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Psychosocial Associations with Virological Failure among Patients on Antiretroviral Therapy at McCord Hospital in KwaZulu-Natal, South Africa

Kearns, Rachel Ann (2013)
Master's Thesis (65 pages)
Committee Chair / Thesis Adviser: Sullivan, Patrick S
Committee Members: Marconi, Vincent
Research Fields: Health Sciences, Epidemiology; Health Sciences, Immunology; Biology, Virology
Partnering Agencies: Emory University schools, faculty or affiliated programs ; Hospital or other health care provider
Keywords: virological failure; HIV; South Africa; psychosocial
Program: Rollins School of Public Health, Epidemiology (Global Epidemiology)
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Objective Understanding factors associated with virological failure may improve prevention, diagnosis and treatment of virological failure among patients on ART. Design The RFVF is a study of cases with virological failure (VL > 1,000 copies/ML) and controls with virological suppression (VL ≤ 1,000 copies/ML) after at least 5 months on their first ART regimen at McCord Hospital in Durban, South Africa between October 2010 and June 2012. Methods Patients completed a questionnaire on medical history, psychosocial factors, depression using Kessler-10, and socioeconomic status, retrospective chart reviews were completed, and drug resistance genotyping was performed on cases. Using multivariate logistic regression, this sub-study assessed the significance of psychosocial factors on virological failure among the full study population, men and women separately. Results 158 cases and 300 controls were enrolled in the study. The sample was predominantly female (64.6%), black Zulu (92%), and Christian (85.8%). In multivariate analysis for the full sample, male gender (OR=2.42, 95% CI 1.51-3.88), younger age (OR=0.83, 95% CI 0.72-0.94), shorter duration of treatment (OR=3.83, 95% CI 2.06-7.13 shortest vs. longest quartile) reporting any depressive symptoms (OR=2.21, 95% CI 1.35-3.61), being not active or having no faith compared to being somewhat or very active in faith (OR=1.60, 95% CI 1.02-2.50), having unsafe sex in prior 6 months (OR=2.50, 95% CI 1.17-5.32), having one or more HIV positive partner or family member (OR=1.70, 95% CI 1.03-2.82), having a treatment supporter (OR=2.02, 95% CI 1.13-3.64), and disclosing HIV status to friends (OR=2.02, 95% CI 1.23-3.33) were associated with virological failure. Among men, having at least one family member who died of HIV (OR=2.98, 95% CI 1.29-6.91) was also significantly associated with virological failure. Conclusions Several psychosocial factors are associated with virological failure in this setting. Patients experiencing failure were more likely to have a treatment supporter and family members with HIV, depressive symptoms, have no active faith, have unsafe sex and disclose their status to friends. Future studies should employ a longitudinal design to assess causality and ideally improve screening and identification of virological failure.

Table of Contents

Chapter I: Background/Literature Review 1 -- Introduction 2 -- Background on McCord Hospital 3 -- HIV Treatment in South Africa 4 -- Defining Treatment Failure and Virological Failure 6 -- Prevalence of Virological Failure 8 -- Diagnosing and Managing Virological Failure 9 -- Causes of Virological Failure 11 -- Risk Factors for Virological Failure 14 -- Gender, Age, and Duration of Antiretroviral Therapy 14 -- Psychosocial Factors 16 -- Social Support and Stigma 16 -- Faith and Spirituality 20 -- Alcohol and Drug Use 20 -- Depression 21 -- Chapter II: Manuscript 25 -- Title/Authors/Abstract 26 -- Introduction 28 -- Methods 30 -- RFVF Study Methods 30 -- Study Location 32 -- Statistical Analysis 32 -- Results 33 -- Characteristics of Study Population 33 -- Univariate Analysis 34 -- Multivariate Analysis 35 -- Discussion 36 -- Limitations 40 -- Conclusion 41 -- References 42 -- Appendices 49 -- Tables 49 -- Table 1. Characteristics of study population overall and by case control status, McCord Hospital, Durban, SA, 2010-2012 49 -- Table 2. Characteristics of female study population overall and by case control status, McCord Hospital, Durban, SA, 2010-2012 51 -- Table 3. Characteristics of male study population overall and by case control status, McCord Hospital, Durban, SA, 2010-2012 53 -- Table 4. Partner characteristics and sex practices among study participants who report a current partner, McCord Hospital, Durban, SA, 2010-2012 55 -- Table 5. Psychosocial characteristics associated with HIV virological failure, McCord Hospital, Durban, SA, 2010-2012 56 -- IRB Letter 57


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