Jeffrey N. Katz [États-Unis] ; Sharon M. Coleman [États-Unis] ; Laura M. Bogart [États-Unis] ; Kenneth A. Freedberg [États-Unis] ; Rochelle P. Walensky [États-Unis] ; Ingrid V. Bassett [États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2013.
Abstract
After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults.
We surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count <100 cells/mm3. We used multivariate regression models to determine the effects of sex, emotional health, social support, distance from clinic, employment, perceived barriers to receiving healthcare, and foregoing healthcare to use money for food, clothing, or housing (“competing needs to healthcare”) on presentation with late-stage HIV disease.
Among 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6%) presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR) 2.8, 95% CI 1.7–4.7], reported competing needs to healthcare (AOR 1.7, 95% CI 1.2–2.4), were male (AOR 1.7, 95% CI 1.2–2.3), worked outside the home (AOR 1.5, 95% CI 1.1–2.1), perceived health service delivery barriers (AOR 1.5, 95% CI 1.1–2.1), and/or had poor emotional health (AOR 1.4, 95% CI 1.0–1.9) had higher odds of late-stage HIV disease presentation.
Independent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. These findings can inform various interventions, such as mobile testing or financial assistance, to reduce the risk of presentation with late-stage HIV disease.
Url:
DOI: 10.1371/journal.pone.0055305
PubMed: 23383147
PubMed Central: 3557232
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Drain</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3"><addr-line>Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff4"><addr-line>Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Losina, Elena" sort="Losina, Elena" uniqKey="Losina E" first="Elena" last="Losina">Elena Losina</name><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3"><addr-line>Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff4"><addr-line>Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff6"><addr-line>Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff10"><addr-line>Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Parker, Gary" sort="Parker, Gary" uniqKey="Parker G" first="Gary" last="Parker">Gary Parker</name><affiliation wicri:level="1"><nlm:aff id="aff14"><addr-line>Department of Medicine, McCord Hospital, Durban, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Medicine, McCord Hospital, Durban</wicri:regionArea><wicri:noRegion>Durban</wicri:noRegion></affiliation></author><author><name sortKey="Giddy, Janet" sort="Giddy, Janet" uniqKey="Giddy J" first="Janet" last="Giddy">Janet Giddy</name><affiliation wicri:level="1"><nlm:aff id="aff14"><addr-line>Department of Medicine, McCord Hospital, Durban, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Medicine, McCord Hospital, Durban</wicri:regionArea><wicri:noRegion>Durban</wicri:noRegion></affiliation></author><author><name sortKey="Ross, Douglas" sort="Ross, Douglas" uniqKey="Ross D" first="Douglas" last="Ross">Douglas Ross</name><affiliation wicri:level="1"><nlm:aff id="aff15"><addr-line>Department of Medicine, St. Mary's Hospital, Durban, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Medicine, St. Mary's Hospital, Durban</wicri:regionArea><wicri:noRegion>Durban</wicri:noRegion></affiliation></author><author><name sortKey="Katz, Jeffrey N" sort="Katz, Jeffrey N" uniqKey="Katz J" first="Jeffrey N." last="Katz">Jeffrey N. Katz</name><affiliation wicri:level="2"><nlm:aff id="aff5"><addr-line>Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff6"><addr-line>Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff9"><addr-line>Departments of Epidemiology and Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Departments of Epidemiology and Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Coleman, Sharon M" sort="Coleman, Sharon M" uniqKey="Coleman S" first="Sharon M." last="Coleman">Sharon M. Coleman</name><affiliation wicri:level="2"><nlm:aff id="aff11"><addr-line>Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff12"><addr-line>Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Bogart, Laura M" sort="Bogart, Laura M" uniqKey="Bogart L" first="Laura M." last="Bogart">Laura M. Bogart</name><affiliation wicri:level="2"><nlm:aff id="aff8"><addr-line>Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff13"><addr-line>Boston Children's Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Boston Children's Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A." last="Freedberg">Kenneth A. Freedberg</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3"><addr-line>Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff7"><addr-line>Center for AIDS Research, Harvard Medical School, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for AIDS Research, Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff9"><addr-line>Departments of Epidemiology and Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Departments of Epidemiology and Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff11"><addr-line>Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Walensky, Rochelle P" sort="Walensky, Rochelle P" uniqKey="Walensky R" first="Rochelle P." last="Walensky">Rochelle P. Walensky</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3"><addr-line>Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff4"><addr-line>Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff7"><addr-line>Center for AIDS Research, Harvard Medical School, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for AIDS Research, Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Bassett, Ingrid V" sort="Bassett, Ingrid V" uniqKey="Bassett I" first="Ingrid V." last="Bassett">Ingrid V. Bassett</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3"><addr-line>Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff7"><addr-line>Center for AIDS Research, Harvard Medical School, Boston, Massachusetts, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for AIDS Research, Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults.</p></sec><sec><title>Methods</title><p>We surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count <100 cells/mm<sup>3</sup>. We used multivariate regression models to determine the effects of sex, emotional health, social support, distance from clinic, employment, perceived barriers to receiving healthcare, and foregoing healthcare to use money for food, clothing, or housing (“competing needs to healthcare”) on presentation with late-stage HIV disease.</p></sec><sec><title>Results</title><p>Among 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6%) presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR) 2.8, 95% CI 1.7–4.7], reported competing needs to healthcare (AOR 1.7, 95% CI 1.2–2.4), were male (AOR 1.7, 95% CI 1.2–2.3), worked outside the home (AOR 1.5, 95% CI 1.1–2.1), perceived health service delivery barriers (AOR 1.5, 95% CI 1.1–2.1), and/or had poor emotional health (AOR 1.4, 95% CI 1.0–1.9) had higher odds of late-stage HIV disease presentation.</p></sec><sec><title>Conclusions</title><p>Independent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. 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sortKey="Byakika Tusiime, J" uniqKey="Byakika Tusiime J">J Byakika-Tusiime</name></author><author><name sortKey="Oyugi, Jh" uniqKey="Oyugi J">JH Oyugi</name></author><author><name sortKey="Tumwikirize, Wa" uniqKey="Tumwikirize W">WA Tumwikirize</name></author><author><name sortKey="Katabira, Et" uniqKey="Katabira E">ET Katabira</name></author><author><name sortKey="Mugyenyi, Pn" uniqKey="Mugyenyi P">PN Mugyenyi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tadios, Y" uniqKey="Tadios Y">Y Tadios</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Park, Bj" uniqKey="Park B">BJ Park</name></author><author><name sortKey="Wannemuehler, Ka" uniqKey="Wannemuehler K">KA Wannemuehler</name></author><author><name sortKey="Marston, Bj" uniqKey="Marston B">BJ Marston</name></author><author><name sortKey="Govender, N" uniqKey="Govender N">N Govender</name></author><author><name sortKey="Pappas, Pg" uniqKey="Pappas P">PG Pappas</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Rosen, S" uniqKey="Rosen S">S Rosen</name></author><author><name sortKey="Fox, Mp" uniqKey="Fox M">MP Fox</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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