Background
Methods
Design and setting
Sample and procedure
Measures
The Revised Sign and Symptom Checklist for Persons with HIV Disease
Health-Related Quality of Life
Alcohol Use Disorder
Internalized AIDS stigma
HIV/AIDS discrimination experiences
Social support
Adherence assessment
Data analysis
Results
Sample characteristics
Variable | N = 519 | % |
---|---|---|
Sex
| ||
Male | 139 | 26.6 |
Female | 370 | 73.4 |
Age in years
| 136 | 26.3 |
18-29 | 222 | 42.9 |
30-39 | 100 | 19.3 |
40-49 | 59 | 11.4 |
50 and above | ||
Marital status
| ||
Never married | 379 | 73.3 |
Currently married | 68 | 13.2 |
Cohabitating | 40 | 7.7 |
Divorced/separated | 11 | 2.2 |
Widowed | 19 | 3.7 |
Highest education
| ||
None | 40 | 7.7 |
Up to Grade 7 | 157 | 30.4 |
Grade 8-11 | 221 | 42.7 |
Grade 12 or more | 99 | 19.1 |
Ethnicity
| ||
Zulu | 513 | 98.8 |
Other | 6 | 1.2 |
Religious affiliation
| ||
African/traditional | 52 | 10.0 |
Christian (Protestant churches) | 73 | 14.1 |
Christian (Catholic) | 49 | 9.4 |
Apostolic | 48 | 9.2 |
Zion Christian Church | 152 | 29.3 |
Other | 71 | 14.0 |
No religion | 74 | 14.3 |
Residence
| ||
Rural village | 221 | 42.7 |
Informal settlements (slums) | 31 | 6.0 |
Urban/metropolitan areas | 49 | 9.5 |
Township | 118 | 22.8 |
Farm | 98 | 19.0 |
Employment situation
| ||
Housewife, home maker | 76 | 15.0 |
Unemployed | 303 | 59.6 |
Employed | 115 | 22.6 |
Pensioner, student, disabled | 21 | 4.2 |
Main source of household income
| ||
Formal salary | 162 | 31.7 |
Contribution by family members | 86 | 16.9 |
Government grant | 113 | 22.1 |
Grants/donations by private welfare organizations | 80 | 15.7 |
No income (other than social grant) | 38 | 7.4 |
Other | 32 | 6.3 |
Disability grant ("for HIV/AIDS")
| ||
Yes | 268 | 52.5 |
No | 242 | 47.5 |
Health characteristics
Variable | N = 519 | % |
---|---|---|
Time since HIV diagnosis | ||
2007/8 | 379 | 75.2 |
2006-1995 | 125 | 24.8 |
CD4 count (cells/uL) = Median = 130 (IQR = 72-185) (at baseline: Median = 119; IQR = 59-163) | ||
1-99 | 188 | 37.2 |
100-200 | 232 | 45.9 |
>200 | 85 | 16.8 |
Number of HIV symptoms (range 0-20) M(SD) | 1.21 (2.60) | |
Overall Quality of Life (range 1-5) M(SD)
| 4.3 (0.7) | |
General health perceptions (range 1-5) M(SD)
| 4.4(0.7) | |
Depression score (range 10-40) M(SD)
| 17.3(3.3) | |
Receiving TB treatment
| 34 | 6.6 |
Hospital admission in the past 6 months
| 53 | 10.3 |
Participated in support group in the past 6 months
| 14 | 2.7 |
Seen someone for counseling/support in the past 6 months
| 123 | 23.8 |
Seen an ARV treatment buddy in the past 6 months
| 132* | 25.6 |
Had alcohol in the past month
| 13 | 2.5 |
AUDIT-C 4 or more
| 10 | 1.9 |
Stigma score (range 0-7) M(SD)
| 2.8 (1.8) | |
Discrimination experience score (range 0-5) M(SD)
| 0.87 (1.11) | |
Social support score (range 3-12) M(SD)
| 8.3 (2.3) |
ART adherence
n | % | ||
---|---|---|---|
30-day VAS at 95% | Adherent | 427 | 82.9 |
Non-adherent | 88 | 17.1 | |
Self-reported 4-day recall dose adherence | Adherent | 435 | 84.5 |
