Introduction
Methods
Study Setting and Design
Data Collection
Analytic Variables
Results
Demographic Characteristics
Baseline Social Support and Health-Seeking Behaviour (Table 1)
Female | Male | Total | |
---|---|---|---|
No | No | No | |
Median age at HIV diagnosis, years (IQR) | 32 (27.0–38.0) | 36 (31.0–42.0) | 33 (28.0–39.0) |
Age at HIV diagnosis, years | |||
18–29.99 | 160 (38.3) | 45 (19.2) | 205 (31.4) |
30–39.99 | 182 (43.5) | 111 (47.4) | 293 (44.9) |
40+ | 76 (18.2) | 78 (33.3) | 154 (23.6) |
Education level | |||
Primary school or less | 52 (12.4) | 39 (16.7) | 91 (14.0) |
Some secondary school | 243 (58.1) | 141 (60.3) | 384 (58.9) |
≥Grade 12 | 123 (29.4) | 54 (23.1) | 177 (27.1) |
English literacy | |||
I can read very well | 245 (58.9) | 110 (47) | 355 (54.6) |
I can read somewhat | 132 (31.7) | 97 (41.5) | 229 (35.2) |
I cannot read | 39 (9.4) | 27 (11.5) | 66 (10.2) |
Primary source of income/finances | |||
Paid job, salary or business | 212 (51.1) | 194 (84.0) | 406 (62.8) |
Spouse/ partner | 102 (24.6) | 10 (4.3) | 112 (17.3) |
Parents/relatives/friends/other | 101 (24.3) | 27 (11.7) | 128 (19.8) |
Breadwinner of household | |||
Yes | 152 (37.1) | 179 (76.8) | 331 (51.5) |
No | 261 (63.7) | 54 (23.2) | 315 (49.0) |
Marital status | |||
Married | 39 (9.4) | 53 (22.6) | 92 (14.1) |
In a relationship (living together) | 152 (36.5) | 78 (33.3) | 230 (35.3) |
In a relationship (not living together) | 139 (33.3) | 63 (26.9) | 202 (31.0) |
Not in a relationship | 87 (20.9) | 40 (17.1) | 127 (19.5) |
Number of sexual partner in the past 12 months | |||
None | 47 (11.5) | 17 (7.3) | 64 (10.0) |
1 partner | 260 (63.4) | 118 (50.6) | 378 (58.8) |
≥ 2 partners | 103 (25.1) | 98 (42.1) | 201 (31.3) |
Condom use at last sex | |||
Yes | 128 (31.1) | 83 (35.6) | 211 (32.7) |
No | 284 (68.9) | 150 (64.4) | 434 (67.3) |
Lives with | |||
Partner/spouse | 181 (49.9) | 105 (47.3) | 286 (48.9) |
Family/friends | 114 (31.4) | 35 (15.8) | 149 (25.5) |
Alone | 68 (18.7) | 82 (36.9) | 150 (25.6) |
Number of child dependents | |||
None | 222 (54.0) | 159 (68.5) | 381 (59.3) |
1–2 children | 145 (35.3) | 52 (22.4) | 197 (30.6) |
≥ 3 children | 44 (10.7) | 21 (9.1) | 65 (10.1) |
Primary house | |||
Current house | 144 (35.0) | 91 (39.6) | 235 (36.7) |
Another province/rural | 145 (35.3) | 80 (34.8) | 225 (35.1) |
Another country | 122 (29.7) | 59 (25.7) | 181 (28.2) |
Housing type | |||
House/Flat | 93 (22.4) | 42 (18.1) | 135 (20.9) |
Cottage/room in backyard | 204 (49.2) | 102 (44.0) | 306 (47.3) |
Informal dwelling/shack | 118 (28.4) | 88 (37.9) | 206 (31.8) |
Household density | |||
Low density | 112 (27.5) | 88 (38.4) | 200 (31.4) |
Med density | 181 (44.4) | 99 (43.2) | 280 (44.0) |
High density | 115 (28.2) | 42 (18.3) | 157 (24.6) |
