Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: a systematic review

Muula, Adamson S; Ngulube, T.J.; Siziya, Seter; Makupe, Cecilia M; Umar, Eric; Prozesky, Hans; Wiysonge, Charles Shey; Mataya, Ronald

doi:10.1186/1471-2458-7-63

Cited by 167 publications

(132 citation statements)

References 34 publications

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“…Such barriers include (but are not limited to) transport costs and time, loss of earnings, lack of financial resources, stigma, lack of family support and perceived need when individuals are asymptomatic. [16][17][18][19][20][21][22] Future research must look for ways to overcome these barriers, either directly or through other interventions, to improve post-VCT medical care. ■…”

Section: Discussionmentioning

confidence: 99%

Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa

Larson

Brennan

McNamara

et al. 2010

Bull. World Health Organ.

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Section: Discussionmentioning

confidence: 99%

Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa

Larson

Brennan

McNamara

et al. 2010

Bull. World Health Organ.

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“…Despite early concerns that women may be disadvantaged in ART programmes, disproportionately more women than men have accessed ART in Southern Africa. [2] In South Africa, for example, 60% of eligible women were receiving ART by mid-2011 compared with 41% of eligible men. [3] Men have a higher mortality than women when receiving ART.…”

mentioning

confidence: 99%

Gender inequality: Bad for men's health

Cornell

2013

South. Afr. j. HIV med.

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FORUMMen's increased risk of death in ART programmes in sub-Saharan Africa is widely reported but poorly understood. Some studies have attributed this risk to men's poorer health-seeking behaviour, which may prevent them from accessing ART, being adherent to treatment, or remaining in care. In a multicentre analysis of 46 201 adults starting ART in urban and rural settings in South Africa, these factors only partly explained men's increased mortality while receiving ART. Importantly, the gender difference in mortality among patients receiving ART (31% higher for men than women) was substantially smaller than that among HIVnegative South Africans, where men had twice the risk of death compared with women. Yet, this extreme gender inequality in mortality, both within and outside of ART programmes, has not given rise to widespread action. Here it is argued that, despite their dominance in society, men may be subject to a wide range of unfair discriminatory practices, which negatively affect their health outcomes. The health needs of men and boys require urgent attention. Sub-Saharan Africa is the centre of the HIV epidemic, with an estimated 68% of all people HIV-infected.[1] Over the past 10 years, largely through international aid programmes, there has been a dramatic increase in the number of HIV-infected individuals who have started antiretroviral therapy (ART) in the region. Despite early concerns that women may be disadvantaged in ART programmes, disproportionately more women than men have accessed ART in Southern Africa.[2] In South Africa, for example, 60% of eligible women were receiving ART by mid-2011 compared with 41% of eligible men. [3] Men have a higher mortality than women when receiving ART. [4][5][6][7][8] Although the reasons for this are poorly understood, a number of possible explanations have been suggested; some implicitly blame men for their own poorer outcomes. For example, numerous studies have suggested that men's poorer 'health-seeking behaviour' may prevent them from accessing ART services, being adherent to treatment or remaining in care. But, is this based on evidence or is it an assumption that has gained currency through widespread usage?To date, there has been no systematic attempt to understand the phenomenon of gender differences on ART. In the past year, we explored the issue in an analysis including 46 201 adults initiating ART in 8 large urban and rural South African cohorts between 2002 and 2009.[5] As 60% of our patients had civil identification (ID) numbers, it was possible to confirm their vital status through linkage to the National Population Register, estimated to capture over 90% of deaths nationally. [9] We were also able to track patients with IDs after they were lost to follow-up (LTF) and confirm whether they were alive or dead. Men's increased mortality on ART unrelated to HIV/AIDSAt the start of treatment, on average men had lower CD4+ cell counts and more advanced HIV disease than women. After we adjusted for such gender differences at ART initiation, men still...

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“…He reported that women who accessed HAART services were more than men by a ratio of 3: 1 and 20% of the women were more likely to adhere to HAART as compared to men. This could be explained that the large numbers of women were more familiar with the health care services as compared to men and especially women interacted with the clinics when accessing other services like antenatal, maternity and family planning as this was also supported by Muala and colleagues [19]. The authors further explained men were thought to be slower in uptake of HAART services due to the stigma acquired with it.…”

Section: Discussionmentioning

confidence: 52%

Factors Affecting Adherence to Highly Active Antiretroviral Therapy among Patients Attending Public Healthcare Facility

Katende-Kyenda¹,

Lubbe²,

Apalata³

2014

JPP

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Abstract:The research focused on factors associated with poor adherence to HAART (highly active antiretroviral therapy) among HIV/AIDS. A descriptive cross sectional study was conducted using a standardized questionnaire and face-to-face exit interviews to collect data. Pill-counts were performed and computed adherence rate of ≥ 95% was considered acceptable. Data were analyzed using SPSS 21.0. Univariate factors associated with poor dherence to HAART were assessed with ANOVA (analysis of variance) and logistic regression model excluded confounders determining independent predictors of poor adherence. A P ≤ 0.05 was statistical significant. Of 102 HIV-infected on HAART for 24.68 ± 20.5 months, 83.3% were females and 16.7% males. The mean age (± SD) was 35.09 ± 9.3 years. Univariate factors associated with poor adherence to HAART were: CD4 count > 350 cells/mm 3 (χ2 = 46; P = 0.05), age > 35 years (χ2 = 28.75; P = 0.011), primary educational background (χ2 = 9.18; P = 0.027), HAART regimen 1A-TDF (χ2 = 14.37; P = 0.003), and > 4 combined tablets (χ2 = 11.87; P = 0.001). There was a linear correlation between age and primary educational background (r = 0.538; P < 0.001). After adjusting for univariate confounders, primary educational background (P = 0.020) and > 4 combined tablets (P = 0.026) were identified as independent predictors of poor adherence to HAART. Although there is an increase number of HIV-infected receiving HAART, these findings have shown that many of these will not adhere to their treatment once they improve clinically. This could be due to lack of education and complexity of combined ARVs with other drugs.

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Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: a systematic review

Cited by 167 publications

References 34 publications

Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa

Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa

Gender inequality: Bad for men's health

Factors Affecting Adherence to Highly Active Antiretroviral Therapy among Patients Attending Public Healthcare Facility

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