High perceived social standing is associated with better health in HIV-infected Ugandan adults on highly active antiretroviral therapy

Ezeamama, Amara E.; Guwatudde, David; Wang, M.; Bagenda, Danstan; Brown, Kristin M.; Kyeyune, Rachel; Smith, Emily L.; Wamani, Henry; Manabe, Yukari C.; Fawzi, Wafaie W.

doi:10.1007/s10865-015-9710-x

Cited by 11 publications

(15 citation statements)

References 44 publications

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“…Socioeconomic status was defined by years of education, employment status and household wealth or assets owned. Composite scores were categorized at quintiles [ 26 ]. History and current use of alcohol and cigarette smoking were self-reported.…”

Section: Methodsmentioning

confidence: 99%

Impaired Hematologic Status in Relation to Clinical Outcomes among HIV-Infected Adults from Uganda: A Prospective Cohort Study

et al. 2018

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Impaired hematologic status (IHS) was investigated as a determinant of immune function defined as cluster of differentiation 4 (CD4) T-helper cell count, quality of life (QOL) weight and hospitalization/mortality over 18-months among 398 adult persons living with HIV/AIDS (PLWHA) on anti-retroviral therapy. IHS was defined as having anemia at baseline (Hemoglobin: <12 g/dL for women and <13 g/dL for men), time-updated anemia or having low (<30 μg/L) or high (>200 μg/L for men and >150 μg/L for women) ferritin levels at baseline. Months-to-hospitalization/death or study-end (if no event) was calculated from enrollment. Multivariable linear-mixed models quantified associations between IHS and changes in CD4 cell-count, weight gain and QOL. Cox proportional hazards models calculated hazard ratios (HR) and corresponding 95% confidence intervals (CI) for IHS-related differences in time-to-hospitalization/death. The prevalences of anemia and high and low ferritin levels at baseline were 48.7% (n = 194), 40.5% (n = 161) and 17% (n = 68), respectively. Most patients (63.4%, n = 123) remained anemic during follow-up. Weight gained (ferritin-time interaction, p < 0.01) and QOL (anemia-time interaction, p = 0.05; ferritin-time interaction, p = 0.01) were lower for PLWHA with versus without IHS. Relative to anemia-free/normal ferritin, the risk of hospitalization/death was elevated for PLWHA with anemia (HR = 2.0; 95% CI: 1.2–3.6), low or high ferritin (HR: 1.8–1.9, 95% CI: 0.9–4.1) and those that developed new/persistent/progressive anemia (HR: 2.3–6.7, 95% CI: 1.0–12.7). Among PLWHA, IHS predicted deficits in QOL, low weight gain and a high risk of hospitalization/death. Intervention to mitigate persistent IHS may be warranted among PLWHA on long-term highly active antiretroviral therapy (HAART) to improve health outcomes.

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Section: Methodsmentioning

confidence: 99%

Impaired Hematologic Status in Relation to Clinical Outcomes among HIV-Infected Adults from Uganda: A Prospective Cohort Study

et al. 2018

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“…The people at the bottom of the ladder are the least well‐off in society – those with the least money, education and worst or no jobs.” Respondents then place an “X” next to the place that best represents their own place in society. This method has been used globally, including in East Africa, and found to predict a range of physical, mental, and behavioral health (Ezeamama et al., ; Macleod, Smith, Metcalfe, & Hart, ; Kondo, Kawachi, Subramanian, Takeda, & Yamagata, ; Singh‐Manoux, Adler, & Marmot, ).…”

Section: Methodsmentioning

confidence: 99%

Subjective Social Standing and Conflict Tactics Among Young Kenyan Men

Goodman

Serag

Raimer-Goodman

et al. 2017

American J of Comm Psychol

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Efforts to reduce intimate partner violence in sub-Saharan Africa generally approach the issue through the lens of women's empowerment. These efforts include foci on women's relative power in the relationship, educational background, and earning potential. The social status of men has largely been ignored, reducing the potential to involve them in efforts to demote intimate partner violence. In this study we consider whether a man's perceived social status predicts conflict tactics, and whether these tactics are mediated by loneliness and collective self-esteem from a community-based sample in semi-rural Kenya (n = 263). We find that men who reported lower perceived social status also reported significantly more frequent violent conflicts with their intimate partners. This association was significantly, and completely, mediated by lower collective self-esteem and higher loneliness. There was no direct association between subjective social status and negotiation-based conflict tactics, although there was an indirect association. Men with higher perceived social status reported higher collective self-esteem, and men with higher collective self-esteem reported more negotiation-based conflict tactics. These findings inform efforts to reduce intimate partner violence by involving men, showing potential to reduce violence by building self-esteem among men-particularly those with lower perceived social status.

