Barriers to Care and 1-Year Mortality Among Newly Diagnosed HIV-Infected People in Durban, South Africa

Background: Prompt entry into HIV care is often hindered by personal and structural barriers. Our objective was to evaluate the impact of self-perceived barriers to health care on 1-year mortality among newly diagnosed HIV-infected individuals in Durban, South Africa. Methods: Before HIV testing at 4 outpatient sites, adults (≥18 years) were surveyed regarding perceived barriers to care including (1) service delivery, (2) financial, (3) personal health perception, (4) logistical, and (5) structural. We assessed deaths via phone calls and the South African National Population Register. We used multivariable Cox proportional hazards models to determine the association between number of perceived barriers and death within 1 year. Results: One thousand eight hundred ninety-nine HIV-infected participants enrolled. Median age was 33 years (interquartile range: 27–41 years), 49% were females, and median CD4 count was 192/μL (interquartile range: 72–346/μL). One thousand fifty-seven participants (56%) reported no, 370 (20%) reported 1–3, and 460 (24%) reported >3 barriers to care. By 1 year, 250 [13%, 95% confidence interval (CI): 12% to 15%] participants died. Adjusting for age, sex, education, baseline CD4 count, distance to clinic, and tuberculosis status, participants with 1–3 barriers (adjusted hazard ratio: 1.49, 95% CI: 1.06 to 2.08) and >3 barriers (adjusted hazard ratio: 1.81, 95% CI: 1.35 to 2.43) had higher 1-year mortality risk compared with those without barriers. Conclusions: HIV-infected individuals in South Africa who reported perceived barriers to medical care at diagnosis were more likely to die within 1 year. Targeted structural interventions, such as extended clinic hours, travel vouchers, and streamlined clinic operations, may improve linkage to care and antiretroviral therapy initiation for these people

Trends in oncological imaging during the COVID‐19 pandemic through the vaccination era

Abstract Background This study examines the impact that the COVID‐19 pandemic has had on computed tomography (CT)‐based oncologic imaging utilization. Methods We retrospectively analyzed cancer‐related CT scans during four time periods: pre‐COVID (1/5/20–3/14/20), COVID peak (3/15/20–5/2/20), post‐COVID peak (5/3/20–12/19/20), and vaccination period (12/20/20–10/30/21). We analyzed CTs by imaging indication, setting, and hospital type. Using percentage decrease computation and Student's t‐test, we calculated the change in mean number of weekly cancer‐related CTs for all periods compared to the baseline pre‐COVID period. This study was performed at a single academic medical center and three affiliated hospitals. Results During the COVID peak, mean CTs decreased (−43.0%, p < 0.001), with CTs for (1) cancer screening, (2) initial workup, (3) cancer follow‐up, and (4) scheduled surveillance of previously treated cancer dropping by 81.8%, 56.3%, 31.7%, and 45.8%, respectively (p < 0.001). During the post‐COVID peak period, cancer screenings and initial workup CTs did not return to prepandemic imaging volumes (−11.4%, p = 0.028; −20.9%, p = 0.024). The ED saw increases in weekly CTs compared to prepandemic levels (+31.9%, p = 0.008), driven by increases in cancer follow‐up CTs (+56.3%, p < 0.001). In the vaccination period, cancer screening CTs did not recover to baseline (−13.5%, p = 0.002) and initial cancer workup CTs doubled (+100.0%, p < 0.001). The ED experienced increased cancer‐related CTs (+75.9%, p < 0.001), driven by cancer follow‐up CTs (+143.2%, p < 0.001) and initial workups (+46.9%, p = 0.007). Conclusions and relevance The pandemic continues to impact cancer care. We observed significant declines in cancer screening CTs through the end of 2021. Concurrently, we observed a 2× increase in initial cancer workup CTs and a 2.4× increase in cancer follow‐up CTs in the ED during the vaccination period, suggesting a boom of new cancers and more cancer examinations associated with emergency level acute care