Browsing by Author "Phillips, Tamsin"
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- ItemOpen AccessExploring the relationship between sexual risk behaviours and HIV Status awareness among men in South Africa: analysis of data from the 2017 South African National house-based HIV prevalence, incidence and behaviour survey(2025) Nhlabatsi, Zanele; Phillips, Tamsin; Moyo, SizuluSouth Africa has one of the highest HIV prevalence rates globally, with men being a key population at risk due to risky sexual behaviours and lower HIV status awareness compared to women. This study explored the relationships between sexual risk behaviours and HIV status awareness among 1,630 sexually active South African men (≥15 years, median age 34 years, interquartile range 24-44) using data from the 2017 South African National House-based HIV Prevalence, Incidence, and Behaviour Surveys (SABSSMV). Overall, 13.5% of men self-reported living with HIV (srHIV+) and there was high concordance between self-reported and laboratory confirmed HIV status with 92.0% (95% confidence interval [CI] 84.1% - 96.1%) and 88.0% (95% CI 85.5% - 90.2%); p<0.001, of men srHIV+ and those self-reporting not living with HIV (srHIV-) being laboratory confirmed, respectively. In total, 68.3% (95% CI 64.6% - 71.8%) of men reported casual sexual partners ( 48.2% [95% CI 39.0% - 57.5%] among men srHIV+ vs. 71.4% [95% CI 67.4% - 75.2%] among men srHIV-); p<0.001, 4.9% (95% CI 3.6% - 6.7%) reported ≥2 sexual partners (2.6% [95% CI 1.1% - 6.2%] vs. 5.3% [95% CI 3.8% - 7.4%]); p = 0.116, 26.5% (95% CI 23.4% - 29.9%) reported inconsistent condom use at last sex with all partners in the past year (23.3% [16.0% - 32.7%] vs. 27.0% [95% CI 23.6% - 30.8%]); p = 0.430, and 14.2% (95% CI 11.8% - 17.1%) reported alcohol use at last sex (16.9% [95% CI 10.9% - 25.1%] vs. 13.8% [11.3% - 16.9%]); p = 0.431, with values in brackets showing the proportion among those (srHIV+) versus (srHIV-), respectively. In logistic regression models, men (srHIV+) were less likely to report engaging in casual sex compared to men (srHIV-) ( (adjusted odds ratio 0.51 95% CI: 0.27–0.97). Variations in sexual risk behaviours were observed by demographic characteristics, and age appeared to modify the association between reported HIV status and some risk behaviours. The findings highlight the impact of HIV status on risky sexual behaviour, emphasizing the need for comprehensive HIV testing and counselling (HTC), safe sex education, and integrated behavioural and structural approaches in healthcare. Tailored interventions such as age-specific messaging, accessible educational content, ensuring condom and PrEP availability, youth-friendly tech-based solutions like online counselling or mobile apps, and public campaigns promoting safe sexual practices, will be essential to address the unique needs of different age groups, education levels, HIV statuses, and geographic settings.
- ItemOpen AccessIntimate partner violence in pregnant women living with HIV in South Africa: prevalence and associated factors(2023) Mkwakwami, Kudzai; Phillips, Tamsin; Noholoza, SandisiweIntroduction Intimate partner violence (IPV) is a significant public health problem that affects individuals across the world, of all ages, genders, and socio-economic backgrounds. In South Africa, the prevalence of IPV among pregnant women is high. This study aims to investigate the prevalence and associated factors of IPV among pregnant women living with HIV in Cape Town, South Africa. Methods We used a cross-sectional design, with data collected through face-to-face interviews at enrolment into a larger study (CareConekta NCT03836625). Using a structured questionnaire, data were collected on sociodemographic characteristics, IPV (measured using the World Health Organisation Violence Against Women questionnaire) and antiretroviral therapy (ART) adherence (using a combined three-item self-reported adherence score where 100 presents perfect adherence). Results Among 197 pregnant women living with HIV, the prevalence of IPV was 43.2%. The most common form of IPV reported was emotional abuse (30.7%), followed by physical abuse (24.5%) and sexual abuse (10.5%). There was also an overlap in IPV experiences observed amongst participants where 32% of women with any IPV reported both physical and emotional abuse, 4% both emotional and sexual and 13% reported all three forms of IPV. Higher poverty score was identified as a factor associated with an increased risk of experiencing IPV (OR= 0.72, 95% CI = 0.32-1.59). In this cohort, 20% of women had perfect self-reported adherence and women who did not experience IPV had higher odds of perfect ART adherence compared to those who had experienced any form of IPV (OR= 1.09, 95% CI = 0.47, 2.39). Conclusion We found that the prevalence of IPV among pregnant women living with HIV in Cape Town, South Africa was very high in all three domains and these findings are consistent with existing literature. The high prevalence of IPV among this population highlights the need for interventions to prevent IPV and to support women experiencing IPV in pregnancy. In this analysis the experience of IPV was associated with poor ART adherence. Experiencing IPV adds on to the challenges and the burden of women living with HIV and it contributes to a plethora of health challenges and complications. Asking women about IPV experiences during antenatal care could be an important intervention to facilitate support for women experiencing IPV in pregnancy.
