Sex differences in antiretroviral treatment outcomes among HIV-infected adults in an urban Tanzanian setting

Hawkins, Claudia; Chalamilla, Guerino; Okuma, James; Spiegelman, Donna; Hertzmark, Ellen; Aris, Eric; Ewald, T arsila; Mugusi, Ferdinand; Mtasiwa, Deo; Fawzi, Wafaie W.

doi:10.1097/qad.0b013e3283471deb

Cited by 128 publications

(117 citation statements)

References 33 publications

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“…17,18 Given the men's strong preference for HIV clinics as their source of FP services, we argue that integrating FP services into HIV clinics should be kept a priority as this model likely fosters male involvement in FP, which, in turn, may improve contraceptive use. 29 In addition, HIVpositive men in SSA tend to have worse clinical outcomes as compared to women [39][40][41][42][43][44][45] and face unique challenges in accessing and remaining in HIV care and treatment, [46][47][48][49][50] and integrated FP services may serve as one of many tools to attract and retain these men.…”

Section: Discussionmentioning

confidence: 99%

HIV-Positive Men's Experiences with Integrated Family Planning and HIV Services in Western Kenya: Integration Fosters Male Involvement

Patel

Baum²,

Grossman

et al. 2014

AIDS Patient Care and STDs

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A growing body of evidence indicates that integrating family planning (FP) services into HIV care is effective at improving contraceptive uptake among HIV-positive women in resource-poor settings, yet little research has examined HIV-positive men's experiences with such integration. We conducted in-depth interviews with 21 HIV-positive men seeking care at HIV clinics in Nyanza, Kenya. All clinics were intervention sites for a FP/ HIV service integration cluster-randomized trial. Grounded theory was used to code and analyze the data. Our findings highlight men's motivations for FP, reasons why men prefer obtaining their FP services, which include education, counseling, and commodities, at HIV care clinics, and specific ways in which integrated FP/HIV services fostered male inclusion in FP decision-making. In conclusion, men appear invested in FP and their inclusion in FP decision-making may bolster both female and male agency. Men's positive attitudes towards FP being provided at HIV care clinics supports the programmatic push towards integrated delivery models for FP and HIV services.

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Section: Discussionmentioning

confidence: 99%

HIV-Positive Men's Experiences with Integrated Family Planning and HIV Services in Western Kenya: Integration Fosters Male Involvement

Patel

Baum²,

Grossman

et al. 2014

AIDS Patient Care and STDs

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“…This prospective observational study was conducted at 12 Management and Development for Health (MDH) HIV care and treatment clinics (CTCs) supported by the U.S. 15,16 For inclusion in these analyses, participants had to be 15 years old and above, not pregnant at the time of enrollment, and have at least two measurements of Hgb concentration.…”

Section: Methodsmentioning

confidence: 99%

Determinants of Anemia Among Human Immunodeficiency Virus-Positive Adults at Care and Treatment Clinics in Dar es Salaam, Tanzania

Petraro¹,

Duggan²,

Spiegelman³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Anemia is often a comorbidity of human immunodeficiency virus (HIV) infection. Many cross-sectional studies have been conducted on anemia and HIV, but few, if any, have addressed incidence of anemia prospectively. A longitudinal analysis was conducted in 48,068 nonpregnant HIV-infected adults in Dar es Salaam, Tanzania, seen at Management and Development for Health–U.S. President's Emergency Plan for AIDS Relief HIV care and treatment programs between 2004 and 2011. Almost 56% (N = 27,184) of study participants had anemia (hemoglobin < 11 g/dL) at the time of enrollment at the clinic. Female gender, low body mass index (BMI), low CD4 T-cell count, high levels of liver enzyme alanine aminotransferase, antiretroviral treatment (ART) regimens, and concurrent tuberculosis treatment were all independently significantly associated with an increased risk of anemia. Low BMI and low CD4 T-cell count were independently significantly associated with an increased risk for iron deficiency anemia (IDA). Higher BMI status and ART use were associated with recovery from anemia. Anemia, including IDA, is a comorbidity that is associated with other adverse consequences (e.g., low BMI and CD4 T-cell count) among individuals with HIV infection, including those on ART. Interventions to prevent anemia and its complications need to be examined in the context of future studies.

