The association between self-reported stigma and loss-to-follow up in treatment eligible HIV positive adults in rural KwaZulu-Natal, South Africa
The association between self-reported stigma and loss-to-follow up in treatment eligible HIV positive adults in rural KwaZulu-Natal, South Africa
Background
The relationship between loss-to-follow-up (LTFU) in HIV treatment and care programmes and psychosocial factors, including self-reported stigma, is important to understand. This prospective cohort study explored stigma and LTFU in treatment eligible adults who had yet not started antiretroviral therapy (ART).
Methods
Psychosocial, clinical and demographic data were collected at a baseline interview. Self-reported stigma was measured with a multi-item scale. LTFU was defined as not attending clinic in the 90 days since last appointment or before death. Data was collected between January 2009 and January 2013 and analysed using Cox Regression.
Results
380 individuals were recruited (median time in study 3.35 years, total time at risk 1065.81 person-years). 203 were retained (53.4%), 109 were LTFU (28.7%), 48 had died and were not LTFU at death (12.6%) and 20 had transferred out (5.3%). The LTFU rate was 10.65 per 100 person-years (95% CI: 8.48–12.34). 362 individuals (95.3%) started ART. Stigma total score (categorised in quartiles) was not significantly associated with LTFU in either univariable or multivariable analysis (adjusting for other variables in the final model): second quartile aHR 0.77 (95%CI: 0.41–1.46), third quartile aHR 1.20(95%CI: 0.721–2.04), fourth quartile aHR 0.62 (95%CI: 0.35–1.11). In the final multivariable model, higher LTFU rates were associated with male gender, increased openness with friends/family and believing that community problems would be solved at higher levels. Lower LTFU rates were independently associated with increased year of age, greater reliance on family/friends, and having children.
Conclusions
Demographic and other psychosocial factors were more closely related to LTFU than self-reported stigma. This may be consistent with high levels of social exposure to HIV and ART and with stigma affecting LTFU less than other stages of care. Research and clinical implications are discussed.
e88235
Evangeli, M.
6bb2aa7e-1cd9-4e12-a9ed-ac4be5542160
Newell, M.L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Richter, L.
1b3d8141-a6e5-46a5-a0ed-3af79028483b
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
20 February 2014
Evangeli, M.
6bb2aa7e-1cd9-4e12-a9ed-ac4be5542160
Newell, M.L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Richter, L.
1b3d8141-a6e5-46a5-a0ed-3af79028483b
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Evangeli, M., Newell, M.L., Richter, L. and McGrath, N.
(2014)
The association between self-reported stigma and loss-to-follow up in treatment eligible HIV positive adults in rural KwaZulu-Natal, South Africa.
PLoS ONE, 9 (2), .
(doi:10.1371/journal.pone.0088235).
(PMID:24586310)
Abstract
Background
The relationship between loss-to-follow-up (LTFU) in HIV treatment and care programmes and psychosocial factors, including self-reported stigma, is important to understand. This prospective cohort study explored stigma and LTFU in treatment eligible adults who had yet not started antiretroviral therapy (ART).
Methods
Psychosocial, clinical and demographic data were collected at a baseline interview. Self-reported stigma was measured with a multi-item scale. LTFU was defined as not attending clinic in the 90 days since last appointment or before death. Data was collected between January 2009 and January 2013 and analysed using Cox Regression.
Results
380 individuals were recruited (median time in study 3.35 years, total time at risk 1065.81 person-years). 203 were retained (53.4%), 109 were LTFU (28.7%), 48 had died and were not LTFU at death (12.6%) and 20 had transferred out (5.3%). The LTFU rate was 10.65 per 100 person-years (95% CI: 8.48–12.34). 362 individuals (95.3%) started ART. Stigma total score (categorised in quartiles) was not significantly associated with LTFU in either univariable or multivariable analysis (adjusting for other variables in the final model): second quartile aHR 0.77 (95%CI: 0.41–1.46), third quartile aHR 1.20(95%CI: 0.721–2.04), fourth quartile aHR 0.62 (95%CI: 0.35–1.11). In the final multivariable model, higher LTFU rates were associated with male gender, increased openness with friends/family and believing that community problems would be solved at higher levels. Lower LTFU rates were independently associated with increased year of age, greater reliance on family/friends, and having children.
Conclusions
Demographic and other psychosocial factors were more closely related to LTFU than self-reported stigma. This may be consistent with high levels of social exposure to HIV and ART and with stigma affecting LTFU less than other stages of care. Research and clinical implications are discussed.
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Published date: 20 February 2014
Organisations:
Primary Care & Population Sciences
Identifiers
Local EPrints ID: 362910
URI: http://eprints.soton.ac.uk/id/eprint/362910
ISSN: 1932-6203
PURE UUID: 310a69dc-83e1-41db-98b8-1beced9a8387
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Date deposited: 10 Mar 2014 15:35
Last modified: 15 Mar 2024 03:47
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Author:
M. Evangeli
Author:
L. Richter
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