- ItemOpen AccessPatterns of HIV care prior to antenatal care, and the impact on later outcomes, among pregnant women living with HIV in Gugulethu, South Africa: A retrospective cohort(2023) Leonard, Bryan; Phillips, TamsinIntroduction: Women living with HIV (WLHIV) entering antenatal care (ANC) are at high risk of disengagement from antiretroviral therapy (ART). Increasing numbers of women conceiving are already on ART, but little is known about their patterns of care before ANC. We described ART history patterns before ANC among WLHIV and the association with maternal outcomes. Methods: We used existing data from a prospective cohort that enrolled WLHIV attending ANC in Gugulethu, South Africa. Data were collected through interviews and abstraction of electronic medical records. Self-reported ART history was examined, and women were grouped into (1) Newly starting ART, (2) ART-experienced without any interruptions, (3) ARTexperienced with interruption. Log-binomial models were used to assess the association between ART history, viral suppression at delivery and engagement in care at 12 weeks postpartum. Results: Among 321 women (median age 32.3 years, IQR 28.1-35.9; 61.4% in their first pregnancy), 52% were ART-experienced with no interruption (median years on ART 6.1, IQR 3.3-10.1), 32.7% were ART-experienced with at least one interruption (median years on ART 6.9, IQR 4.4-9.4), and 15.3% were newly starting ART in pregnancy. Among the 105 ARTexperienced women with interruption, 94.3% reported only one interruption. After adjusting for age, women newly initiating ART (adjusted risk ratio (aRR): 1.78; 95% CI: 0.91-3.79) and ART-experienced women with interruption (aRR: 2.39; 95% CI 1.39-4.35) were more likely to have a viral load >50 copies/ml at delivery when compared to ART-experienced women without interruption. After adjusting for age and relationship status, ART-experienced women with interruption (aRR: 6.20; 95% CI: 2.05-18.77) and without interruption (aRR: 3.10; 95% CI 0.99-9.71) were more likely to be disengaged from care at 12 weeks postpartum when compared to women newly starting ART. Conclusion: Most women in this study were ART-experienced before pregnancy, and a third had treatment interruption history. Women with any interruption had increased risk of being unsuppressed at delivery and disengaged from care at 12 weeks postpartum. These findings highlight the need to explore mechanisms driving these associations and examine possible interventions to support continuous engagement in HIV care postpartum.
- ItemOpen AccessPrediction of loss to follow-up in postpartum others living with HIV(2025) Fielding, Christopher; Phillips, Tamsin; Arua, EkeIntroduction: In South Africa, postpartum women living with HIV are at an increased risk of loss to follow-up, which poses a critical barrier in vertical transmission prevention. Previous studies have focused on the aetiology of loss to follow-up, with little emphasis on predictive methods. The aim of this study was to use machine learning methods, applied to routine care data, to predict loss to follow-up among postpartum women living with HIV. Methods: This study is a secondary data analysis of 333 peripartum women living with HIV enrolled in the Routine Electronic Mother-Infant Data study in Gugulethu, Cape Town. Data from routine medical records obtained in the parent study were analysed using descriptive statistics, and several machine learning models.. An extreme gradient boosting model was developed and validated to predict the risk of loss to follow-up within the first 9 months postpartum based on routinely available patient data at the point of discharge after delivery. Model calibration was performed on the trained extreme gradient boosting model (n=233), and calibration performance validated on the validation dataset (n=100). Sensitivity and specificity trade-offs were examined and the Youden Index used to identify the optimal classification threshold (i.e., threshold that maximised sensitivity and specificity). Results: Key factors associated with being lost to follow-up included younger maternal age, shorter duration from HIV diagnosis to antiretroviral therapy initiation, and not actively being on antiretroviral therapy at estimated conception. The extreme gradient boosting model demonstrated an area under the receiver operating characteristic curve of 0.721 when validated on the validation dataset, indicating good predictive performance. Model calibration did not significantly improve when calibration methods were applied. Youden Index calculations indicated that the optimal classification threshold was 0.252, providing a sensitivity of 0.827 and a specificity of 0.634. Conclusions: This study emphasises the importance of antiretroviral associated behavioural and healthcare factors in predicting loss to follow-up among postpartum women living with HIV. The developed predictive model showed good predictive power and could assist healthcare providers in identifying high-risk individuals, allowing targeted preventative measures that cost-effectively improve vertical transmission prevention. Future research should focus on validating this model in larger and more diverse populations and integrating it into existing healthcare practices.
