The association between self-reported stigma and loss-to-follow up in treatment eligible HIV positive adults in rural Kwazulu-Natal, South Africa
Download this report
If you would like to obtain a copy of this Research Output, please contact Hanlie Baudin at firstname.lastname@example.org.
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.
Related Research Outputs:
- Photo-voice as an analytical and activist tool in the fight against HIV and AIDS stigmatisation in a rural KwaZulu-Natal school
- The impact of HIV/AIDS on land issues in Kwazulu-Natal province South Africa: case studies from Muden, Dondotha, Kwadumisa and Kwanyuswa
- Investment into eco-tourism projects: KwaZulu-Natal coastal belt: South Africa
- NASFAM funding proposal for the National AIDS Commission
- Trends and policy challenges in the rural economy: four provincial case studies
- What can a woman do with a camera?: turning the female gaze on poverty and HIV and AIDS in rural South Africa
- A comparative analysis of quantitative and qualitative HIV stigma data from a community based randomized trial in Kwa-Zulu Natal, South Africa (project Accept HPTN 043)
- Working with community based mobilisers (CBMs) to promote community-based voluntary counseling and testing in rural KwaZulu-Natal, South Africa
- Perceived stigma among patients receiving antiretroviral therapy: a prospective study in KwaZulu-Natal, South Africa
- Design and methods of a longitudinal study investigating the impact of antiretroviral treatment on the partnerships and sexual behaviour of HIV-infected individuals in rural KwaZulu-Natal, South Africa
- The influence of antiretroviral treatment on willingness to test: a qualitative study in rural KwaZulu-Natal, South Africa
- Spirituality and religion in antiretroviral therapy (ART) in KwaZulu-Natal, South Africa: a longitudinal study
- TB and HIV/TB co-infection: adherence to drug treatment in three selected provinces in South Africa
- Professional nurses' views regarding stigma and discrimination in the care of HIV and AIDS patients in rural hospitals of the Limpopo province, South Africa
- Uthando Lwethu ('our love'): a protocol for a couples-based intervention to increase testing for HIV: a randomized controlled trial in rural KwaZulu-Natal, South Africa
- HIV-related symptoms and management in HIV and antiretroviral therapy patients in KwaZulu-Natal, South Africa: a longitudinal study
- Sexual risk after HIV diagnosis: a comparison of pre-ART individuals with CD4>500 cells/ul and ART-eligible individuals in a HIV treatment and care programme in rural KwaZulu-Natal, South Africa
- Men's moralising discourses on gender and HIV risk in rural KwaZulu-Natal, South Africa
- Living with HIV, disclosure patterns and partnerships a decade after the introduction of HIV programmes in rural South Africa
- Maternal and child psychological outcomes of HIV disclosure to young children in rural South Africa: the Amagugu intervention