Short-term and long-term risk of tuberculosis associated with CD4 cell recovery during antiretroviral therapy in South Africa

Aim: To examine the hypothesis that circular labour migrants who become seriously ill while living away from home return to their rural homes to convalesce and possibly to die. Methods: Drawing on longitudinal data collected by the Agincourt health and demographic surveillance system in rural northeastern South Africa between 1995 and 2004, discrete time event history analysis is used to estimate the likelihood of dying for residents, short-term returning migrants, and long-term returning migrants controlling for sex, age, and historical period. Results: The annual odds of dying for short-term returning migrants are generally 1.1 to 1.9 times (depending on period, sex, and age) higher than those of residents and long-term returning migrants, and these differences are generally highly statistically significant. Further supporting the hypothesis is the fact that the proportion of HIV/TB deaths among short-term returning migrants increases dramatically as time progresses, and short-term returning migrants account for an increasing proportion of all HIV/TB deaths. Conclusions: This evidence strongly suggests that increasing numbers of circular labour migrants of prime working age are becoming ill in the urban areas where they work and coming home to be cared for and eventually to die in the rural areas where their families live. This shifts the burden of caring for them in their terminal illness to their families and the rural healthcare system with significant consequences for the distribution and allocation of health care resources.

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Current CD4 Cell Count and the Short‐Term Risk of AIDS and Death before the Availability of Effective Antiretroviral Therapy in HIV‐Infected Children and Adults

The Journal of Infectious Diseases ◽

10.1086/524686 ◽

2008 ◽

Vol 197 (3) ◽

pp. 398-404 ◽

Cited By ~ 62

Author(s):

David Dunn ◽

Patrick Woodburn ◽

Trinh Duong ◽

Julian Peto ◽

Andrew Phillips ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Cell Count ◽

Short Term ◽

Cd4 Cell Count ◽

Cd4 Cell

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Using record linkage to assess the impact of late presentation for care and treatment on short-term mortality among HIV-infected adults in rural South Africa.

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.398 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Chodziwadziwa Whiteson Kabudula ◽

Georges Reniers ◽

Francesc Xavier Gómez-Olivé ◽

Kathleen Kahn ◽

Stephen Tollman

Keyword(s):

South Africa ◽

Cell Count ◽

Late Presentation ◽

Short Term ◽

Cd4 Cell Count ◽

Short Term Mortality ◽

Care And Treatment ◽

Cd4 Cell ◽

The Impact ◽

Rural South Africa

ABSTRACT ObjectivesTo assess the impact of late presentation (CD4 cell count <200 cells/μl at presentation) for care and treatment on short-term mortality (death within a year of presentation) among HIV-infected adults in rural South Africa. ApproachWe applied deterministic and probabilistic record linkage approaches to link adult patients seeking care and treatment for HIV from a health facility between 2007 and 2013 to population under continuous surveillance by the Agincourt Health and Demographic Surveillance System (HDSS) in rural northeast South Africa. The resulting record-linked dataset was thereafter analysed to estimate short-term mortality (death within a year of presentation) differences in late presenters (initial presentation at health facility with CD4 cell count less than 200 cells/μl) and early presenters (presentation with CD4 cell count of 200 or more cells/μl). In the linked dataset, CD4 cell count was extracted from the health facility database where as date of death came from the HDSS database. ResultsA total of 3,553 patients who sought care and treatment for HIV at Bhubhezi clinic between 2007 and 2013 were linked to the Agincourt HDSS surveillance population. Proportion of patients classified as late presenters was 60.9%. Short-term mortality was 8.9% (317/3,553): 11.1% among those who presented late and 5.5 % among those who presented early (P<0.001). ConclusionRecord linkage facilitated the assessment of the impact of late presentation for care and treatment on short-term mortality among HIV-infected adults in rural South Africa. In the population studied, late presentation is high and is contributing to high mortality among people living with HIV. Strategies that would facilitate early presentation are needed in order to reduce mortality among people living with HIV.

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