- ItemOpen AccessSelf-reported side effects and adherence to antiretroviral therapy in HIV-infected pregnant women under option B+: a prospective study(Public Library of Science, 2016) Phillips, Tamsin; Cois, Annibale; Remien, Robert H; Mellins, Claude A; McIntyre, James A; Petro, Greg; Abrams, Elaine J; Myer, LandonBACKGROUND: Antiretroviral therapy (ART) regimens containing efavirenz (EFV) are recommended as part of universal ART for pregnant and breastfeeding women. EFV may have appreciable side effects (SE), and ART adherence in pregnancy is a major concern, but little is known about ART SE and associations with adherence in pregnancy. METHODS: We investigated the distribution of patient-reported SE (based on Division of AIDS categories) and the association of SE with missed ART doses in a cohort of 517 women starting EFV+3TC/FTC+TDF during pregnancy. In analysis, SE were considered in terms of their overall frequency, by systems category, and by latent classes. RESULTS: Overall 97% of women reported experiencing at least one SE after ART initiation, with 48% experiencing more than five SE. Gastrointestinal, central nervous system, systemic and skin SE were reported by 81%, 85%, 79% and 31% of women, respectively, with considerable overlap across groups. At least one missed dose was reported by 32% of women. In multivariable models, ART non-adherence was associated with systemic SE compared to other systems categories, and measures of the overall burden of SE experienced were most strongly associated with missed ART doses. CONCLUSION: These data demonstrate very high levels of SE in pregnant women initiating EFV-based ART and a strong association between SE burden and ART adherence. ART regimens with reduced SE profiles may enhance adherence, and as countries expand universal ART for all adult patients, counseling must include preparation for ART SE.
- ItemOpen AccessSocial determinants of art adherence among adolescent and young pregnant and postpartum women living with HIV in Cape Town, South Africa(2024) Mosigi, Popo; Phillips, TamsinWomen living with HIV in South Africa are at risk of poor antiretroviral therapy (ART) adherence during and after pregnancy. Adolescents have lower adherence rates than other age groups and experience several barriers to adherence. Pregnancy and postpartum periods also present unique obstacles. We assessed the association between social determinants of health and ART adherence (using a three-item self-report adherence scale and reported missed ART doses) among 100 pregnant and postpartum women aged 16-24 years and on ART in Gugulethu, Cape Town. Overall, 72% of women scored ≤95% on the adherence scale (69% and 75% among pregnant and postpartum women, respectively p=0.533) and 22% of women reported missing ≥1 day of ART in the past 30 days (31% and 15% among pregnant and postpartum women, respectively p=0.050). An adherence score ≤95% versus >95% was associated with lower employment (32% versus 50%, p=0.093) and slightly lower social connectedness scores (mean 4.71 versus 4.97, p=0.084). No demographic or social characteristics were statistically significantly associated with adherence in multivariable models. These findings highlight nuances to measuring self-reported ART adherence. Larger studies are needed to further explore adherence challenges and the role of social connection and adherence among young pregnant and postpartum women living with HIV in South Africa.
