1
|
Randera-Rees S, Clarence Safari W, Gareta D, Herbst K, Baisley K, Grant AD. Can we find the missing men in clinics? Clinic attendance by sex and HIV status in rural South Africa. Wellcome Open Res 2023; 6:169. [PMID: 37767058 PMCID: PMC10521066 DOI: 10.12688/wellcomeopenres.16702.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 09/29/2023] Open
Abstract
Background: HIV-negative men are over-represented in tuberculosis (TB) prevalence surveys including the first South African national TB prevalence survey in 2018. Traditionally, TB screening is focused in clinics. We aimed to determine the frequency of primary healthcare clinic (PHC) attendance among HIV-negative men in a TB-prevalent setting. Methods: Since January 2017, PHC attendees in a rural South African demographic surveillance area (DSA) were asked their reason for attendance. HIV status was defined as positive if tested positive in a DSA sero-survey or attended clinic for HIV care; negative if tested negative between January 2014-December 2017 and no HIV-related visits; and HIV-unknown otherwise. Results: Among 67124 DSA residents (≥15 years), 27038 (40.3%) were men; 14196 (21.2%) were classified HIV-positive, 18892 (28.1%) HIV-negative and 34036 (50.7%) HIV-unknown. Between April 2017 and March 2018, 24382/67124 (36.3%, 95% confidence interval [CI] 36.0-36.7) adults made ≥1 PHC visit, comprising 9805/40086 (24.5%, 95%CI 23.6-25.3) of HIV-negative or unknown women and 3440/27038 (12.7%, 95%CI 11.6-13.8) of HIV-negative or unknown men. Overall, HIV care accounted for 37556/88109 (42.6%) of adult PHC visits. Conclusion: In this rural population, HIV-negative and -unknown men rarely attend PHCs. Improving TB screening in clinics may not reach a key population with respect to undiagnosed TB. Additional strategies are needed to diagnose and treat TB earlier.
Collapse
Affiliation(s)
- Safiyya Randera-Rees
- Africa Health Research Institute, KwaZulu Natal, South Africa
- National Health Laboratory Services, Johannesburg, 2192, South Africa
| | - Wende Clarence Safari
- Africa Health Research Institute, KwaZulu Natal, South Africa
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu Natal, South Africa
- DSI-MRC, South African Population Research Infrastructure Network, KwaZulu Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu Natal, South Africa
- DSI-MRC, South African Population Research Infrastructure Network, KwaZulu Natal, South Africa
| | - Kathy Baisley
- Africa Health Research Institute, KwaZulu Natal, South Africa
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Alison D. Grant
- Africa Health Research Institute, KwaZulu Natal, South Africa
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
2
|
Medina-Marino A, Bezuidenhout D, Ngcelwane N, Cornell M, Wainberg M, Beyrer C, Bekker LG, Daniels J. Qualitative Identification of Intervention Preferences to Support Men's Engagement and Retention in TB Care in South Africa. Am J Mens Health 2022; 16:15579883221129349. [PMID: 36218175 PMCID: PMC9558889 DOI: 10.1177/15579883221129349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Globally and in South African specifically, men account for 56% and 62% of all tuberculosis (TB) cases, respectively. Men are at increased risk of not accessing TB testing or treatment, and having poor treatment outcomes. Unfortunately, no interventions exist to address these issues. Toward the development of targeted, patient-centered TB care and support interventions, we used semistructured interviews to explored men's social network composition, TB testing behaviors, disclosure and treatment support, clinical experiences, and TB's influence on daily living. Data were analyzed using a thematic approach guided by the Network Individual Resource Model to identify mental and tangible resources influential and preferred during engagement in TB treatment. Men emphasized the desire for peer-to-peer support to navigate TB-related stigma and unhealthy masculinity norms. Men advocated for awareness events to educate communities about their challenges with TB. Men strongly suggested that interventions be delivered in familiar locations where men congregate. Since 2022, no TB treatment support interventions have included the preferred components or delivery modes described by men in our study. To improve men's TB-related health outcomes, the global TB community must identify and address men's unique challenges when designing interventions.