Duration at current house | |||
Less than 1 year | 89 (21.4) | 34 (14.6) | 123 (19.0) |
1–5 years | 145 (34.9) | 67 (28.8) | 212 (32.7) |
More than 5 years | 182 (43.8) | 132 (56.7) | 314 (48.4) |
Recent clinic attendance (any reason) | |||
Never | 40 (9.7) | 67 (28.8) | 107 (16.6) |
≤ 12 months | 89 (38.2) | 342 (53.0) | |
> 12 months | 119 (28.9) | 77 (33.0) | 196 (30.4) |
HIV testing history | |||
≤ 12 months ago | 149 (36.3) | 54 (23.2) | 203 (31.6) |
> 12 months ago | 202 (49.1) | 85 (36.5) | 287 (44.6) |
Never tested for HIV before current test | 60 (14.6) | 93 (39.9) | 153 (23.8) |
Reason for seeking an HIV testing | |||
Just to know | 86 (20.9) | 26 (11.2) | 112 (17.4) |
Current or previous HIV risk | 48 (11.7) | 48 (20.7) | 96 (14.9) |
Experiencing symptoms | 277 (67.4) | 158 (68.1) | 435 (67.6) |
Perceived social support (PSS) | |||
Med to high PSS | 391 (95.1) | 221 (95.7) | 612 (95.3) |
Low PSS | 20 (4.9) | 10 (4.3) | 30 (4.7) |
Disclosed intention to test for HIV | |||
Partner/spouse | 132 (32.1) | 92 (39.7) | 224 (34.8) |
Family/friends/other | 136 (33.1) | 41 (17.7) | 177 (27.5) |
No one | 143 (34.8) | 99 (42.7) | 242 (37.6) |
Support at clinic for latest HIV test | |||
Partner/spouse | 37 (9.0) | 39 (16.8) | 76 (11.8) |
Family | 54 (13.1) | 9 (3.9) | 63 (9.8) |
Other | 22 (5.4) | 6 (2.6) | 28 (4.4) |
No one | 298 (72.5) | 178 (76.7) | 476 (74.0) |
Intention to disclose HIV test result | |||
Yes | 395 (96.3) | 223 (96.5) | 618 (96.3) |
No | 15 (3.7) | 8 (3.5) | 24 (3.7) |
Intention to start ART | |||
Yes | 406 (99.3) | 225 (99.6) | 631 (99.4) |
No | 3 (0.7) | 1 (0.4) | 4 (0.6) |
Depression | |||
No depression | 372 (91.0) | 205 (91.1) | 577 (91.0) |
Major depression | 37 (9.0) | 20 (8.9) | 57 (9.0) |
Concerns regarding ART | |||
Low | 197 (47.9) | 110 (47.4) | 307 (47.7) |
Medium | 214 (52.1) | 121 (52.2) | 335 (52.1) |
High | 0 | 1 (0.4) | 1 (0.2) |
Baseline CD4 count | |||
< 350 | 120 (28.7) | 71 (30.3) | 191 (29.3) |
350–500 | 38 (9.1) | 19 (8.1) | 57 (8.7) |
> 500 | 62 (14.8) | 10 (4.3) | 72 (11.0) |
Missing | 198 (47.4) | 134 (57.3) | 332 (50.9) |
ART Deferral at the Testing Site, Six-Months After HIV Diagnosis (Table 2)
Not initiated on ART (n = 99) | RR | RR | |
---|---|---|---|
No. (%) | 95% CI | 95% CI | |
Sex | |||
Female | 51 (12.2) | 1 | 1 |
Male | 48 (20.5) | 1.7 (1.2–2.4) | 1.1 (0.8–1.6) |
Age at HIV diagnosis. years | |||
18–29.9 | 21 (10.2) | 1 | 1 |
30–39.9 | 57 (19.5) | 1.9 (1.2–3.0) | 1.5 (1.0–2.2) |
40+ | 21 (13.6) | 1.3 (0.8–2.3) | 1.2 (0.8–2.0) |
Marital status | |||
Married | 19 (20.7) | 1 | |
In a relationship (living together) | 28 (12.2) | 0.6 (0.3–1.0) | |
In a relationship (not living together) | 31 (15.3) | 0.7 (0.4–1.2) | |
Not in a relationship | 21 (16.5) | 0.8 (0.5–1.4) | |
Education level | |||