- ItemOpen AccessThe use of patient choice in public health interventions for HIV treatment and prevention. A systematic review(2024) Kanganga, Desire; Phillips, Tamsin; Mogoba PheposadiIntroduction: Africa has the highest burden of HIV globally. A growing number of evidencebased HIV intervention are being scaled up to eliminate HIV transmission and minimise morbidity and mortality. We reviewed the published HIV literature to describe interventions in which patients are given a choice in their HIV care, and examine the impact of patient choice on reported health outcomes among studies including a non-choice comparison group. Methods: We searched PubMed and reference lists, from 1 January 2010 to 8 December 2023. Included studies were HIV related interventions where patients were making a choice in some aspect of their care and carried out in Africa. The choice components and related results were described, and grouped by HIV continuum focus area. Measures of association were summarised for studies reporting comparison of health outcomes between choice and non-choice groups. Results: Eleven out of 593 studies were included. Six focused on HIV prevention, four on HIV treatment and one on HIV care and support. Five studies described choices offered in routine care; six were research interventions. Choices provided included product choice, location of services, duration of dispensing and choice treatment support. Limited details were provided on the implementation of the choice intervention in most studies. In two prevention studies comparing a choice and non-choice group, pre-exposure prophylaxis coverage was significantly higher in the choice arm compared to the control. In one HIV treatment study, there was no difference in viral suppression but retention in care was significantly higher in the choice arm compared to the non-choice arm. Conclusions: This review shows that patient choice is being offered in HIV preventative and treatment services and is allowing people to select what they need when needed. More research is required to understand how patient choice can be sustainably implemented in HIV services in high-burden and low-resource settings.
- ItemOpen AccessTravel and adherence to antiretroviral therapy among postpartum women living with HIV in South Africa: a cross-sectional study(2020) Mvududu, Rufaro; Phillips, TamsinIn sub-Saharan Africa, women are disproportionately affected by HIV. Sustained adherence to lifelong antiretroviral therapy (ART) is needed to ensure their own health and prevent transmission of HIV to their partners and their children. However, non-adherence to ART remains a substantial challenge with many associated risk factors. Travel is often reported in the qualitative literature as a barrier to ART adherence among women living with HIV, but few quantitative studies have explored this association. This research aimed to describe travel in the past year among mothers living with HIV in the Long-term Adherence and Care Engagement (LACE) study, to explore factors associated with travel, and to investigate the associations between travel and i) self-reported adherence, and ii) HIV viral load. Part A of this dissertation is the study protocol that introduces the need for this research and presents how the research will be carried out. Part B is a narrative literature review. The review summarises and synthesises existing research relating to HIV treatment and travel in sub-Saharan Africa, giving context to the dissertation. Part C is the journal “ready” manuscript. This section presents an analysis of data from the LACE study, a cross-sectional survey of women living with HIV approximately four years after they had started ART during pregnancy in Gugulethu, Cape Town. At the LACE study visit, data on short-term travel patterns (stayed away from home for 3 or more nights) in the past year and self-reported adherence in the past 30 days (using a validated three-item scale) were collected through structured questionnaires, and a blood specimen was tested for HIV viral load. Poisson regression models with robust standard errors were used to explore factors associated with travel (any versus none), self-reported adherence (100% versus <100%), and viral suppression (≤50 copies/mL). Results were reported as crude risk ratios (RR) and adjusted risk ratios (aRR) with 95% confidence intervals (CI). The results showed that among 353 women enrolled in the LACE study (mean age 32.6 years, 48% employed, 38% married/cohabiting, median 44 months postpartum) 23% (n=81) reported travelling in the past year. Of the women who travelled, most went to the Eastern Cape (90%) and travelled 1-2 times during the year (93%). Women who travelled were more likely to be married/cohabiting than women who had not travelled (aRR = 1.45; 95% Cl: 0.97 - 2.16). Only 9% of women who travelled (7 of 81) reported difficulty with ART adherence due to travel. Overall, 59% of women reported 100% adherence in the past 30 days: 52% of women who had travelled in the past year versus 61% of those who had not travelled (aRR = 0.83; 95% Cl: 0.66-1.04). Only 56% of the cohort were virally suppressed: 60% and 55% of those who had and had not travelled in the past year, respectively (aRR = 1.10; 95% Cl: 0.89-1.36). Travel in the past year was not significantly associated with self-reported adherence or viral suppression in crude or adjusted analyses. These results highlight that poor adherence and viremia were very common in this cohort of women, four years after starting ART in pregnancy. Almost a quarter of women reported travel in the past year but only a v few reported difficulties with adherence related to travel and we found no association between travel in the past year, self-reported adherence in the past 30 days or viremia. Further research is needed to understand adherence patterns during periods of travel and interventions are clearly needed to support women's long-term adherence to ART.