Barcelona 2013
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| Abstract #520 - Stigma and Discrimination | ||||
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Session: 46.4: Stigma and Discrimination (Parallel) on Wednesday @ 09.00-11.00 in Teatre Chaired by Piedad Arazo, Joseph Lau Authors: Presenting Author: dr Michael Evangeli - Royal Holloway University of London, United Kingdom |
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| Additional Authors: Dr M Paz Berm Dr Gualberto Buela-Casal, | ||||
| Aim: Loss to follow-up (LTFU) from HIV treatment and care programmes for those eligible to initiate antiretroviral therapy (ART) presents public health problems in high HIV prevalence areas, given the risk of mortality and morbidity, onward transmission and ART resistance. Understanding the relationship between LTFU and psychosocial factors such as stigma may be important in addressing such problems. There is limited research on the association between psychosocial factors and LTFU, although stigma has been found to be related to other stages of the cascade of care. This study used a prospective cohort design to explore the association between psychosocial variables, including self-reported stigma, and LTFU from an HIV treatment and care programme in KwaZulu-Natal, South Africa. The relationship between medical, demographic variables and LTFU was also investigated. | ||||
| Method / Issue: Psychosocial and demographic data were collected in a baseline interview when patients had recently been assessed as eligible to start ART. Psychosocial exposures included questions on stigma, social capital, social support, HIV disclosure, reason for testing, and ART knowledge. Demographic exposures included marital status, age, gender, current sexual relationships, government grants, and religious affiliation and importance. Medical exposures included CD4 count, duration since HIV diagnosis and TB. LTFU was defined as not being seen in clinic for 90 days since the last clinic appointment. The relationship between exposures and LTFU in the Programme between 1st January 2009 and 13th January 2013 was analysed prospectively using Cox Regression. | ||||
| Results / Comments: 380 individuals were recruited (241 female, 139 male; median age 35; median CD4 count at baseline 133 cells/mm3). 356 of these individuals (93.7%) started ART during the study period. The median time in the study was 3.35 years and the total study time at risk was 1065.81 person/years. As of 13th January 2013, 203 were retained in the Programme (53.4%), 109 were LTFU (28.7%), 48 had died and did not meet the definition of LTFU at the time of their death (12.6%) and 20 had transferred out (5.3%). The overall LTFU rate was 10.65 per 100 person/years (95% CI: 8.48-12.34). Stigma was not associated with LTFU in crude (p=0.27) or adjusted analysis (p=0.08). There were independent relationships in multivariate analysis between higher LTFU rates and lower age, male gender, not having children, social support (greater openness with friends/family; less reliance on family/friends) and social capital (community working together to solve problems). | ||||
| Discussion: Stigma was not related to LTFU, although other psychosocial factors were (social support and social capital). The relationship between social support and LTFU may be particularly complex given the association between LTFU and both higher and lower levels of different types of social support in this study. The relationship between LTFU and both lower age and gender are consistent with other studies. Efforts should be made to further investigate how social factors, in particular, relate to LTFU and how this could contribute to public health interventions to reduce rates of LTFU. | ||||
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