Collapse
Affiliation(s)
- Andrew Medina-Marino
- Division of Men’s Health, Desmond Tutu
HIV Centre, University of Cape Town, Cape Town, South Africa,Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, USA,Research Unit, Foundation for
Professional Development, East London, South Africa,Andrew Medina-Marino, Division of Men’s
Health, Desmond Tutu HIV Centre, University of Cape Town, Cape Town, 7915, South
Africa.
| | - Dana Bezuidenhout
- Research Unit, Foundation for
Professional Development, East London, South Africa,Department of Epidemiology, Mailman
School of Public Health, Columbia University, New York City, NY, USA
| | - Nondumiso Ngcelwane
- Buffalo City Health District, Eastern
Cape Provincial Department of Health, Bisho, South Africa
| | - Morna Cornell
- School of Public Health & Family
Medicine, University of Cape Town, Cape Town, South Africa
| | - Milton Wainberg
- Department of Psychiatry, Columbia
University Vagelos College of Physicians and Surgeons, New York City, NY, USA,New York State Psychiatric Institute,
New York City, NY, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke
University, Durham, NC, USA,Desmond Tutu HIV Centre, University
of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University
of Cape Town, Cape Town, South Africa
| | - Joseph Daniels
- Edson College of Nursing and Health
Innovation, Arizona State University, Phoenix, AZ, USA
| |
Collapse
|
3
|
Daniels J, Medina-Marino A, Glockner K, Grew E, Ngcelwane N, Kipp A. Masculinity, resources, and retention in care: South African men's behaviors and experiences while engaged in TB care and treatment. Soc Sci Med 2021; 270:113639. [PMID: 33493956 DOI: 10.1016/j.socscimed.2020.113639] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE Globally, the prevalence of tuberculosis (TB) disease is significantly higher among men compared to women. This is compounded by men's poorer uptake of TB testing and treatment, and worse outcomes for smear conversion and successful treatment completion compared to women; in South Africa specifically, TB accounts for a large portion of sex-specific life expectancy differences. OBJECTIVE To understand men's unique barriers to accessing care and their needs while engaged in TB treatment, we conducted a qualitative study with men currently in or who recently completed TB treatment to understand how social norms for masculinity influence resource access and health behaviors, and in turn affect their engagement in care. METHODS We interviewed 31 men using a semi-structured protocol, with domains including: social network composition and support; TB illness; and testing, treatment, and clinical care experiences. Interviews were analyzed using a constant comparison approach to identify resources and how these are exchanged within men's social networks for TB care. RESULTS We found that men's prioritizing of work ensured food security and maintenance of masculinity norms, but delayed seeking and engagement in care. Once in treatment, men found it difficult both to negotiate clinic hours and work schedules and to navigate clinic environments without being labeled as weak. To mitigate individual resource gaps and losses, men typically accessed women family members who provided key resources (e.g., food, money, and emotional encouragement). Masculine identification with fatherhood was a key motivator to remain engaged in TB care and treatment. Loss from care was facilitated by isolation and limited access to social network resources. CONCLUSION To improve men's engagement in care and successful treatment outcomes, interventions that leverage their social networks and build upon existing resources should be strongly considered.
Collapse
Affiliation(s)
- Joseph Daniels
- Department of Psychiatry and Human Behaviors, Charles R. Drew University of Medicine and Science, Los Angeles, USA.
| | - Andrew Medina-Marino
- Foundation for Professional Development, East London, South Africa; Division of Men's Health, Desmond Tutu HIV Centre, University of Cape Town, South Africa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | | | | | - Nondumiso Ngcelwane
- Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, South Africa
| | - Aaron Kipp
- Department of Public Health, East Carolina University, USA
| |
Collapse
|
4
|
Mejia-Pailles G, Berrington A, McGrath N, Hosegood V. Trends in the prevalence and incidence of orphanhood in children and adolescents <20 years in rural KwaZulu-Natal South Africa, 2000-2014. PLoS One 2020; 15:e0238563. [PMID: 33232331 PMCID: PMC7685426 DOI: 10.1371/journal.pone.0238563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In South Africa, large increases in early adult mortality during the 1990s and early 2000s have reversed since public HIV treatment rollout in 2004. In a rural population in KwaZulu-Natal, we investigate trends in parental mortality and orphanhood from 2000-2014. METHODS Using longitudinal demographic surveillance data for a population of approximately 90,000, we calculated annual incidence and prevalence of maternal, paternal and double orphanhood in children and adolescents (<20 years) and, overall and cause-specific mortality of parents by age. RESULTS The proportion of children and adolescents (<20 years) for whom one or both parents had died rose from 26% in 2000 to peak at 36% in 2010, followed by a decline to 32% in 2014. The burden of orphanhood remains high especially in the oldest age group: in 2014, 53% of adolescents 15-19 years had experienced the death of one or both parents. In all age groups and years, paternal orphan prevalence was three-five times higher than maternal orphan prevalence. Maternal and paternal orphan incidence peaked in 2005 at 17 and 27 per 1,000 person years respectively (<20 years) before declining by half through 2014. The leading cause of parental death throughout the period, HIV/AIDS and TB cause-specific mortality rates declined substantially in mothers and fathers from 2007 and 2009 respectively. CONCLUSIONS The survival of parents with children and adolescents <20 years has improved in tandem with earlier initiation and higher coverage of HIV treatment. However, comparatively high levels of parental deaths persist in this rural population in KwaZulu-Natal, particularly among fathers. Community-level surveillance to estimate levels of orphanhood remains important for monitoring and evaluation of targeted state welfare support for orphans and their guardians.
