Distribution of advanced HIV disease from three high HIV prevalence settings in Sub-Saharan Africa: a secondary analysis data from three population-based cross-sectional surveys in Eshowe (South Africa), Ndhiwa (Kenya) and Chiradzulu (Malawi)
| Autor: | Gilles van Cutsem, Jean-François Etard, David Maman, Elisabeth Szumilin, Eric Goemaere, Menard L. Chihana, Helena Huerga, Stephen Wanjala, Tom Ellman, Charlie Masiku, Mary-Ann Davies |
|---|---|
| Přispěvatelé: | Epicentre [Paris] [Médecins Sans Frontières], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Montpellier (UM), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1) |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Malawi Cross-sectional study Human immunodeficiency virus (HIV) HIV Infections medicine.disease_cause Logistic regression Severity of Illness Index South Africa 0302 clinical medicine [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases Secondary analysis Odds Ratio Prevalence 030212 general & internal medicine 030503 health policy & services Health Policy lcsh:Public aspects of medicine Middle Aged Hiv prevalence 3. Good health Anti-Retroviral Agents Female Original Article 0305 other medical science ART Hiv disease Adult Adolescent Young Adult 03 medical and health sciences Sex Factors medicine Humans business.industry Public Health Environmental and Occupational Health HIV lcsh:RA1-1270 Odds ratio Kenya Confidence interval CD4 CD4 Lymphocyte Count population-level Cross-Sectional Studies Logistic Models Africa business [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology Demography |
| Zdroj: | Global Health Action Global Health Action, 2019, 12 (1), pp.1679472. ⟨10.1080/16549716.2019.1679472⟩ Global Health Action, Häggeby : Co-Action Publishing, 2019, 12 (1), pp.1679472. ⟨10.1080/16549716.2019.1679472⟩ Global Health Action, Vol 12, Iss 1 (2019) |
| ISSN: | 1654-9716 1654-9880 |
| DOI: | 10.1080/16549716.2019.1679472⟩ |
| Popis: | International audience; Background: Despite substantial progress in antiretroviral therapy (ART) scale up, some people living with HIV (PLHIV) continue to present with advanced HIV disease, contributing to ongoing HIV-related morbidity and mortality.Objective: We aimed to quantify population-level estimates of advanced HIV from three high HIV prevalence settings in Sub-Saharan Africa.Methods: Three cross-sectional surveys were conducted in (Ndhiwa (Kenya): September-November 2012), (Chiradzulu (Malawi): February-May 2013) and (Eshowe (South Africa): July-October 2013). Eligible individuals 15-59 years old who consented were interviewed at home followed by rapid HIV test and CD4 count test if tested HIV-positive. Advanced HIV was defined as CD4 < 200 cells/µl. We used logistic regression to identify patient characteristics associated with advanced HIV.Results: Among 18,991 (39.2% male) individuals, 4113 (21.7%) tested HIV-positive; 385/3957 (9.7% (95% Confidence Interval [CI]: 8.8-10.7)) had advanced HIV, ranging from 7.8% (95%CI 6.4-9.5) Chiradzulu (Malawi) to 11.8% (95%CI 9.8-14.2) Ndhiwa (Kenya). The proportion of PLHIV with advanced disease was higher among men 15.3% (95% CI 13.2-17.5) than women 7.5% (95%CI 6.6-8.6) p < 0.001. Overall, 62.7% of all individuals with advanced HIV were aware of their HIV status and 40.3% were currently on ART. Overall, 65.6% of individuals not on ART had not previously been diagnosed with HIV, while only 29.6% of those on ART had been on ART for ≥6 months. Individuals with advanced HIV disease were more likely to be men (adjusted Odds Ratio [aOR]; 2.1 (95%CI 1.7-2.6), and more likely not to be on ART (aOR; 1.7 (95%CI 1.3-2.1).Conclusion: In our study, about 1 in 10 PLHIV had advanced HIV with nearly 40% of them unaware of their HIV status. However, a substantial proportion of patients with advanced HIV were established on ART. Our findings suggest the need for a dual focus on alternative testing strategies to identify PLHIV earlier as well as improving ART retention. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|