Browsing by Author "Chodziwadziwa W Kabudula"

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    Cohort Profile: Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI).
    (2018) F Xavier Go´ mez-Olive´; Livia Montana; Ryan G Wagner; Chodziwadziwa W Kabudula; Julia K Rohr; Kathleen Kahn; Till Ba¨rnighausen; Mark Collinson; David Canning; Thomas Gaziano; Joshua A Salomon; Collin F Payne; Alisha Wad; Stephen M Tollman; Lisa Berkman
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    Cohort Profile: South African Population Research Infrastructure Network (SAPRIN)
    (2021-12-30) Mark A Collinson; Taurayi Mudzana; Tinofa Mutevedzi; Kathleen Kahn; Eric Maimela; F Xavier Go´ mez-Olive´; Thobeka Mngomezulu; Dickman Gareta; Chodziwadziwa W Kabudula; Rathani Nemuramba; Joseph Tlouyamma; Stephen Tollman; Kobus Herbst
    South Africa is striving to emerge from a legacy of gross social injustice and consequent health and socioeconomic inequality, to becoming a country where all residents have opportunities to build productive lives. However, recent declines in economic performance and unemployment, exacerbated by weaknesses in national and provincial level governance, coupled with colliding epidemics of HIV/ AIDS and non-communicable diseases, have left the country’s leadership with serious, seemingly intractable challenges. Moreover as with most countries, the effects of stringent sociobehavioural responses to the coronavirus disease 2019 (COVID-19), with serious economic consequences, serve to amplify such challenges.
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    Estimating the Prevalence of over- and Under-Reporting in HIV Testing, Status and Treatment in Rural Northeast South Africa: A Comparison of a Survey and Clinic Records
    (2023-10-27) Hannah H Leslie; Chodziwadziwa W Kabudula; Rebecca L West; Mi-Suk Kang Dufour; Aimée Julien; Nkosinathi G Masilela; Stephen M Tollman; Audrey Pettifor; Kathleen Kahn; Sheri A Lippman
    We assess the accuracy of self-reported testing, HIV status, and treatment responses compared to clinical records in Ehlanzeni District, South Africa. We linked a 2018 population-based survey of adults 18-49 years old with clinical data at local primary healthcare facilities from 2014 to 2018. We calculated self-reported testing, HIV status, and treatment, and triangulated findings with clinic record data. We adjusted testing estimates for known gaps in HIV test documentation. Of 2089 survey participants, 1657 used a study facility and were eligible for analysis. Half of men and 84% of women reported an HIV test in the past year. One third of reported tests could be confirmed in clinic data within 1 year and an additional 13% within 2 years; these fractions increased to 57% and 22% respectively limiting to participants with a verified clinic file. After accounting for gaps in clinic documentation, we found that prevalence of recent HIV testing was closer to 15% among men and 51% in women. Estimated prevalence of known HIV was 16.2% based on self-report vs. 27.6% with clinic documentation. Relative to clinical records among confirmed clinic users, self report of HIV testing and of current treatment were highly sensitive but non-specific (sensitivity 95.5% and 98.8%, specificity 24.2% and 16.1% respectively), while self report of HIV status was highly specific but not sensitive (sensitivity 53.0%, specificity 99.3%). While clinical records are imperfect, survey-based measures should be interpreted with caution in this rural South African setting.
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    Pregnancy-related healthcare utilisation in Agincourt, South Africa, 1993–2018: a longitudinal surveillance study of rural mothers
    (2021-10-01) Sack, Daniel; Ryan G Wagner; Daniel Ohene-Kwofie; Chodziwadziwa W Kabudula; Jessica Price; Carren Ginsburg; Carolyn M Audet
    ntroduction Pregnancy-related health services, an important mediator of global health priorities, require robust health infrastructure. We described pregnancy-related healthcare utilisation among rural South African women from 1993 to 2018, a period of social, political and economic transition. Methods We included participants enrolled in the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga Province, South Africa, a population-based longitudinal cohort, who reported pregnancy between 1993 and 2018. We assessed age, antenatal visits, years of education, pregnancy intention, nationality, residency status, previous pregnancies, prepregnancy and postpregnancy contraceptive use, and student status over the study period and modelled predictors of antenatal care utilisation (ordinal), skilled birth attendant presence (logistic) and delivery at a health facility (logistic).
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    Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019
    (2022-02-22) Brian Houle; Chodziwadziwa W Kabudula; Andrea M Tilstra; Sanyu A Mojola; Enid Schatz; Samuel J Clark; Nicole Angotti; F Xavier Gómez-Olivé; Jane Menken
    Background: Sub-Saharan African settings are experiencing dual epidemics of HIV and hypertension. We investigate effects of each condition on mortality and examine whether HIV and hypertension interact in determining mortality. Methods: Data come from the 2010 Ha Nakekela population-based survey of individuals ages 40 and older (1,802 women; 1,107 men) nested in the Agincourt Health and socio-Demographic Surveillance System in rural South Africa, which provides mortality follow-up from population surveillance until mid-2019. Using discrete-time event history models stratified by sex, we assessed differential mortality risks according to baseline measures of HIV infection, HIV-1 RNA viral load, and systolic blood pressure. Results: During the 8-year follow-up period, mortality was high (477 deaths). Survey weighted estimates are that 37% of men (mortality rate 987.53/100,000, 95% CI: 986.26 to 988.79) and 25% of women (mortality rate 937.28/100,000, 95% CI: 899.7 to 974.88) died. Over a quarter of participants were living with HIV (PLWH) at baseline, over 50% of whom had unsuppressed viral loads. The share of the population with a systolic blood pressure of 140mm Hg or higher increased from 24% at ages 40-59 to 50% at ages 75-plus and was generally higher for those not living with HIV compared to PLWH. Men and women with unsuppressed viral load had elevated mortality risks (men: adjusted odds ratio (aOR) 3.23, 95% CI: 2.21 to 4.71, women: aOR 2.05, 95% CI: 1.27 to 3.30). There was a weak, non-linear relationship between systolic blood pressure and higher mortality risk. We found no significant interaction between systolic blood pressure and HIV status for either men or women (p>0.05). Conclusions: Our results indicate that HIV and elevated blood pressure are acting as separate, non-interacting epidemics affecting high proportions of the older adult population. PLWH with unsuppressed viral load were at higher mortality risk compared to those uninfected. Systolic blood pressure was a mortality risk factor independent of HIV status. As antiretroviral therapy becomes more widespread, further longitudinal follow-up is needed to understand how the dynamics of increased longevity and multimorbidity among people living with both HIV and high blood pressure, as well as the emergence of COVID-19, may alter these patterns.