Mortality and Treatment Failure among HIV-Infected Adults in Dar Es Salaam, Tanzania

Chalamilla, Guerino; Hawkins, Claudia; Okuma, James; Spiegelman, Donna; Aveika, Akum; Christian, Beatrice; Koda, Happiness; Kaaya, Sylvia; Mtasiwa, Deo; Fawzi, Wafaie W.

doi:10.1177/1545109711406733

Cited by 20 publications

(20 citation statements)

References 28 publications

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“…Indeed, researchers whose project was running care and treatment clinics in Dar es Salaam at the time of the study published two papers indicating that men on ART had higher mortality than their female counterparts (41, 42). Similar findings have been reported elsewhere in sub-Saharan Africa (43–45).…”

Section: Discussionmentioning

confidence: 99%

Masculine attitudes of superiority deter men from accessing antiretroviral therapy in Dar es Salaam, Tanzania

Nyamhanga

Muhondwa

Shayo

2013

Global Health Action

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BackgroundThis article presents part of the findings from a larger study that sought to assess the role that gender relations play in influencing equity regarding access and adherence to antiretroviral therapy (ART). Review of the literature has indicated that, in Southern and Eastern Africa, fewer men than women have been accessing ART, and the former start using ART late, after HIV has already been allowed to advance. The main causes for this gender gap have not yet been fully explained.ObjectiveTo explore how masculinity norms limit men's access to ART in Dar es Salaam.DesignThis article is based on a qualitative study that involved the use of focus group discussions (FGDs). The study employed a stratified purposive sampling technique to recruit respondents. The study also employed a thematic analysis approach.ResultsOverall, the study's findings revealed that men's hesitation to visit the care and treatment clinics signifies the superiority norm of masculinity that requires men to avoid displaying weakness. Since men are the heads of families and have higher social status, they reported feeling embarrassed at having to visit the care and treatment clinics. Specifically, male respondents indicated that going to a care and treatment clinic may raise suspicion about their status of living with HIV, which in turn may compromise their leadership position and cause family instability. Because of this tendency towards ‘hiding’, the few men who register at the public care and treatment clinics do so late, when HIV-related signs and symptoms are already far advanced.ConclusionThis study suggests that the superiority norm of masculinity affects men's access to ART. Societal expectations of a ‘real man’ to be fearless, resilient, and emotionally stable are in direct conflict with expectations of the treatment programme that one has to demonstrate health-promoting behaviour, such as promptness in attending the care and treatment clinic, agreeing to take HIV tests, and disclosing one's status of living with HIV to at least one's spouse or partner. Hence, there is a need for HIV control agencies to design community-based programmes that will stimulate dialogue on the deconstruction of masculinity notions.

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Section: Discussionmentioning

confidence: 99%

Masculine attitudes of superiority deter men from accessing antiretroviral therapy in Dar es Salaam, Tanzania

Nyamhanga

Muhondwa

Shayo

2013

Global Health Action

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“…This prospective observational study was conducted at 12 Management and Development for Health (MDH) HIV care and treatment clinics (CTCs) supported by the U.S. 15,16 For inclusion in these analyses, participants had to be 15 years old and above, not pregnant at the time of enrollment, and have at least two measurements of Hgb concentration.…”

Section: Methodsmentioning

confidence: 99%

Determinants of Anemia Among Human Immunodeficiency Virus-Positive Adults at Care and Treatment Clinics in Dar es Salaam, Tanzania

Petraro¹,

Duggan²,

Spiegelman³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Anemia is often a comorbidity of human immunodeficiency virus (HIV) infection. Many cross-sectional studies have been conducted on anemia and HIV, but few, if any, have addressed incidence of anemia prospectively. A longitudinal analysis was conducted in 48,068 nonpregnant HIV-infected adults in Dar es Salaam, Tanzania, seen at Management and Development for Health–U.S. President's Emergency Plan for AIDS Relief HIV care and treatment programs between 2004 and 2011. Almost 56% (N = 27,184) of study participants had anemia (hemoglobin < 11 g/dL) at the time of enrollment at the clinic. Female gender, low body mass index (BMI), low CD4 T-cell count, high levels of liver enzyme alanine aminotransferase, antiretroviral treatment (ART) regimens, and concurrent tuberculosis treatment were all independently significantly associated with an increased risk of anemia. Low BMI and low CD4 T-cell count were independently significantly associated with an increased risk for iron deficiency anemia (IDA). Higher BMI status and ART use were associated with recovery from anemia. Anemia, including IDA, is a comorbidity that is associated with other adverse consequences (e.g., low BMI and CD4 T-cell count) among individuals with HIV infection, including those on ART. Interventions to prevent anemia and its complications need to be examined in the context of future studies.

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“…Despite marked increases in ART coverage, PLH initiating treatment in sub-Saharan Africa continue to experience high rates of morbidity and mortality as compared to PLH in high-income settings, particularly during the initial months of ART [2, 3]. In the Dar es Salaam, Tanzania HIV care and treatment program, adult men and women initiating ART have a 1-year mortality risk of 13.1% [4]. As a result, low-cost ART adjunct interventions are urgently needed to improve survival and quality of life for PLH in sub-Saharan Africa.…”

Section: Introductionmentioning

confidence: 99%

Depression at antiretroviral therapy initiation and clinical outcomes among a cohort of Tanzanian women living with HIV

Sudfeld

Kaaya

Gunaratna

et al. 2017

Aids

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Objective The objective of the study was to assess the relationship of depression at antiretroviral therapy (ART) initiation with mortality and clinical outcomes among Tanzanian women living with HIV. Design We conducted a prospective cohort study of 1,487 women who initiated ART in Dar es Salaam, Tanzania. Methods Symptoms of depression and anxiety were assessed using a Tanzanian adapted and validated version of the Hopkins Symptom Checklist (HSCL-25). Participants attended monthly clinic visits during the first two years of ART and CD4 T-cell counts were assessed every four months. Proportional hazard models were used to assess the relationship of depression with mortality and clinical outcomes. Results Symptoms consistent with depression were prevalent among 57.8% of women at ART initiation. After multivariate adjustment including social support and stigma, depression at ART initiation was associated with increased risk of mortality (HR: 1.92; 95% CI: 1.15-3.20; p=0.01) and incidence of severe anemia (hemoglobin <8.5 g/dL) (HR: 1.59; 95% CI: 1.07-2.37; p=0.02). Under the assumption of causality, we estimate 36.1% (95% CI: 13.6-55.1%) of deaths among the study cohort were attributable to depression and its consequences. Depression was not significantly associated with trajectory of CD4 T-cell reconstitution or the risk of immunologic failure (p-values >0.05). Conclusions Elimination of depression may reduce mortality during the first two years of ART by one-third in our study cohort. Randomized trials and rigorous implementation studies are needed to evaluate the individual- and population-level effects of integrated mental health interventions and HIV treatment approaches in resouce-limited settings.

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Mortality and Treatment Failure among HIV-Infected Adults in Dar Es Salaam, Tanzania

Cited by 20 publications

References 28 publications

Masculine attitudes of superiority deter men from accessing antiretroviral therapy in Dar es Salaam, Tanzania

Masculine attitudes of superiority deter men from accessing antiretroviral therapy in Dar es Salaam, Tanzania

Determinants of Anemia Among Human Immunodeficiency Virus-Positive Adults at Care and Treatment Clinics in Dar es Salaam, Tanzania

Depression at antiretroviral therapy initiation and clinical outcomes among a cohort of Tanzanian women living with HIV

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