Determinants of the risk of dying of HIV/AIDS in a rural South African community over the period of the decentralised roll-out of antiretroviral therapy: a longitudinal study.
Determinants of the risk of dying of HIV/AIDS in a rural South African community over the period of the decentralised roll-out of antiretroviral therapy: a longitudinal study.
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DOI：
10.3402/gha.v7.24826
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发表时间：
2014
影响因子：
2.6
通讯作者：
Byass P
中科院分区：
文献类型：
--
作者：
Mee P;Collinson MA;Madhavan S;Kabudula C;Gómez-Olivé FX;Kahn K;Tollman SM;Hargreaves J;Byass P
抗逆转录病毒治疗显著降低了南非的艾滋病毒死亡率。并非所有群体都能享受到这些好处。在这里，我们调查与这些不平等相关的因素。这项研究位于南非农村地区，使用了2007年至2010年收集的数据，这一时期分散式抗逆转录病毒治疗开始可用。大约三分之一的人口是莫桑比克裔。在城市地区和这个社区之间有一种重复循环迁移的模式。开发了生存分析模型，以确定艾滋病毒死亡率的人口、社会经济和空间风险因素。在105,149人的研究人群中，有2,890人死亡。2007-2008年和2009-2010年期间，艾滋病毒/结核病死亡率下降了27%。对于其他死因，减少了10%。双变量分析发现，以下人群的艾滋病毒/结核病死亡风险较低：居住在布贝齐社区卫生中心5公里范围内的人群；女性;年轻的成年人;居住时间较长的外来移民；永久性居民;家庭成员拥有机动交通工具，社会经济地位较高，受教育程度较高。此外，多变量模型显示，原籍国为南非的人比原籍国为莫桑比克的人有更高的艾滋病毒/结核病死亡风险。对于男性、南非裔和最近的移民来说，与艾滋病毒/结核病相关的死亡风险明显高于其他原因。在该社区，在推广抗逆转录病毒治疗期间，多种因素与死于艾滋病毒/结核病的风险增加有关。有证据表明，对人口中特定亚群体的成功治疗存在障碍，如果要保持最近在人口死亡率水平上的改善，就必须解决这些障碍。
Antiretroviral treatment (ART) has significantly reduced HIV mortality in South Africa. The benefits have not been experienced by all groups. Here we investigate the factors associated with these inequities. This study was located in a rural South African setting and used data collected from 2007 to 2010, the period when decentralised ART became available. Approximately one-third of the population were of Mozambican origin. There was a pattern of repeated circular migration between urban areas and this community. Survival analysis models were developed to identify demographic, socioeconomic, and spatial risk factors for HIV mortality. Among the study population of 105,149 individuals, there were 2,890 deaths. The HIV/TB mortality rate decreased by 27% between 2007–2008 and 2009–2010. For other causes of death, the reduction was 10%. Bivariate analysis found that the HIV/TB mortality risk was lower for: those living within 5 km of the Bhubezi Community Health Centre; women; young adults; in-migrants with a longer period of residence; permanent residents; and members of households owning motorised transport, holding higher socioeconomic positions, and with higher levels of education. Multivariate modelling showed, in addition, that those with South Africa as their country of origin had an increased risk of HIV/TB mortality compared to those with Mozambican origins. For males, those of South African origin, and recent in-migrants, the risk of death associated with HIV/TB was significantly greater than that due to other causes. In this community, a combination of factors was associated with an increased risk of dying of HIV/TB over the period of the roll-out of ART. There is evidence for the presence of barriers to successful treatment for particular sub-groups in the population, which must be addressed if the recent improvements in population-level mortality are to be maintained.