Non-adherent | 80 | 15.5 | |
Self-reported time adherence | Adherent | 372 | 72.4 |
Non-adherent | 142 | 27.6 | |
Self-reported food adherence | Adherent | 369 | 71.7 |
Non-adherent | 146 | 28.3 | |
Adherence to all (Dose, Schedule and Food) | Adherent | 364 | 70.8 |
Non-adherent | 150 | 29.2 |
Determinants of ART adherence
VAS adherence (≥ 95%) | Dose, schedule and food adherence | ||||
---|---|---|---|---|---|
N = 519 (%) | Crude OR (95% CI) | P | Crude OR (95% CI) | P | |
Sex
| |||||
Female | 370 (26.6) | 1.00 | 1.00 | ||
Male | 139 (73.4) | 1.08 (0.54-1.56) | .747 | 1.03 (0.63-1.50) | .887 |
Age | 0.99 (0.97-1.02) | .673 | 1.01 (0.99-1.03) | .615 | |
Formal education
| |||||
lower (up to Grade 7) | 197 (38.1) | 1.00 | 1.00 | ||
higher (Grade 8 or more) | 320 (61.9) | 0.89 (0.81-1.00) | .050 | 0.99 (0.91-1.08) | .895 |
Marital status
| |||||
Married/cohabitating | 108 (20.9) | 1.00 | 1.00 | ||
Single/separated/divorced/widowed | 409 (79.2) | 1.79 (1.02-3.00) | .028 | 0.99 (0.62-1.59) | .974 |
Employment status
| |||||
Unemployed | 393 (77.4) | 1.00 | 1.00 | ||
Employed | 115 (22.6) | 1.00 (0.58-1.74) | .991 | 1.23 (0.77-1.97) | .386 |
On disability grant ("for AIDS")
| |||||
No | 242 (47.5) | 1.00 | 1.00 | ||
Yes | 268 (52.5) | 1.09 (0.69-1.72) | .722 | 0.91 (0.62-1.34) | .642 |
Residence
| |||||
Rural | 319 (61.7) | 1.00 | 1.00 | ||
Urbanct | 198 (38.3) | 2.78 (1.60-4.83) | .000 | 3.34 (2.13-5.25) | .000 |
VAS adherence (≥ 95%) | Dose, schedule and food adherence | ||||||||
---|---|---|---|---|---|---|---|---|---|
N (%) 519 | Crude OR (95% CI) | P | Adjusted ORa, b
(95% CI) | P | Crude OR (95% CI) | P | Adjusted ORa, c
(95% CI) | P | |
Time since diagnosis
| |||||||||
2006-1995 | 125 (24.8) | 1.00 | 1.00 | ||||||
2007/8 | 379 (75.2) | 0.49 (0.26-0.92) | .026 | ... | 0.80 (0.50-1.26) | .330 | --- | ||
Hospital admission in the past 6 months | |||||||||
No | 463 (89.7) | 1.00 | 1.00 | ||||||
Yes | 53 (10.3) | 1.51 (0.62-3.69) | .326 | ... | 0.98 (0.51-1.85) | .937 | --- | ||
CD4 count
| |||||||||
≤ 200 | 420 (83.2) | 1.00 | ... | 1.00 | 1.00 | ||||
>200 | 85 (16.8) | 1.19 (0.63-2.26) | .599 | 2.90 (1.52-5.53) | .001 | 3.32 (1.18-9.38) | .023 | ||
HIV symptoms (range 0-20)
| |||||||||
M (SD) | 1.2 (2.6) | 1.08 (0.96-1.21) | .213 | ... | 1.06 (0.97-1.15) | .199 | --- | ||
Overall Quality of Life
d
| |||||||||
M (SD) | 4.3 (0.7) | 2.87 (2.00-4.10) | .000 | 0.94 (0.52-1.68) | .830 | 3.91 (2.71-5.65) | .000 | 2.06 (1.07-3.98) | .031 |
General health perceptionsd
| |||||||||
M (SD) | 4.4 (0.7) | 2.69 (1.95-3.73) | .000 | 1.72 (1.01-2.95) | .047 | 3.72 (2.62-5.28) | .000 | 1.57 (0.89-2.79) | .121 |
WHOQOL-HIV BREFscores
| |||||||||
Physical domaine
| 15.6 (2.7) | 1.35 (1.22-1.49) | .000 | 0.94 (0.78-1.13) | .512 | 1.54 (1.40-1.69) | .000 | 0.87 (0.70-1.08) | .201 |
Psychological domaine
| 14.6 (3.2) | 1.40 (1.28-1.53) | .000 | 1.17 (0.97-1.41) | .099 | 1.65 (1.50-1.81) | .000 | 1.00 (0.81-1.23) | .970 |
Level of independence domaine
