Electronic Theses and Dissertations (Masters)
Permanent URI for this collectionhttps://hdl.handle.net/10539/37955
Browse
Search Results
Item Factors associated with late HAART initiation: A retrospective study of adults living with HIV in Gauteng Province, South Africa, 2016 to 2022(University of the Witwatersrand, Johannesburg, 2024) Govender, Logashnee; Kufa-Chakezha, TendesayiThe nationwide implementation of antiretroviral therapy (HAART) in South Africa (SA) has been in effect since 2005. Despite the improved access to HAART, there is a persistent trend of delayed presentation for Human Immunodeficiency Virus (HIV) care, resulting in increased premature mortality. Between 2010-2011 and 2014-2015, Gauteng Province (GP) reported the highest number of patients entering HIV care with CD4 cell counts of < 200 cells/mm³, this being the benchmark for Advanced HIV Disease (AHD). This study therefore aimed to establish the prevalence of AHD in HAART naïve adults entering the HIV HAART programme between March 2016 and March 2022. The intention was to identify the factors associated with AHD at entry into HIV care and to assess the evolution of AHD before, during and after the COVID-19 vaccination era. The secondary data analysis entailed utilizing archived specimen data from the National Health Laboratory Service Corporate Data Warehouse (NHLS CDW). Logistic regression analysis was used to determine the associations between various factors and AHD, and time series analysis to visualise the trend of AHD over time. The multivariable logistic regression model was applied to determine factors associated with AHD and trend analysis was used to investigate the impact of COVID-19 on proportion of AHD patients starting ART. Among the 859 152 individuals included in the analysis, the median age was 39 years [IQR 32-46], 64.8% were females, and 79.2% entered the HIV care programme from clinics. There was a consistent decrease in the proportion of patients entering care over time, from 19.4% in 2017 to 11.4% in 2021. The prevalence of AHD in patients initiating HAART for the first time in Gauteng Province ranged between 24% and 27% from March 2016 to March 2022. The COVID-19 pre-vaccination period showed an increase in median CD4 counts in some districts, while others remained stable or decreased slightly. Compared to 18–24-year age group, patients in the 35 to 49 age group had a higher odds (OR =1.57, [95% CI: 1.542-1.60], p value < 0.001) of presenting with AHD at HAART initiation. Compared to females, male patients had higher odds of AHD at HAART initiation (OR=2.06, [95% CI: 2.04-2.08], p value <0.001). Patients presenting for HAART initiation in the West Rand District had a higher odds of AHD (OR =1.11, [95% CI: 1.08-1.13], p value < 0.001) compared to Johannesburg Metro. Patients presenting to clinic facilities for HAART initiation had lower odds (OR =0.61, [95% CI: 0.60- 0.62], p value < 0.001) of AHD than those at hospitals. v Limitations included missing and incorrect data, which resulted in data having to be excluded. Despite the nation-wide availability of HAART, the prevalence of AHD in Gauteng Province remained high, indicating the presence of barriers hindering access to readily available HIV treatment. Further research is required to identify the barriers experienced by patients with AHD in accessing HAART across all districts, with a focus on men. HAART programmes for men need to be prioritised to encourage them to test and treat for HIV timeously. The results highlight the significant effects that pandemics and unexpected adverse events can have on people living with HIV.