Evidence map›Paper›PMID 40610975›Full record

ArticleBMC public health2025

"If your CD4 count lowers, that is when you are similar to a person that is non-existent" A qualitative exploration of perceptions around advanced HIV disease in South Africa.

T P Pita, S Misra, T Madonsela, A Tshazi, S Bosman, I Ayakaka, E Vlieghe, T Decroo, K Reither, A van Heerden and 1 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05526885 (Tuberculosis Diagnostic Trial of CAD4TB Screening Alone Compared to CAD4TB Screening Combined With a CRP Triage Test, Both Followed by Confirmatory Xpert MTB/RIF Ultra in Communities of Lesotho and South Africa), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05526885 nacompletednot on this map

Tuberculosis Diagnostic Trial of CAD4TB Screening Alone Compared to CAD4TB Screening Combined With a CRP Triage Test, Both Followed by Confirmatory Xpert MTB/RIF Ultra in Communities of Lesotho and South Africa

TypeinterventionalSponsorKlaus ReitherRan2022 to 2024Enrolled20,000ConditionsTuberculosisArmsCAD4TB, POC-CRP, Xpert MTB/RIF Ultra
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

T P PitaHuman Science Research Council, Pietermaritzburg, South Africa. TPPita@hsrc.ac.za.
S MisraHuman Science Research Council, Pietermaritzburg, South Africa.
T MadonselaHuman Science Research Council, Pietermaritzburg, South Africa.
A TshaziHuman Science Research Council, Pietermaritzburg, South Africa.
S BosmanHuman Science Research Council, Pietermaritzburg, South Africa.
I AyakakaSolidarMed, Maseru, Lesotho.
E VliegheGlobal Health Institute, University of Antwerp, Wilrijk, Belgium.
T DecrooClinical sciences, Institute of Tropical Medicine, Antwerp, Belgium.
K ReitherSwiss Tropical and Public Health Institute, Allschwil, Switzerland.
A van HeerdenUniversity of the Witwatersrand, Johannesburg, South Africa.
T GilsGlobal Health Institute, University of Antwerp, Wilrijk, Belgium.

Funding

European and Developing Countries Clinical Trials Partnership (RIA2018D-2498; TB TRIAGE+)
6 · The paper itself

Abstract

backgroundDespite widespread availability and differentiated delivery of antiretroviral treatment (ART), advanced HIV disease (AHD) remains prevalent, with high mortality risk. In South Africa, we assessed perceptions about the meaning of AHD and social and behavioural factors influencing AHD development.

methodsIn-depth interviews were conducted with 13 PWH screened for AHD during a community-based tuberculosis triage trial, and five stakeholders involved in policy-making or implementation of AHD-related programmes. Two focus group discussions were conducted with seven study nurses and two with seven public sector nurses. Thematic analysis and data triangulation were performed.

resultsWe found that PWH did not commonly know the term AHD and confused CD4 count with viral load testing. Perceptions about AHD among PWH ranged from AHD being a death sentence, causing opportunistic infections, to AHD diagnosis presenting a survival opportunity. Adherence problems and clinic avoidance were behavioural factors directly leading to AHD, with ART fatigue being emphasized by and in aging PWHs. The main themes which arose when discussing factors influencing AHD development, which were confirmed by different stakeholders, were (i) missed opportunities to (re)-engage in care due to clinic barriers, (ii) emotional stress and impaired mental health, (iii) alternative beliefs about medicines and health, and (iv) stigma, denial, and non-disclosure.

conclusionsThe term "AHD" was commonly unknown among PWH, while opportunistic infections were known. Structural barriers to care, mental health challenges, reliance on traditional medicine, and stigma, contributed to disengagement from care and progression to AHD in our population. These findings highlight the need to raise awareness about AHD among PWH and to create demand for CD4 testing, to implement effective welcome-back strategies for those disengaging from care, integration of mental health screening for PWHs, and revamping community education to reduce stigma and improve ART and AHD-related literacy.

trial registrationClinicaltrials.gov: NCT05526885, 02 September 2022.

Indexed as

HIV InfectionsAdultCD4 Lymphocyte CountFemaleFocus GroupsHumansInterviews as TopicMaleMiddle AgedQualitative ResearchSocial StigmaSouth AfricaAdvanced HIV diseaseHIV/AIDSQualitative researchSouth Africa

Identifiers

PMID40610975
PMCPMC12225181

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.