Collapse
Affiliation(s)
| | - Ann Berrington
- Department of Social Statistics & Demography, University of Southampton, Southampton, United Kingdom
| | - Nuala McGrath
- Department of Social Statistics & Demography, University of Southampton, Southampton, United Kingdom
- Department of Population Sciences & Primary Care, University of Southampton, Southampton, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Victoria Hosegood
- Department of Social Statistics & Demography, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
5
|
Kerkhoff AD, Sikombe K, Eshun-Wilson I, Sikazwe I, Glidden DV, Pry JM, Somwe P, Beres LK, Simbeza S, Mwamba C, Bukankala C, Hantuba C, Moore CB, Holmes CB, Padian N, Geng EH. Mortality estimates by age and sex among persons living with HIV after ART initiation in Zambia using electronic medical records supplemented with tracing a sample of lost patients: A cohort study. PLoS Med 2020; 17:e1003107. [PMID: 32401797 PMCID: PMC7219718 DOI: 10.1371/journal.pmed.1003107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Men in sub-Saharan Africa have lower engagement and retention in HIV services compared to women, which may result in differential survival. However, the true magnitude of difference in HIV-related mortality between men and women receiving antiretroviral therapy (ART) is incompletely characterized. METHODS AND FINDINGS We evaluated HIV-positive adults ≥18 years old newly initiating ART in 4 Zambian provinces (Eastern, Lusaka, Southern, and Western). In addition to mortality data obtained from routine electronic medical records, we intensively traced a random sample of patients lost to follow-up (LTFU) and incorporated tracing outcomes through inverse probability weights. Sex-specific mortality rates and rate differences were determined using Poisson regression. Parametric g-computation was used to estimate adjusted mortality rates by sex and age. The study included 49,129 adults newly initiated on ART between August 2013 and July 2015; overall, the median age among patients was 35 years, the median baseline CD4 count was 262 cells/μl, and 37.2% were men. Men comprised a smaller proportion of individuals starting ART (37.2% versus 62.8%), tended to be older (median age 37 versus 33 years), and tended to have lower CD4 counts (median 220 versus 289 cells/μl) at the time of ART initiation compared to women. The overall rate of mortality among men was 10.3 (95% CI 8.2-12.4) deaths/100 person-years (PYs), compared to 5.5 (95% CI 4.3-6.8) deaths/100 PYs among women (difference +4.7 [95% CI 2.3-7.2] deaths/100 PYs; p < 0.001). Compared to women in the same age groups, men's mortality rates were particularly elevated among those <30 years old (+6.7 deaths/100 PYs difference), those attending rural health centers (+9.4 deaths/100 PYs difference), those who had an initial CD4 count < 100 cells/μl (+9.2 deaths/100 PYs difference), and those who were unmarried (+8.0 deaths/100 PYs difference). After adjustment for potential confounders and mediators including CD4 count, a substantially higher mortality rate was predicted among men <30 years old compared to women of the same age, while women ≥50 years old had a mortality rate similar to that of age-matched men, but considerably higher than that predicted among young women (<30 years old). No clinically significant differences were evident with respect to rates of facility transfer or care disengagement between men and women. The main study limitations were the inability to successfully ascertain outcomes in all patients selected for tracing and missing clinical and laboratory data due to the use of medical records. CONCLUSIONS In this study, we found that among HIV-positive adults newly initiating ART, mortality among men exceeded mortality among women; disparities were most pronounced among young patients. Older women, however, also experienced high mortality. Specific interventions for men and older women at highest mortality risk are needed to improve HIV treatment outcomes.