Primary school or less | 16 (17.6) | 1 | |
Some secondary school | 64 (16.7) | 0.9 (0.6–1.6) | |
≥Grade 12 | 19 (10.7) | 0.6 (0.3–1.1) | |
English literacy | |||
I can read very well | 44 (12.4) | 1 | 1 |
I can read somewhat | 43 (18.8) | 1.5 (1–2.0) | 1.2 (0.9–1.7) |
I cannot read | 12 (18.2) | 1.5 (0.8–2.6) | 0.9 (0.5–1.6) |
Primary house | |||
Current house | 22 (9.4) | 1 | 1 |
Another province/rural | 34 (15.1) | 1.6 (0.9–2.7) | 1.6 (1.1–2.3) |
Another country | 41 (22.7) | 2.4 (1.5–3.9) | 2.1 (1.4–3.1) |
Primary source of income/finances | |||
Paid job. salary or business | 63 (15.5) | 1 | |
Spouse/partner | 15 (13.4) | 0.9 (0.5–1.5) | |
Parents/ relatives/friends/other | 18 (14.1) | 0.9 (0.6–1.5) | |
Breadwinner of household | |||
Yes | 50 (15.1) | 1 | |
No | 47 (14.9) | 1.0 (0.7–1.4) | |
Lives with | |||
Partner/spouse | 37 (12.9) | 1 | |
Family/friends | 24 (16.1) | 1.2 (0.8–2.0) | |
Alone | 25 (16.7) | 1.3 (0.8–2.1) | |
Number of child dependents | |||
None | 55 (14.4) | 1 | |
1–2 children | 17 (14.0) | 1.0 (0.6–1.6) | |
≥3 children | 27 (18.0) | 1.2 (0.8–1.9) | |
Last visit to any health provider | |||
Never | 21 (19.6) | 1 | |
Within a year | 51 (14.9) | 0.8 (0.5–1.2) | |
More than a year ago | 25 (12.8) | 0.6 (0.4–1.1) | |
Ever visited current clinic | |||
Yes | 37 (14.3) | 1 | |
No | 39 (13.9) | 1.0 (0.6–1.5) | |
Last HIV test before current test | |||
≤12 months ago | 19 (9.4) | 1 | 1 |
> 12 months ago | 49 (17.1) | 1.8 (1.1–3.0) | 1.3 (0.9–2.0) |
Never tested for HIV before current test | 27 (17.6) | 1.9 (1.1–3.3) | 1.3 (0.8–2.0) |
Condom use at last sex | |||
Yes | 35 (16.6) | 1 | |
No | 62 (14.3) | 0.9 (0.6–1.3) | |
Number of sexual partner in the past 12 months | |||
None | 9 (14.1) | 1 | |
1 partner | 59 (15.6) | 1.1 (0.6–2.1) | |
2+ partners | 29 (14.4) | 1.1 (0.5–2.1) | |
Reason for seeking an HIV testing | |||
Just to know | 10 (8.9) | 1 | 1 |
Current or previous HIV risk | 11 (11.5) | 1.3 (0.6–2.9) | 1.0 (0.5–2.0) |
Experiencing symptoms | 73 (18.0) | 2.0 (1.1–3.8) | 1.2 (0.7–2.0) |
Depression | |||
No depression | 81 (14.0) | 1 | |
Major depression | 12 (21.1) | 1.5 (0.9–2.6) | |
Perceived social support | |||
Medium to high | 90 (14.7) | 1 | |
Low | 4 (13.3) | 0.9 (0.4–2.3) | |
Intention to disclose | |||
Yes | 91 (14.7) | 1 | |
No | 3 (12.5) | 0.8 (0.3–2.5) | |
Disclosed intention to test | |||
partner/spouse | 21 (9.4) | 1 | 1 |
Family/friends/other | 16 (9.0) | 1.0 (0.5–1.8) | 1.1 (0.7–1.9) |
No one | 58 (24) | 2.6 (1.6–4.1) | 1.9 (1.3–2.8) |
Concerns regarding ART | |||
Low | 54 (17.6) | 1 | |
Medium | 68 (20.3) | 1.2 (0.8–1.6) | |
High | 1 (100) | – | |
Support at clinic for latest HIV test | |||
Partner/spouse | 8 (10.5) | 1 | |
Family/other | 14 (15.4) | 1.5 (0.6–3.3) | |
No one | 73 (15.3) | 1.5 (0.7–2.9) | |