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“…Socioeconomic status was defined by years of education, employment status and household wealth or assets owned. Composite household wealth scores were categorized at quintiles [27]. History and current use of alcohol (former, current or never drinker) and ever vs. never cigarette smoking were self-reported.…”

Section: Methodsmentioning

confidence: 99%

Evolution of Anemia Types During Antiretroviral Therapy—Implications for Treatment Outcomes and Quality of Life Among HIV-Infected Adults

et al. 2019

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This study examined whether the type of anemia in persons living with HIV/AIDS (PLWHA) changed from the beginning of highly antiretroviral therapy (HAART) and had implications for treatment outcomes and quality of life (QOL). If present, the anemia-type was defined as microcytic, macrocytic or anemia of chronic disease (ACD) at study months 0, 6, 12, and 18. Multinomial logistic regression quantified sociodemographic and HIV-treatment factors associated with incident microcytic anemia or ACD over 18 months. Repeated measures linear regression models estimated the anemia-type associated change in the CD4 cell-count, QOL, body mass index (BMI) and frailty over 18 months. Cox proportional hazard models estimated associations between anemia-type and time to (a) gain at least 100 CD4 cells/L and (b) hospitalization/death. Analyses were implemented in Statistical Analysis Software (v.9.4) from which odds ratios (ORs) mean differences (β) and corresponding 95% confidence intervals (CI) were estimated. At enrollment, ACD, macrocytic and microcytic anemia was present in 36.8% (n = 147), 11.3% (n = 45) and 9.5% (n = 38), respectively with 42% (n = 170) anemia-free. By the study end, only 23% (n = 115) were without anemia. Among the 251 with anemia at the study end, 53.3% (n = 195) had macrocytic anemia, 12.8% (n = 47) had ACD and 2.5% (n = 9) had microcytic anemia. Incident macrocytic anemia was positively associated with baseline hyperferritinemia (OR = 1.85, 95%CI: 1.03–3.32), inversely associated with wealth (OR = 0.87, 95%CI: 0.67–1.03) and inversely associated with efavirenz-containing HAART (OR = 0.42, 95%CI: 0.21–0.85). ACD incidence decreased by 53% (95%CI: 0.27–0.79) per 100 cells/L increase in baseline CD4-cell count and decreased by 90% (95%CI: 0.01,0.87) among adults treated with nevirapine-containing HAART. ACD was associated with a lower BMI at months 6 (β = −0.33, 95% CI: −0.64, −0.01) and 12 (β = −0.41, 95%CI: −0.73, −0.09), with lower QOL (β = −3.2, 95%CI: −5.94, −0.53) at month 12 and with elevated frailty (β = 1.2; 95%CI: 0.46, 1.86) at month 12. Macrocytic anemia did not predict a post-enrollment change in CD4, BMI or QOL during follow-up. However, the time to gain 100 CD4 cells/L was 43% slower (p < 0.05) and the frailty was higher at month 12 for PLWHA with the baseline or sustained macrocytic vs. no anemia. A substantial decline in ACD and microcytic anemia occurred in tandem with large increase in the macrocytic anemia over 18 months on HAART. Interventions to mitigate all anemia—particularly ACD, is expected to improve the immune recovery rate, lower frailty, and enhanced QOL.

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High perceived social standing is associated with better health in HIV-infected Ugandan adults on highly active antiretroviral therapy

Cited by 11 publications

References 44 publications

Impaired Hematologic Status in Relation to Clinical Outcomes among HIV-Infected Adults from Uganda: A Prospective Cohort Study

Impaired Hematologic Status in Relation to Clinical Outcomes among HIV-Infected Adults from Uganda: A Prospective Cohort Study

Subjective Social Standing and Conflict Tactics Among Young Kenyan Men

Evolution of Anemia Types During Antiretroviral Therapy—Implications for Treatment Outcomes and Quality of Life Among HIV-Infected Adults

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