The HIV Care Cascade for Older Adults in Rural South Africa: A Longitudinal Cohort Study (2014-2019).
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 Aug 2024
01 Aug 2024
Historique:
received:
08
12
2023
accepted:
11
04
2024
medline:
25
6
2024
pubmed:
25
6
2024
entrez:
25
6
2024
Statut:
ppublish
Résumé
As people with HIV grow older, stable engagement in care is essential for healthy aging. We evaluate the HIV care cascade for older adults in rural South Africa at 2 time points cross-sectionally and assess movement in the cascade over time. We evaluated the cascade stage at waves 1 (2014-2015) and 2 (2018-2019) of Health and Aging in Africa: A Longitudinal Study of an INDPETH Community in South Africa, a population-based longitudinal cohort study in Mpumalanga Province, South Africa. Biomarker screening defined cascade stages [HIV+/no antiretroviral therapy (ART); ART+/unsuppressed viral load; ART+/suppressed viral load]. Between-wave probability of death, cascade progression, regression, cascade transitions, and sociodemographic predictors were assessed with Poisson regression. The impact of death was considered using the Fine and Gray competing risk model. We observed a higher prevalence of antiretroviral therapy with viral suppression over time (50% in wave 1 vs. 70% in wave 2). Among those alive, the oldest age group (70+ years old) was most likely to have cascade progression [adjusted risk ratio for treatment initiation vs. 40-49 years old: 1.38 (95% confidence interval: 1.02 to 1.86)]. However, there was a significant risk of death and cascade regression. Death between waves reached 40% for 70+-year-olds who were ART+/unsuppressed. In competing risk models, older age was associated with equivalent or less cascade progression. Older age groups who were unsuppressed on treatment and men had poorer cascade outcomes. Improvements observed in HIV treatment coverage over time for older adults must be interpreted in the context of the high risk of death for older HIV-positive adults, especially among those failing treatment.
Sections du résumé
BACKGROUND
BACKGROUND
As people with HIV grow older, stable engagement in care is essential for healthy aging. We evaluate the HIV care cascade for older adults in rural South Africa at 2 time points cross-sectionally and assess movement in the cascade over time.
SETTING
METHODS
We evaluated the cascade stage at waves 1 (2014-2015) and 2 (2018-2019) of Health and Aging in Africa: A Longitudinal Study of an INDPETH Community in South Africa, a population-based longitudinal cohort study in Mpumalanga Province, South Africa.
METHODS
METHODS
Biomarker screening defined cascade stages [HIV+/no antiretroviral therapy (ART); ART+/unsuppressed viral load; ART+/suppressed viral load]. Between-wave probability of death, cascade progression, regression, cascade transitions, and sociodemographic predictors were assessed with Poisson regression. The impact of death was considered using the Fine and Gray competing risk model.
RESULTS
RESULTS
We observed a higher prevalence of antiretroviral therapy with viral suppression over time (50% in wave 1 vs. 70% in wave 2). Among those alive, the oldest age group (70+ years old) was most likely to have cascade progression [adjusted risk ratio for treatment initiation vs. 40-49 years old: 1.38 (95% confidence interval: 1.02 to 1.86)]. However, there was a significant risk of death and cascade regression. Death between waves reached 40% for 70+-year-olds who were ART+/unsuppressed. In competing risk models, older age was associated with equivalent or less cascade progression.
CONCLUSION
CONCLUSIONS
Older age groups who were unsuppressed on treatment and men had poorer cascade outcomes. Improvements observed in HIV treatment coverage over time for older adults must be interpreted in the context of the high risk of death for older HIV-positive adults, especially among those failing treatment.
Identifiants
pubmed: 38916427
doi: 10.1097/QAI.0000000000003445
pii: 00126334-202408010-00004
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
334-340Subventions
Organisme : NIA NIH HHS
ID : P01 AG041710
Pays : United States
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no funding or conflicts of interest to disclose.
Références
Kaplan-Lewis E, Aberg JA, Lee M. Aging with HIV in the ART era. Semin Diagn Pathol. 2017;34:384–397.
Mahy M, Autenrieth CS, Stanecki K, et al. Increasing trends in HIV prevalence among people aged 50 years and older: evidence from estimates and survey data. AIDS. 2014;28(suppl 4):S453–S459.
Shiau S, Bender AA, O'Halloran JA, et al. The current state of HIV and aging: findings presented at the 10th International Workshop on HIV and Aging. AIDS Res Hum Retroviruses. 2020;36:973–981.
Autenrieth CS, Beck EJ, Stelzle D, et al. Global and regional trends of people living with HIV aged 50 and over: estimates and projections for 2000-2020. PLoS One. 2018;13:e0207005.