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“…[3] Men have a higher mortality than women when receiving ART. [4][5][6][7][8] Although the reasons for this are poorly understood, a number of possible explanations have been suggested; some implicitly blame men for their own poorer outcomes. For example, numerous studies have suggested that men's poorer 'health-seeking behaviour' may prevent them from accessing ART services, being adherent to treatment or remaining in care.…”

mentioning

confidence: 99%

Gender inequality: Bad for men's health

Cornell

2013

South. Afr. j. HIV med.

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FORUMMen's increased risk of death in ART programmes in sub-Saharan Africa is widely reported but poorly understood. Some studies have attributed this risk to men's poorer health-seeking behaviour, which may prevent them from accessing ART, being adherent to treatment, or remaining in care. In a multicentre analysis of 46 201 adults starting ART in urban and rural settings in South Africa, these factors only partly explained men's increased mortality while receiving ART. Importantly, the gender difference in mortality among patients receiving ART (31% higher for men than women) was substantially smaller than that among HIVnegative South Africans, where men had twice the risk of death compared with women. Yet, this extreme gender inequality in mortality, both within and outside of ART programmes, has not given rise to widespread action. Here it is argued that, despite their dominance in society, men may be subject to a wide range of unfair discriminatory practices, which negatively affect their health outcomes. The health needs of men and boys require urgent attention. Sub-Saharan Africa is the centre of the HIV epidemic, with an estimated 68% of all people HIV-infected.[1] Over the past 10 years, largely through international aid programmes, there has been a dramatic increase in the number of HIV-infected individuals who have started antiretroviral therapy (ART) in the region. Despite early concerns that women may be disadvantaged in ART programmes, disproportionately more women than men have accessed ART in Southern Africa.[2] In South Africa, for example, 60% of eligible women were receiving ART by mid-2011 compared with 41% of eligible men. [3] Men have a higher mortality than women when receiving ART. [4][5][6][7][8] Although the reasons for this are poorly understood, a number of possible explanations have been suggested; some implicitly blame men for their own poorer outcomes. For example, numerous studies have suggested that men's poorer 'health-seeking behaviour' may prevent them from accessing ART services, being adherent to treatment or remaining in care. But, is this based on evidence or is it an assumption that has gained currency through widespread usage?To date, there has been no systematic attempt to understand the phenomenon of gender differences on ART. In the past year, we explored the issue in an analysis including 46 201 adults initiating ART in 8 large urban and rural South African cohorts between 2002 and 2009.[5] As 60% of our patients had civil identification (ID) numbers, it was possible to confirm their vital status through linkage to the National Population Register, estimated to capture over 90% of deaths nationally. [9] We were also able to track patients with IDs after they were lost to follow-up (LTF) and confirm whether they were alive or dead. Men's increased mortality on ART unrelated to HIV/AIDSAt the start of treatment, on average men had lower CD4+ cell counts and more advanced HIV disease than women. After we adjusted for such gender differences at ART initiation, men still...

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Sex differences in antiretroviral treatment outcomes among HIV-infected adults in an urban Tanzanian setting

Cited by 128 publications

References 33 publications

HIV-Positive Men's Experiences with Integrated Family Planning and HIV Services in Western Kenya: Integration Fosters Male Involvement

HIV-Positive Men's Experiences with Integrated Family Planning and HIV Services in Western Kenya: Integration Fosters Male Involvement

Determinants of Anemia Among Human Immunodeficiency Virus-Positive Adults at Care and Treatment Clinics in Dar es Salaam, Tanzania

Gender inequality: Bad for men's health

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