HIV services in sub-Saharan Africa: the greatest gap is men

Cornell, Morna; Majola, Mandla; Johnson, Leigh F.; Dubula-Majola, Vuyiseka

doi:10.1016/s0140-6736(21)01163-6

Cited by 33 publications

(21 citation statements)

References 17 publications

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“…This result aligns with previous studies reporting poorer HIV outcomes among males than females [ 64 ]. Sex disparities within HIV outcomes have been attributed to male health care-seeking behaviour arising from harmful masculine norms, higher rates of harmful alcohol and substance use leading to poor ART adherence, and the gendered nature of health services creating health care barriers for males [ 64 – 68 ].…”

Section: Discussionmentioning

confidence: 99%

Mental Health, ART Adherence, and Viral Suppression Among Adolescents and Adults Living with HIV in South Africa: A Cohort Study

et al. 2023

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We followed adolescents and adults living with HIV aged older than 15 years who enrolled in a South African private-sector HIV programme to examine adherence and viral non-suppression (viral load > 400 copies/mL) of participants with (20,743, 38%) and without (33,635, 62%) mental health diagnoses. Mental health diagnoses were associated with unfavourable adherence patterns. The risk of viral non-suppression was higher among patients with organic mental disorders [adjusted risk ratio (aRR) 1.55, 95% confidence interval (CI) 1.22–1.96], substance use disorders (aRR 1.53, 95% CI 1.19–1.97), serious mental disorders (aRR 1.30, 95% CI 1.09–1.54), and depression (aRR 1.19, 95% CI 1.10–1.28) when compared with patients without mental health diagnoses. The risk of viral non-suppression was also higher among males, adolescents (15–19 years), and young adults (20–24 years). Our study highlights the need for psychosocial interventions to improve HIV treatment outcomes—particularly of adolescents and young adults—and supports strengthening mental health services in HIV treatment programmes.

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Section: Discussionmentioning

confidence: 99%

Mental Health, ART Adherence, and Viral Suppression Among Adolescents and Adults Living with HIV in South Africa: A Cohort Study

et al. 2023

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“…For alcohol and bipolar disorders, sex disparities in excess mortality are at least partly attributable to higher mortality from unnatural causes among men than women. For other disorders, lower health care utilisation rates among men compared with women, 24 arising from the gendered nature of health services creating health care barriers for men, 25,26 harmful masculine norms, 27 self-stigmatizing beliefs, 28 or differences in coping strategies 29 may contribute to higher excess mortality for men than women. Further work is needed to design, implement, and evaluate strategies addressing men’s physical and mental health care needs.…”

Section: Discussionmentioning

confidence: 99%

Life-years lost associated with mental illness: a cohort study of beneficiaries of a South African medical insurance scheme

Ruffieux

Wettstein

Maartens

et al. 2023

Preprint

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Background People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown. Methods We analysed reimbursement claims and vital registration data from South African medical insurance scheme beneficiaries aged 15-85 years. We estimated excess life years lost (LYL) associated with organic, substance use, psychotic, mood, anxiety, eating, personality, developmental or any mental disorders. Findings We followed 1 070 183 beneficiaries, of whom 282 926 (26.4%) received mental health diagnoses. Life expectancy of people with mental health diagnoses was 3.83 years (95% CI 3.58-4.10) shorter for men and 2.19 years (1.97-2.41) shorter for women. Excess mortality varied by sex and diagnosis, ranging from 11.50 LYL (95% CI 9.79-13.07) among men with alcohol use disorder to 0.87 LYL (0.40-1.43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (3.42 among men and 1.94 among women). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1.52) or substance use (2.45) disorder. Interpretation The burden of premature mortality among persons with mental disorders in South Africa is high. Our findings support implementing interventions for prevention, early detection, and treatment of physical comorbidities among people with mental disorders. Suicide prevention and substance use treatment programmes are needed to reduce excess mortality from unnatural causes, especially among men. Funding Swiss National Science Foundation and National Institutes of Health

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“…Men are a priority group for HIV services in sub-Saharan Africa (SSA) because of their low uptake of both testing and ART services. In SSA, compared with women, men living with HIV are disproportionately unaware of their HIV status and are not engaged in antiretroviral therapy (ART) programs [1,2]. Once on ART, men have twice the mortality than women [3,4], largely due to late diagnosis and poor retention in care [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Engaging men through HIV self-testing with differentiated care to improve ART initiation and viral suppression among men in Malawi (ENGAGE): A study protocol for a randomized control trial

Choko

Coates

Mphande³

et al. 2023

PLoS ONE

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Background Men experience twice the mortality of women while on ART in sub-Saharan Africa (SSA) largely due to late HIV diagnosis and poor retention. Here we propose to conduct an individually randomized control trial (RCT) to investigate the impact of three-month home-based ART (hbART) on viral suppression among men who were not engaged in care. Methods and design A programmatic, individually randomized non-blinded, non-inferiority-controlled trial design (ClinicalTrials.org NCT04858243). Through medical chart reviews we will identify “non-engaged” men living with HIV, ≥15years of age who are not currently engaged in ART care, including (1) men who have tested HIV-positive and have not initiated ART within 7 days; (2) men who have initiated ART but are at risk of immediate default; and (3) men who have defaulted from ART. With 1:1 computer block randomization to either hbART or facility-based ART (fbART) arms, we will recruit men from 10–15 high-burden health facilities in central and southern Malawi. The hbART intervention will consist of 3 home-visits in a 3-month period by a certified male study nurse ART provider. In the fbART arm, male participants will be offered counselling at male participant’s home, or a nearby location that is preferred by participants, followed with an escort to the local health facility and facility navigation. The primary outcome is the proportion of men who are virally suppressed at 6-months after ART initiation. Assuming primary outcome achievement of 24.0% and 33.6% in the two arms, 350 men per arm will provide 80% power to detect the stated difference. Discussion Identifying effective ART strategies that are convenient and accessible for men in SSA is a priority in the HIV world. Men may not (re-)engage in facility-based care due to a myriad of barriers. Two previous trials investigated the impact of hbART on viral suppression in the general population whereas this trial focuses on men. Additionally, this trial involves a longer duration of hbART i.e., three months compared to two weeks allowing men more time to overcome the initial psychological denial of taking ART.

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HIV services in sub-Saharan Africa: the greatest gap is men

Cited by 33 publications

References 17 publications

Mental Health, ART Adherence, and Viral Suppression Among Adolescents and Adults Living with HIV in South Africa: A Cohort Study

Mental Health, ART Adherence, and Viral Suppression Among Adolescents and Adults Living with HIV in South Africa: A Cohort Study

Life-years lost associated with mental illness: a cohort study of beneficiaries of a South African medical insurance scheme

Engaging men through HIV self-testing with differentiated care to improve ART initiation and viral suppression among men in Malawi (ENGAGE): A study protocol for a randomized control trial

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