Hontelez JA, Lurie MN, Newell ML, et al. Ageing with HIV in South Africa. AIDS. 2011;25:1665–1667.
Kong AM, Pozen A, Anastos K, et al. Non-HIV comorbid conditions and polypharmacy among people living with HIV age 65 or older compared with HIV-negative individuals age 65 or older in the United States: a retrospective claims-based analysis. AIDS Patient Care STDS. 2019;33:93–103.
Rosenberg M, Gomez-Olive FX, Wagner RG, et al. The relationships between cognitive function, literacy and HIV status knowledge among older adults in rural South Africa. J Int AIDS Soc. 2020;23:e25457.
Sun-Suslow N, Paolillo EW, Morgan EE, et al. Brief report: frailty and HIV disease severity synergistically increase risk of HIV-associated neurocognitive disorders. J Acquir Immune Defic Syndr. 2020;84:522–526.
Payne CF, Houle B, Chinogurei C, et al. Differences in healthy longevity by HIV status and viral load among older South African adults: an observational cohort modelling study. Lancet HIV. 2022;9:e709–e716.
Cascade Data Use Manual: To Identify Gaps in HIV and Health Services for Programme Improvement. Geneva: World Health Organization; 2018.
Mugglin C, Klager D, Gueler A, et al. The HIV care cascade in sub-Saharan Africa: systematic review of published criteria and definitions. J Int AIDS Soc. 2021;24:e25761.
UNAIDS. Understanding Fast-Track: Accelerating Action to End the AIDS Epidemic by 2030. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS; 2015.
Haber N, Tanser F, Bor J, et al. From HIV infection to therapeutic response: a population-based longitudinal HIV cascade-of-care study in KwaZulu-Natal, South Africa. Lancet HIV. 2017;4:e223–e230.
Lurie MN, Kirwa K, Callaway J, et al. Quantifying the HIV treatment cascade in a South African health sub-district by gender: retrospective cohort study. Trop Med Int Health. 2020;25:186–192.
Marinda E, Simbayi L, Zuma K, et al. Towards achieving the 90-90-90 HIV targets: results from the South African 2017 national HIV survey. BMC Public Health. 2020;20:1375.
Huerga H, Van Cutsem G, Ben Farhat J, et al. Progress towards the UNAIDS 90-90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey. BMC Public Health. 2018;18:303.
Nardell MF, Adeoti O, Peters C, et al. Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis. J Int AIDS Soc. 2022;25:e25889.
Takuva S, Brown AE, Pillay Y, et al. The continuum of HIV care in South Africa: implications for achieving the second and third UNAIDS 90-90-90 targets. AIDS. 2017;31:545–552.
HSRC. South African National HIV Prevalence, Incidence, Behaviour and Communication Survey 2017. Pretoria, South Africa: Human Science Research Council; 2018.
Rohr JK, Manne-Goehler J, Gomez-Olive FX, et al. HIV treatment cascade for older adults in rural South Africa. Sex Transm Infect. 2020;96:271–276.
Haber NA, Lesko CR, Fox MP, et al. Limitations of the UNAIDS 90-90-90 metrics: a simulation-based comparison of cross-sectional and longitudinal metrics for the HIV care continuum. AIDS. 2020;34:1047–1055. doi.
Mody A, Glidden DV, Eshun-Wilson I, et al. Longitudinal care cascade outcomes among people eligible for antiretroviral therapy who are newly linking to care in Zambia: a multistate analysis. Clin Infect Dis. 2020;71:e561–e570.
Hogg RS. Understanding the HIV care continuum. Lancet HIV. 2018;5:e269–e270.
Jose S, Delpech V, Howarth A, et al. A continuum of HIV care describing mortality and loss to follow-up: a longitudinal cohort study. Lancet HIV. 2018;5:e301–e308.
Gomez-Olive FX, Montana L, Wagner RG, et al. Cohort profile: health and ageing in Africa: a longitudinal study of an INDEPTH community in South Africa (HAALSI). Int J Epidemiol. 2018;47:689–690.
Kahn K, Collinson MA, Gomez-Olive FX, et al. Profile: Agincourt health and socio-demographic surveillance system. Int J Epidemiol. 2012;41:988–1001.
Riumallo-Herl C, Canning D, Wagner RG, et al. Health Gradients in South Africa: Inequalities in the Measure of the Beholder. PGDA Working Paper No 139. 2017.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.
Mauer N, Geldsetzer P, Manne-Goehler J, et al. Longitudinal evidence on treatment discontinuation, adherence, and loss of hypertension control in four middle-income countries. Sci Transl Med. 2022;14:eabi9522.
Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702–706.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.
Haber N, Pillay D, Porter K, et al. Constructing the cascade of HIV care: methods for measurement. Curr Opin HIV AIDS. 2016;11:102–108.