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The association between social capital and HIV treatment outcomes in South Africa

<div><p>Background</p><p>HIV treatment has reduced morbidity and mortality. By 2012, it was estimated that 60.4% of eligible South Africans accessed antiretroviral treatment; however, treatment adherence and retention remain the greatest challenges. There is a growing belief that social capital, seen as "the features of social organization that facilitate cooperation for mutual benefit", is important in promoting HIV treatment retention. The aim of this study was to establish whether social capital is associated with HIV treatment outcomes.</p><p>Methods and findings</p><p>This was a cross-sectional analysis of data from a cohort study that investigated how patient outcomes were linked to clinical characteristics, and included exploratory factor and logistic regression analysis. Data from 943 patients were analyzed. Outcomes for the analysis were visit non-adherence, unsuppressed viral load, and treatment failure. Sixteen percent of patients (n = 118) had unsuppressed viral loads; 19% (n = 179) were non-adherent; and 32% (n = 302) experienced treatment failure. Social capital had two dimensions that were described by two factors. There was no association between either factor and visit non-adherence. Social capital factor 1 was marginally associated with lower risks of unsuppressed viral load and treatment failure at 12 months (OR = 0.78; 95% CI = 0.58–1.03 and OR = 0.76; 95% CI = 0.62–0.93, respectively); but not with visit non-adherence (OR = 0.93; 95% CI = 0.71–1.22). After controlling for confounders, the odds of both unsuppressed viral load and treatment failure decreased with an increase in social capital factor 1.</p><p>Conclusion</p><p>This study suggests that social capital, in terms of the number of groups to which an HIV-infected person belongs, the diversity of the groups, availability of child support, and time available for community projects, is protective against poor HIV treatment outcomes. Implementers and policy makers in the areas of HIV treatment and prevention need to consider the inclusion of social capital in the design of HIV/AIDS treatment program.</p></div

Demographic characteristics of study participants (N = 943).

<p>Demographic characteristics of study participants (N = 943).</p

Categories of social capital measured on the questionnaire.

<p>Categories of social capital measured on the questionnaire.</p

Results of factor analysis, showing loadings.

<p>Results of factor analysis, showing loadings.</p

Multivariable logistic model showing association between social capital and the three treatment outcomes.

<p>Multivariable logistic model showing association between social capital and the three treatment outcomes.</p

Univariable logistic regression analysis for HIV treatment outcomes.

<p>Univariable logistic regression analysis for HIV treatment outcomes.</p

Mean social capital scores at baseline.

<p>Mean social capital scores at baseline.</p

Number and proportions of participants in the study at various stages.

<p>Number and proportions of participants in the study at various stages.</p

Depression and alcohol use disorder at antiretroviral therapy initiation led to disengagement from care in South Africa

<div><p>We sought to assess mental health at the time of antiretroviral therapy (ART) initiation and subsequent retention in care over a six-month follow-up period. A total of 136 people living with HIV in South Africa were administered surveys measuring demographic information and mental health indicators at the time of ART initiation. Follow-up was completed via chart abstraction to assess for six-month outcomes of retention in care and viral suppression. At enrollment, 45/136 (33%), 67/136 (49%), and 45/136 (33%) participants screened positive for depression, anxiety, and alcohol use disorder, respectively. After six months of follow-up, 96/136 (71%) participants remained in care; 35/87 (40.2%) participants who remained in care had a level <50 copies/mL. Those with depression (49% vs. 77% retained; p < 0.01) and those with alcohol use disorder (52% vs. 76% retained; p < 0.01) were less likely to be retained in care. In multivariable logistic regression, depression OR 3.46 (95% CI: 1.33, 7.97; p < 0.01) and alcohol abuse OR 3.89 (95% CI: 1.70, 8.97; p < 0.01) were independently associated with loss from care. These results emphasize the importance of mental health on early ART outcomes and the HIV care continuum.</p></div