ArticleGlobal health action2014
Factors associated with mortality in HIV-infected people in rural and urban South Africa.
Article in Global health action, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.
- Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis.BMC infectious diseases · 2021Pooled it
- Cause-specific hazards of antiretroviral therapy programmatic adherence, defaulting and mortality among HIV/AIDS patients who had attained CD4 count recovery after antiretroviral therapy initiation in South Africa.Frontiers in reproductive health · 2026Article
- Effects of Pension Eligibility Expansion on Men's Cognitive Function: Findings from Rural South Africa.Journal of aging & social policy · 2024Article
- Association Between Body Mass Index Variation and Early Mortality Among 834 Ethiopian Adults Living with HIV on ART: A Joint Modelling Approach.Infectious diseases and therapy · 2023Article
- Article
- Article
- Risk Factors for Infectious Diseases in Urban Environments of Sub-Saharan Africa: A Systematic Review and Critical Appraisal of Evidence.Tropical medicine and infectious disease · 2019Review
- Variation in attrition at subnational level: review of the Botswana National HIV/AIDS Treatment (Masa) programme data (2002-2013).Tropical medicine & international health : TM & IH · 2016Article
- Programmatic treatment outcomes in HIV-infected and uninfected drug-resistant TB patients in Khayelitsha, South Africa.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2015Article
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Authors and funding
5 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundFactors associated with mortality in HIV-infected people in sub-Saharan Africa are widely reported. However rural-urban disparities and their association with all-cause mortality remain unclear. Furthermore, commonly used classical Cox regression ignores unmeasured variables and frailty.
objectiveTo incorporate frailty in assessing factors associated with mortality in HIV-infected people in rural and urban South Africa.
designUsing data from a prospective cohort following 6,690 HIV-infected participants from Soweto (urban) and Mpumalanga (rural) enrolled from 2003 to 2010; covariates of mortality were assessed by the integrated nested Laplace approximation method.
resultsWe enrolled 2,221 (33%) rural and 4,469 (67%) urban participants of whom 1,555 (70%) and 3,480 (78%) were females respectively. Median age (IQR) was 36.4 (31.0-44.1) in rural and 32.7 (28.2-38.1) in the urban participants. The mortality rate per 100 person-years was 11 (9.7-12.5) and 4 (3.6-4.5) in the rural and urban participants, respectively. Compared to those not on HAART, rural participants had a reduced risk of mortality if on HAART for 6-12 (HR: 0.20, 95% CI: 0.10-0.39) and >12 months (HR: 0.10, 95% CI: 0.05-0.18). Relative to those not on HAART, urban participants had a lower risk if on HAART >12 months (HR: 0.35, 95% CI: 0.27-0.46). The frailty variance was significant and >1 in rural participants indicating more heterogeneity. Similarly it was significant but <1 in the urban participants indicating less heterogeneity.
conclusionThe frailty model findings suggest an elevated risk of mortality in rural participants relative to the urban participants potentially due to unmeasured variables that could be biological, socio-economic, or healthcare related. Use of robust methods that optimise data and account for unmeasured variables could be helpful in assessing the effect of unknown risk factors thus improving patient management and care in South Africa and elsewhere.
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