| 14.5 (1.9) | 1.42 (1.29-1.56) | .080 | ... | 1.10 (0.98-1.24) | .103 | ... | ||
Social relationships domaine
| 13.4 (2.6) | 1.52 (1.37-1.69) | .000 | 1.14 (1.00-1.30) | .048 | 1.65 (1.49-1.83) | .000 | 1.05 (0.89-1.24) | .549 |
Environment domaine
| 13.9 (2.6) | 1.76 (1.56-2.00) | .000 | 1.56 (1.28-1.89) | .000 | 2.46 (2.11-2.87) | .000 | 2.21 (1.71-2.86) | .000 |
Spirituality/religion/personal beliefs domaine
| 15.3 (2.9) | 1.17 (1.08-1.27) | .000 | 0.76 (0.63-0.91) | .003 | 1.40 (1.29-1.51) | .000 | 1.06 (0.89-1.28) | .507 |
Depression score (higher score = more depressed) | 17.3 (3.3) | 0.78 (0.72-0.84) | .000 | 0.88 (0.80-0.96) | .006 | 0.63 (0.58-0.69) | .000 | 0.71 (0.62-0.80) | .000 |
ART regimen | |||||||||
3TC, d4T + Efavirenz | 411 (79.2) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
3TC, d4T + Nevirapine | 108 (20.8) | 4.08 (1.73-9.63) | .001 | 2.16 (0.80-5.87) | .130 | 5.25 (2.57-10.72) | .000 | 4.61 (1.48-14.34) | .008 |
VAS adherence (≥ 95%) | Dose, schedule and food adherence | ||||||||
---|---|---|---|---|---|---|---|---|---|
Behavioural variables (moderating factors) | N (%) 519 | Crude OR (95% CI) | P | Adjusted ORa, b
(95% CI) | P | Crude OR (95% CI) | P | Adjusted ORa, c
(95% CI) | P |
TCAM use for HIV
| |||||||||
No | 375 (72.0) | 1.00 | 1.00 | 1.00 | |||||
Yes | 144 (28.0) | 0.41 (0.28-0.66) | .000 | 0.62 (0.29-1.34) | .226 | 0.66 (0.43-1.00) | .049 | ... | |
Herbal use for HIV
| |||||||||
No | 476 (92.0) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
Yes | 43 (8.0) | 0.13 (0.07-0.26) | .000 | 0.70 (0.21-1.61) | .296 | 0.04 (0.02-0.12) | .000 | 0.12 (0.03-0.51) | .004 |
Past month alcohol use
| |||||||||
No | 509 (97.5) | 1.00 | 1.00 | 1.00 | |||||
Yes | 13 (2.5) | 0.08 (0.03-0.28) | .000 | 0.47 (0.04-5.84) | .556 | 0.03 (0.00-0.25) | .001 | ... | |
AUDIT-C 4 or more
| |||||||||
No | 506 (98.1) | 1.00 | 1.00 | 1.00 | |||||
Yes | 10 (1.9) | 0.08 (0.02-0.33) | .000 | 0.76 (0.04-13.48) | .851 | 0.04 (0.01-0.35) | .003 | ... | |
Discrimination experiences score (higher score= higher level of discrimination)
| 0.44 (0.36-0.54) | .000 | 0.60 (0.46-0.78) | .000 | 0.20 (0.15-0.27) | .000 | 0.28 (0.19-0.41) | .000 | |
Stigma score (higher score= higher stigma)
| 1.11 (0.97-1.27) | .141 | ... | 0.98 (0.88-1.09) | .717 | ... | |||
Social support score (higher score = higher support
| 1.26 (1.13-1.40) | .000 | 1.20 (1.00-1.45) | .046 | 1.17 (1.08-1.28) | .000 | 0.97 (0.81-1.17) | .769 | |
Information-motivation-behavioural skills model
| |||||||||
IMB adherence information (higher score = higher adherence information) | 1.42 (1.31-1.55) | .000 | 1.11 (1.01-1.22) | .032 | 1.55 (1.43-1.69) | .000 | 1.26 (1.12-1.43) | .000 | |
IMB adherence motivation (higher score = higher adherence motivation) | 1.13 (1.08-1.17) | .000 | 1.03 (0.97-1.10) | .333 | 1.14 (1.10-1.18) | .000 | 1.02 (0.96-1.10) | .482 | |
IMB behavioral skills (higher score = higher behavioural skills) | 1.21 (1.16-1.26) | .000 | 1.07 (1.01-1.14) | .023 | 1.34 (1.28-1.41) | .000 | 1.14 (1.07-1.21) | .000 |