scholarly journals Leveraging the ART Advantage: diabetes and hypertension along the HIV care cascade in rural South Africa

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S58-S58
Author(s):  
Jennifer Manne-Goehler ◽  
Mark Siedner ◽  
Pascal Geldsetzer ◽  
Guy Harling ◽  
Livia Montana ◽  
...  
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Regression Models ◽  
Self Report ◽  
Hiv Care ◽  
Linear Regression Models ◽  
Rural South ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Rural South Africa

Abstract Background Participation in antiretroviral therapy (ART) programs has been associated with greater utilization of care for diabetes and hypertension in rural South Africa. However, there is limited data about whether this apparent “ART advantage” translates into improved chronic disease management indicators. Methods The Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) is a cohort of 5,059 adults >40 in Agincourt. The study collects data on demographics, healthcare utilization, height, weight, blood pressure (BP), and blood glucose. HIV infection, HIV-1 RNA viral load (VL) and ART drug levels are tested via dried blood spots. We defined hypertension (HTN) based on measured BP or self-report of diagnosis by a healthcare provider or use of antihypertensive medication and diabetes (DM) by measured glucose or self-report of diagnosis by a healthcare provider or the use of DM medications. Our primary predictor of interest was stage along the HIV care cascade (HIV-, HIV+ not on ART, ART with a detectable VL, and with a suppressed VL). We compared the proportion in each sub-group who were aware of and treated for their hypertension or diabetes diagnosis, and fit adjusted linear regression models to estimate differences in systolic BP and glucose among those with diagnosed HTN or DM. Results Rates of HTN and DM were higher in HIV- than those with a suppressed VL (HTN: 68.4% v. 46.4%, DM: 12.9% vs.. 8.8%, respectively). However, the suppressed VL group had higher crude rates of awareness of HTN diagnosis and treated HTN as compared with the HIV- group (Aware: 69.9% vs.. 65.2%, p = 0.118; Treated: 50.2% vs.. 46.4%, p = 0.002). There were no significant differences in awareness or treatment rates for DM. In adjusted linear regression models among those with diagnosed HTN or DM, having a suppressed VL was associated with lower mean systolic BP (-5.94mm Hg, 95% CI: -9.68 – -2.20) and lower mean glucose (-3.74 mmol/L, 95% CI: -5.95 – -0.58), compared with being HIV-. This effect was preserved in models restricted to overweight and obese participants. Conclusion The HIV care delivery platform in South Africa appears to offer a vehicle for healthcare delivery for other chronic conditions. Future studies are needed to assess causality of these relationships, and to determine optimal methods of integrating chronic disease with HIV management. Disclosures All authors: No reported disclosures.

scholarly journals Hypertension and diabetes control along the HIV care cascade in rural South Africa

2019 ◽  
Vol 22 (3) ◽  
pp. e25213 ◽  
Author(s):  
Jennifer Manne‐Goehler ◽  
Mark J Siedner ◽  
Livia Montana ◽  
Guy Harling ◽  
Pascal Geldsetzer ◽  
...  
Keyword(s):  
South Africa ◽  
Diabetes Control ◽  
Hiv Care ◽  
Rural South ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Rural South Africa

scholarly journals 844. Engagement in HIV Care as an Avenue to Primary Care in Rural South Africa: Results from the Vukuzazi Population Health Platform

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S13-S14 ◽  
Author(s):  
Itai M`yambo Magodoro ◽  
Stephen Oliver ◽  
Dickman Gareta ◽  
Tshwaraganang H Modise ◽  
Olivier Koole ◽  
...  
Keyword(s):  
South Africa ◽  
Regression Models ◽  
Noncommunicable Disease ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Rural South ◽  
Art Programs ◽  
The Past ◽  
Rural South Africa ◽  
Hiv Negative

Abstract Background The healthcare infrastructure developed in response to the HIV epidemic in sub-Saharan Africa has been proposed as a model to respond to the emerging noncommunicable disease (NCD) burden in the region. However, the evidence for the effectiveness of such a strategy is equivocal. Methods We conducted a population-wide health screening among adults ≥15 years within a demographic and health surveillance site (DHSS) in rural South Africa. We collected blood pressure (BP), glycated hemoglobin (HbA1c), HIV disease indicators, and healthcare utilization data. We defined hypertension (HTN) as BP ≥140/90mmHg or use of antihypertensive medication in the past 2 weeks, and diabetes (DM) as HbA1c ≥6.5% or use of hypoglycemic medication in the past two weeks. Cascade of care indicators included: (1) awareness of NCD diagnosis, (2) seeing a provider within the past 6 months; (3) reported use of medication; and (4) disease control, defined as BP <140/90 mmHg or HbA1c <6.5%. We fit regression models to NCD care indicators between people with HIV on ART (PWHA) and HIV negatives. To make population-level estimates, we used inverse probability sampling weights derived from sex- and age-adjusted regression models drawn from the entire DHSS population. Results Of 7,992 individuals, 5,911 (74.2%) were HIV-negative and 2,080 (25.8%) were PWHA (Table 1). PWHA had lower prevalence of both DM (6.8% vs. 10.4%) and HTN (18.0% vs. 24.8%). In multivariable models, linkage to HIV care was associated with improved HTN care cascade indicators, but not DM indicators (Figure 1). PWHA had lower systolic BP and HbA1c than HIV negatives (Figures 2 and 3). Conclusion Linkage to ART programs may be associated with better HTN but not DM care in rural South Africa. Future work should explore how to translate success in ART programs to other NCDs, and for HIV-negative individuals. Disclosures All Authors: No reported Disclosures.

scholarly journals The church and paediatric HIV care in rural South Africa: a qualitative study

AIDS Care ◽  
2015 ◽  
Vol 27 (11) ◽  
pp. 1404-1409 ◽  
Author(s):  
Wilma A.J. Norder ◽  
Remco P.H. Peters ◽  
Maarten O. Kok ◽  
Sabine L. van Elsland ◽  
Helen E. Struthers ◽  
...  
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Hiv Care ◽  
Rural South ◽  
Paediatric Hiv ◽  
The Church ◽  
Rural South Africa

scholarly journals Factors influencing HIV care outcomes among adolescents living with HIV in rural South Africa

2021 ◽  
Author(s):  
Lindsey Filiatreau ◽  
Audrey Pettifor ◽  
Jess Edwards ◽  
Nkosinathi Masilela ◽  
Rhian Twine ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Care ◽  
Rural South ◽  
Factors Influencing ◽  
Care Outcomes ◽  
Living With Hiv ◽  
Rural South Africa

scholarly journals The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Roxanna Haghighat ◽  
Elona Toska ◽  
Nontuthuzelo Bungane ◽  
Lucie Cluver
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Clinical Records

Abstract Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.

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