Baseline CD4 | |||
< 350 | 18 (9.4) | 1 | |
350–500 | 6 (10.5) | 1.1 (0.5–2.7) | 1.3 (0.6–3.1) |
> 500 | 4 (5.6) | 0.6 (0.2–1.7) | 0.7 (0.2–2.0) |
Missing | 98 (29.5) | 3.1 (2.0–5.0) | 3.0 (1.8–4.7) |
Baseline Predictors of ART Deferral Among Newly Diagnosed Male Participants (Table 3)
Not initiated on ART (n = 48) | RR | |
---|---|---|
No. (%) | 95% CI | |
Age at HIV diagnosis. years | ||
18–29.99 | 5 (11.1) | 1 |
30–39.99 | 29 (26.1) | 2.4 (1.0–5.7) |
40+ | 14 (17.9) | 1.6 (0.6–4.2) |
Marital status | ||
Married | 12 (22.6) | 1 |
In a relationship (living together) | 12 (15.4) | 0.7 (0.3–1.4) |
In a relationship (not living together) | 15 (23.8) | 1.1 (0.5–2.0) |
Not in a relationship | 9 (22.5) | 0.9 (0.5–2.1) |
Education level | ||
Primary school or less | 11 (28.2) | 1 |
Some secondary school | 29 (20.6) | 0.7 (0.4–1.3) |
≥ Grade 12 | 8 (14.8) | 0.5 (0.2–1.2) |
English literacy | ||
I can read very well | 18 (16.4) | 1 |
I can read somewhat | 22 (22.7) | 1.4 (0.8–2.4) |
I cannot read | 8 (29.6) | 1.8 (0.9–3.7) |
Primary house | ||
Current house | 11 (12.1) | 1 |
Another province/rural | 16 (20.0) | 1.7 (0.8–3.4) |
Another country | 20 (33.9) | 2.8 (1.4–5.4) |
Primary source of income/finances | ||
Paid job salary or business | 38 (19.6) | 1 |
Spouse/ partner | 2 (20.0) | 0.9 (0.3–3.7) |
Parents/relatives/friends/other | 6 (22.2) | 1.1 (0.5–2.4) |
Breadwinner of household | ||
Yes | 31 (17.3) | 1 |
No | 16 (29.6) | 1.7 (1.0–2.9) |
Lives with | ||
Partner/spouse | 16 (15.2) | 1 |
Family/friends | 11 (31.4) | 2.1 (1.0–4.0) |
Alone | 16 (19.5) | 1.3 (0.7–2.4) |
Number of child dependents | ||
None | 29 (18.2) | 1 |
1–2 children | 9 (28.1) | 1.5 (0.8–2.9) |
≥3 children | 10 (23.3) | 1.3 (0.7–2.4) |
Last visit to any health provider | ||
Never | 16 (23.9) | 1 |
Within a year | 17 (19.1) | 0.8 (0.4–1.5) |
More than a year ago | 14 (18.2) | 0.8 (0.4–1.4) |
Ever visited current clinic | ||
Yes | 13 (17.6) | 1 |
No | 18 (19.6) | 1.1 (0.6–2.1) |
Last HIV test before current test | ||
≤ 12 months ago | 9 (16.7) | 1 |
> 12 months ago | 21 (24.7) | 1.8 (1.1–3.0) |
Never tested for HIV before current test | 16 (17.2) | 1.9 (1.1–3.3) |
Condom use at last sex | ||
Yes | 17 (20.5) | 1 |
No | 30 (20.0) | 1.0 (0.6–1.7) |
Number of sexual partner in the past 12 months | ||
None | 3 (17.6) | 1 |
1 partner | 25 (21.2) | 1.2 (0.4–3.6) |
2+ partners | 19 (19.4) | 1.1 (0.4–3.3) |
Reason for seeking an HIV test | ||
Just to know | 1 (3.8) | 1 |
Current or previous HIV risk | 5 (10.4) | 2.7 (0.3–22.1) |
Experiencing symptoms | 41 (26.5) | 6.9 (0.9–48.1) |
Depression | ||
No depression | 37 (18.0) | 1 |
Major depression | 7 (35.0) | 1.9 (0.9–3.8) |
Perceived social support | ||
Medium to high | 43 (19.5) | 1 |
Low | 2 (20.0) | 1.0 (0.3–3.7) |
