Changing contextual factors from baseline to 9-months post-HIV diagnosis predict 5-year mortality in Durban, South Africa

ABSTRACT

Changes in an individual’s contextual factors following HIV diagnosis may influence long-term outcomes. We evaluated how changes to contextual factors between HIV diagnosis and 9-month follow-up predict 5-year mortality among HIV-infected individuals in Durban, South Africa enrolled in the Sizanani Trial (NCT01188941). We used random survival forests to identify 9-month variables and changes from baseline predictive of time to mortality. We incorporated these into a Cox proportional hazards model including age, sex, and starting ART by 9 months a priori, 9-month social support and competing needs, and changes in mental health between baseline and 9 months. Among 1,154 participants with South African ID numbers, 900 (78%) had baseline and 9-month data available of whom 109 (12%) died after 9-month follow-up. Those who reported less social support at 9 months had a 16% higher risk of mortality. Participants who went without basic needs or healthcare at 9 months had a 2.6 times higher hazard of death compared to participants who did not. Low social support and competing needs at 9-month follow-up substantially increase long-term mortality risk. Reassessing contextual factors during follow-up and targeting interventions to increase social support and affordability of care may reduce long-term mortality for HIV-infected individuals in South Africa.

KEYWORDS:

• HIV infection
• predictors of mortality
• mortality
• South Africa

Acknowledgements

The authors would like to acknowledge the assistance of Ogochukwu Ufio in the preparation of this manuscript. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the US National Institutes of Health or the MGH Executive Committee on Research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, [IVB], upon reasonable request.

Additional information

Funding

This work was supported by the US National Institute of Mental Health [grant numbers R01 MH090326 and R01 MH108427]; and Weissman Family MGH Research Scholar Award.