A comparison of sexual risk behaviour between HIV positive and HIV negative men in Gauteng and the Western Cape

A research report submitted in partial fulfilment of the requirements for the degree of Master of Science in Epidemiology in the field of Infectious Diseases School of Public Health, University of the Witwatersrand May 2014South Africa continues to grapple with the HIV/AIDS epidemic almost 30 years since the disease was first described. South Africa has 6.4 million people living with HIV thereby contributing 17% to the global burden of HIV/AIDs even though it makes up 0.7% of the world population translating to an HIV prevalence of 10.6% in the general population. . Multiple concurrent sexual partnerships (MCP) and inconsistent condom use are notably the major contributors to the spread or transmission of HIV in South Africa. The South African government has allocated massive financial resources to support HIV/AIDS interventions, however, the epidemic continues to amplify in South Africa and there is a growing need for targeted HIV prevention interventions which will address behaviour change. Objectives The objectives of the study were to determine the differences in sexual risk behaviour between self-identified HIV positive and HIV negative men and identify factors associated with sexual risk behaviour. Methodology This was secondary data analysis of a cross sectional design study called "Risk Perceptions of HIV Positive Men" and it was conducted in clinics from Soweto, Cape Town and the Cape Winelands from October 2010 to July 2011. The sample size was 451 and the study population comprised self-identified HIV positive and negative men between ages 18 - 60 years. Proportion of consistent condom use (CCU) and multiple concurrent partnerships (MCP) were calculated and difference between those self-identified HIV positive and negative were determined using Chi-square tests. Factors associated with MCP and CCU between the two groups was determined using univariable and multivariable logistic regression Results We analysed data for 451 men with a mean age of 39 years (std. dev. 11.30). Out of the 451 men 311 (69%) identified themselves as HIV positive and there was a statistical significant difference in baseline characteristics between HIV positive and HIV negative men (age, race, relationship status, employment status, education level, religion, area of residence, age at sexual debut, condom use at first sex, sexual orientation and circumcision status). HIV positive men were four times more likely to have used condoms consistently in the last six months compared to HIV negative men (AOR=3.72, CI: 1.95-7.11), however, HIV positive men were also four times more likely to have had Multiple Concurrent Partnerships in the last 12 months compared to HIV negative men (AOR=4.60, CI: 2.09- 10.12) . Other factors associated with sexual risk behaviour were; relationship status, age group, race, age at sexual debut, alcohol frequency, sexual orientation and perceptions about undetectable viral load reducing HIV transmission risk. Conclusion and recommendation There is a difference in sexual risk behaviour between men who identified themselves as HIV positive and those who identified themselves as HIV negative. Men who identified themselves as HIV negative were less likely to have used condoms consistently in the last six months. Though the HIV positive men are using condoms consistently they have multiple concurrent partners. There is need to strengthen post HIV test counselling coupled with targeted messages for both HIV positive and HIV negative men

Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa.

Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO).We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO.The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO.Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care

Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa.

Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO).We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO.The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO.Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care

Patient characteristics by provider type.

<p>Patient characteristics by provider type.</p

Participant enrollment and MDR-TB treatment outcomes between CNP and MO.

<p>Participant enrollment and MDR-TB treatment outcomes between CNP and MO.</p

Patient outcome data by provider type.

<p>Patient outcome data by provider type.</p

Multivariate Cox proportional harzard model on time to one of the four treatment outcomes for comparison of cause-specific hazard between provider type.

<p>Multivariate Cox proportional harzard model on time to one of the four treatment outcomes for comparison of cause-specific hazard between provider type.</p