Intention to disclose HIV positive diagnosis | ||
Yes | 43 (19.3) | 1 |
No | 2 (25.0) | 1.3 (0.4–4.4) |
Disclosed intention to test for HIV | ||
Partner/spouse | 9 (9.8) | 1 |
Family/friends/other | 5 (12.2) | 1.2 (0.4–3.5) |
No one | 32 (32.3) | 3.3 (1.7–6.6) |
Concerns regarding ART | ||
Low | 21 (19.1) | 1 |
Medium | 33 (27.3) | 1.4 (0.9–2.3) |
High | 1 (100) | – |
Support at clinic for latest HIV test | ||
Partner/spouse | 2 (5.1) | 1 |
Family | 2 (13.3) | 2.6 (0.4–16.9) |
No one | 42 (23.6) | 4.6 (1.2–18.3) |
Baseline CD4 (up to 30 post-test) | ||
< 350 | 7 (9.9) | 1 |
350–500 | 1 (5.3) | 0.5 (0.1–4.1) |
> 500 | 1 (10.0) | 1.0 (0.1–7.4) |
Missing | 48 (35.8) | 3.6 (1.7–7.6) |
Reason for Deferring ART Initiation Among Newly Diagnosed Participants (Table 4)
Women | Men | Total | No ART at six months | |
---|---|---|---|---|
N = 24 | N = 19 | N = 43 | ||
n (%) | n (%) | n (%) | RR (95 % CI) | |
Did you move from your house in the last 6 months? | ||||
Yes | 14 (58.3) | 12 (63.2) | 26 (60.5) | 1.6 (0.9–2.7) |
No | 10 (41.7) | 7 (36.8) | 17 (39.5) | 1 |
New location of those who moved | ||||
Yes, other country | 1 (5.0) | 1 (5.9) | 2 (5.4) | 1.1 (0.2–4.7) |
Yes, other province in SA | 3 (15.0) | 0 | 3 (8.1) | 2.1 (1.2–3.5) |
Yes, other town/suburb in Gauteng | 6 (30.0) | 9 (52.9) | 15 (40.5) | 1.4 (0.8–2.7) |
No relocation | 10 (50.0) | 7 (41.2) | 17 (48.6) | 1 |
Self-reported ART start at six months | ||||
Yes | 20 (83.3) | 7 (36.8) | 27 (62.8) | |
No | 4 (16.7) | 12 (63.2) | 16 (37.2) | |
ART start at six months at diagnosing clinic | ||||
Yes | 10 (50.0) | 4 (57.1) | 14 (51.9) | |
No | 10 (50.0) | 3 (42.9) | 13 (48.1) | |
ART concerns at six months | ||||
High ART concerns | 1 (5.0) | 2 (10.5) | 3 (7.7) | 0.5 (0.1–2.4) |
Medium ART concerns | 9 (45.0) | 12 (63.2) | 21 (53.8) | 0.9 (0.6–1.4) |
Low ART concerns | 10 (50.0) | 5 (26.3) | 15 (38.5) | 1 |
Depression at six months | ||||
No depression | 12 (92.3) | 12 (92.3) | 24 (92.3) | 1 |
Major depression | 1 (7.7) | 1 (7.7) | 2 (7.7) | 0.8 (0.2–3.4) |
Perceived social support at six months | ||||
Low | 4 (26.7) | 3 (23.1) | 7 (25.0) | 1 |
Medium | 11 (73.3) | 10 (76.9) | 21 (75.0) | 0.9 (0.5–1.6) |
“I have not started my medication yet. I had an emergency in my home country, lost my son in Zimbabwe and was there for five months. I left the country before they could initiate me on treatment, but I am now back but currently in Durban.” – Male participant.“I moved back home to Bulawayo (Zimbabwe) because my mother was sick, after starting ART, but how will I continue with my treatment now that I have moved?”—Female participant.“I have not started ART because I was sick and hospitalized and then moved back home to recuperate. I have just moved back to my current house recently.” – Female participant.