Collapse
Affiliation(s)
- Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, United States of America
| | | | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri, United States of America
- Center for Dissemination and Implementation, Institute for Public Health, Washington University, St. Louis, Missouri, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - David V. Glidden
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Jake M. Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri, United States of America
- Center for Dissemination and Implementation, Institute for Public Health, Washington University, St. Louis, Missouri, United States of America
| | - Paul Somwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K. Beres
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sandra Simbeza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chama Bukankala
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Cardinal Hantuba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Carolyn Bolton Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Charles B. Holmes
- Center for Dissemination and Implementation, Institute for Public Health, Washington University, St. Louis, Missouri, United States of America
- Georgetown University, Washington, District of Columbia, United States of America
| | - Nancy Padian
- University of California, Berkeley, Berkeley, California, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri, United States of America
- Center for Dissemination and Implementation, Institute for Public Health, Washington University, St. Louis, Missouri, United States of America
| |
Collapse
|
6
|
Kishamawe C, Rumisha SF, Mremi IR, Bwana VM, Chiduo MG, Massawe IS, Mboera LEG. Trends, patterns and causes of respiratory disease mortality among inpatients in Tanzania, 2006-2015. Trop Med Int Health 2018; 24:91-100. [PMID: 30303586 DOI: 10.1111/tmi.13165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the causes, patterns and trends of respiratory diseases-related deaths in hospitals of Tanzania 2006-2015. METHODS Retrospective study involving 39 hospitals. Medical records of patients who died in hospital were retrieved, reviewed and analysed. Sources of data were hospital admission registers, death registers and International Classification of Diseases report forms. Information on demographic characteristics, date of death, the immediate underlying cause of death and co-morbid conditions was collected. RESULTS Of the 247 976 deaths reported during the 10-year period, respiratory diseases accounted for 12.92% (n = 32 042). The majority of the respiratory mortality was reported among males (55.9%). Overall median age at death was 31 years with an interquartile range (IQR) of 1-47. Median age at death was significantly higher among males (35 years) than females (28 years) (P < 0.0001). Most deaths (37.8%) occurred in eastern Tanzania. About one-third (31.3%) of all respiratory mortality was reported among under-five children, being among girls than boys (34.3% vs. 28.9%, χ2 = 10.3, P < 0.0001). Adolescent and young adult females (15-29 years) had higher age-standardised mortality rates per 100 000 due respiratory diseases than males. Pneumonia (n = 16 639; 51.9%) and pulmonary tuberculosis (n = 9687; 30.2%) accounted for the majority of deaths due to respiratory diseases. Significantly more females (n = 7665; 54.5%) than males died from pneumonia (n = 8878; 49.8%; χ2 = 8.5, P < 0.0001). By contrast, significantly more males (n = 6024; 34%) than females (n = 3596; 26%; χ2 = 15.5, P < 0.0001) died of tuberculosis. The proportion of death due to tuberculosis declined from 32.8% in 2006-2010 to 7.9% in 2011-2015. However, there was a significant increase in the proportion of death due to pneumonia from 49.6% in 2006-2010 to 53.4% in 2011-2015. Co-morbid conditions contributed to 9.1% (2871/31 628) of all deaths due to respiratory diseases. The most common co-morbid condition was HIV which accounted for 1735 (60.4%) deaths and was more common among males (60.8%; n = 957) than among females (59.7%; n = 764). CONCLUSIONS Respiratory diseases account for a substantial proportion of all causes of hospital death in Tanzania. Pneumonia and tuberculosis contribute to more than three quarters of all deaths due to respiratory diseases. Since most major respiratory illnesses are avoidable, it is important to strengthen the capacity of the health delivery system in managing cases of respiratory diseases.
Collapse
Affiliation(s)
- Coleman Kishamawe
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Irene R Mremi
- National Institute for Medical Research, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Surveillance, Africa Centre of Excellence for Infectious Diseases of Humans and Animals in Eastern and Southern Africa, Morogoro, Tanzania
| | - Veneranda M Bwana
- Amani Research Centre, National Institute for Medical Research, Muheza, Tanzania
| | - Mercy G Chiduo
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | - Isolide S Massawe
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | - Leonard E G Mboera
- National Institute for Medical Research, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Surveillance, Africa Centre of Excellence for Infectious Diseases of Humans and Animals in Eastern and Southern Africa, Morogoro, Tanzania
| |
Collapse
|