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Antiretroviral therapy coverage associated with increased co-residence between older and working-age adults in Africa.

ABSTRACT: OBJECTIVES:To determine whether national antiretroviral therapy (ART) coverage is associated with changes in the living arrangements of older adults. DESIGN:Retrospective analysis using 103 nationally representative surveys from 28 African countries between 1991 and 2015. METHODS:The sample consisted of individuals aged at least 60 years. We investigated how three measures of living arrangements of older adults have changed with ART coverage: the number of older individuals living without working-age adults, the number of older individuals living with only dependent children (i.e. 'missing generation' households), and the number of working-age adults per household where an older individual lives. RESULTS:Our sample consisted of 297?331 older adults. An increase in ART coverage of 1% was associated with a 0.7 percentage point reduction (P?

SUBMITTER: De Neve JW

PROVIDER: S-EPMC7293712 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Antiretroviral therapy coverage associated with increased co-residence between older and working-age adults in Africa.

De Neve Jan-Walter JW Karlsson Omar O Coetzee Lelani L Schröder Henning H Subramanian S V SV Bärnighausen Till T Vollmer Sebastian S

AIDS (London, England) 20180901 14

<h4>Objectives</h4>To determine whether national antiretroviral therapy (ART) coverage is associated with changes in the living arrangements of older adults.<h4>Design</h4>Retrospective analysis using 103 nationally representative surveys from 28 African countries between 1991 and 2015.<h4>Methods</h4>The sample consisted of individuals aged at least 60 years. We investigated how three measures of living arrangements of older adults have changed with ART coverage: the number of older individuals ...[more]

PMID: 29894389

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Project description:INTRODUCTION: The authors report on a health systems strengthening intervention using quality improvement (QI) methods at the subdistrict level to accelerate highly active antiretroviral treatment (HAART) initiation in South Africa. METHODS: Using a phased scale-up design between August 2006 and November 2009, 14 primary healthcare clinics, one community health centre, one district hospital and one tertiary hospital in a subdistrict were recruited into a 'learning network' using QI methods to facilitate cross-facility learning/mentorship/support. Clinic teams consisting of nurses, counsellors, clerks and/or doctors set collective and individual performance targets, analysed their care systems using 'real-time' data feedback, and designed/implemented a set of simple changes to improve HIV testing and HAART initiation rates across the region. DATA ANALYSIS: Primary clinic data were used to measure HAART initiation rates (primary outcome) and HIV testing (secondary outcome). We analysed data variation/trends using an interrupted time series design. Logistic regression analysis was applied to examine trends in HAART initiation during the intervention phases. RESULTS: Clinics in the learning network increased HIV testing by 301.8% from 891/month (SD=94.2) to 3580/month (SD=327.7) (p<0.0001). Monthly HAART initiations increased by 185.5% from 179/month (SD=17.22) to 511/month (SD=44.93) (p<0.0001). During the pilot (phase I), the monthly rate of HAART initiations increased by 3.6 patients. In the prototype collaborative (phase II), there was no acceleration in the rate of increase (3.3/month, p=0.92). Significant acceleration was observed in the rate of increase during the QI scale up (phase III) (10.1/month, p<0.001). The proportion of estimated need for HAART met in the region increased from 35.8% to 72.4% at a time of rapid population growth. CONCLUSION: A QI approach, using learning networks to teach simple data-driven methods for addressing system failures, with increased training and resource inputs, can assist districts to quickly reach universal coverage targets.

Project description:BACKGROUND: Little is known about social capital and health among older adults in South Africa. This study investigates the association between social capital and several health variables, namely: self-rated health, depressive symptoms, cognitive functioning and physical inactivity, among older South Africans. METHODS: We conducted a national population-based cross-sectional study with a national probability sample of 3840 individuals aged 50 years or older who participated in the Study of Global Ageing and Adults Health (SAGE wave 1) in 2008 in South Africa. Measures included socio-demographic characteristics, health variables, cognitive functioning and physical activity. Social capital was assessed with six components, namely: marital status, social action, sociability, trust and solidarity, safety, and civic engagement. RESULTS: The social capital assessment revealed that 56% of the respondents were married or cohabiting, 45% reported low (0) social action, 42% reported medium (2-3) sociability, 43% reported high (2) trust and solidarity, 50% reported high (2-4) civic engagement and 42% reported medium (6) psychological resources. In multivariate analysis, self-reported good health was associated with younger age, having secondary education and higher social capital (being married or cohabiting, high trust and solidarity and greater psychological resources). Depressive symptoms were associated with lower social capital (not being married or cohabiting, lack of high trust and solidarity and low psychological resources). Better cognitive functioning was associated with younger age, higher educational level, greater wealth and higher social capital (being married or cohabiting, high trust and solidarity, lack of safety, higher civic engagement and greater psychological resources). Physical inactivity was associated with older age and lower social capital (lower social action, lack of safety, lower civic engagement and poorer psychological resources). CONCLUSIONS: Given the basis of these findings on cross sectional data and subsequent limitation, it was found that these study findings mimic the findings of many European and American studies. Social capital among the elderly generation in South Africa is imperative for better health.

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Antiretroviral therapy coverage associated with increased co-residence between older and working-age adults in Africa.

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Antiretroviral therapy coverage associated with increased co-residence between older and working-age adults in Africa.

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