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The Impacts of Residential Location on the Risk of HIV Virologic Failure Among ART Users in Durban, South Africa

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Abstract

Using a case–control study of patients receiving antiretroviral treatment (ART) in 2010–2012 at McCord Hospital in Durban, South Africa, we sought to understand how residential locations impact patients’ risk of virologic failure (VF). Using generalized estimating equations to fit logistic regression models, we estimated the associations of VF with socioeconomic status (SES) and geographic access to care. We then determined whether neighborhood-level poverty modifies the association between individual-level SES and VF. Automobile ownership for men and having non-spouse family members pay medical care for women remained independently associated with increased odds of VF for patients dwelling in moderately and severely poor neighborhoods. Closer geographic proximity to medical care was positively associated with VF among men, while higher neighborhood-level poverty was positively associated with VF among women. The programmatic implications of our findings include developing ART adherence interventions that address the role of gender in both the socioeconomic and geographical contexts.

Resumen

Utilizando un estudio de casos y controles de pacientes que estaban recibiendo terapia antiretroviral (TAR), llevado a cabo en el Hospital McCord en Durban Sudáfrica, entre 2010 y 2012, buscamos entender cómo el sitio de residencia impacta en el riesgo de falla virológica (FV) de los pacientes. Valiéndonos de ecuaciones estimativas generalizadas para ajustar los modelos de regresión logística, estimamos la asociación de FV con nivel socioeconómico (NSE) y accesibilidad geográfica a los servicios de salud. Luego determinamos si el nivel de pobreza del barrio modifica la asociación entre el NSE individual y la FV. Se observó que para los pacientes habitantes de barrios con niveles de pobreza moderada y severa dos factores se mantienen independientes en su asociación con mayores probabilidades de FV: para los hombres la propiedad de un automóvil y para las mujeres contar con familiares (no incluye la pareja) que pagan sus servicios salud. Para los hombres la cercanía geográfica a los servicios de salud tuvo una asociación positiva con FV mientras que para las mujeres la asociación positiva se dio con un mayor nivel de pobreza del barrio donde habitan. Entre las principales sugerencias programáticas resultantes de esta investigación esta el desarrollo de intervenciones para la adherencia a TAR que incluyan en su diseño las implicaciones del género en los contextos socioeconómico y geográfico.

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Acknowledgements

The authors would like to express our utmost gratitude for the patients who participated in the study, our local collaborators (i.e., Sabelo Dladla, Roma Maharaj, Kristy Nixon, Melisha Pertab and Sifiso Shange) who provided crucial assistance for the data collection and analysis, and Dr. Mónica C. Méndez who kindly assisted with the Spanish translation of the manuscript’s abstract. In addition, we thank the Sinikithemba Clinic at McCord Hospital in Durban, South Africa for their dedication to supporting research and enhancing the quality of patient care. The success of this study was made possible because of the meaningful contributions from their counsellors, medical records staff, nurses, and medical officers. Lastly, we also thank the Rollins School of Public Health at Emory University for providing technological capacity essential for performing related analyses. This work was supported by the Emory University Center for AIDS Research (CFAR) (V.C.M., P30AI050409); Research and Health Sciences IT Division grant support (V.C.M. UL1RR025008); NIH (V.C.M. R01 AI098558-01A1); Elizabeth Glaser Paediatric AIDS Foundation as part of Project HEART (H.S.); and The Gilead Foundation (H.S.).

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Authors and Affiliations

  1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Yi-No Chen, Daniella Coker, Michael R. Kramer & Kristin M. Wall

  2. Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA

    Brent A. Johnson

  3. Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Claudia E. Ordóñez & Vincent C. Marconi

  4. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Darius McDaniel & Alex Edwards

  5. Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA

    Anna Q. Hare

  6. Infectious Diseases Unit, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

    Henry Sunpath

  7. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

    Vincent C. Marconi

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  1. Yi-No Chen
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Chen, YN., Coker, D., Kramer, M.R. et al. The Impacts of Residential Location on the Risk of HIV Virologic Failure Among ART Users in Durban, South Africa. AIDS Behav 23, 2558–2575 (2019). https://doi.org/10.1007/s10461-019-02523-7

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