Psychosocial Associations with Virological Failure among Patients on Antiretroviral Therapy at McCord Hospital in KwaZulu-Natal, South Africa Open Access

Kearns, Rachel Ann (2013)

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Understanding factors associated with virological failure may improve prevention, diagnosis and treatment of virological failure among patients on ART.


The RFVF is a study of cases with virological failure (VL > 1,000 copies/ML) and controls with virological suppression (VL ≤ 1,000 copies/ML) after at least 5 months on their first ART regimen at McCord Hospital in Durban, South Africa between October 2010 and June 2012.


Patients completed a questionnaire on medical history, psychosocial factors, depression using Kessler-10, and socioeconomic status, retrospective chart reviews were completed, and drug resistance genotyping was performed on cases. Using multivariate logistic regression, this sub-study assessed the significance of psychosocial factors on virological failure among the full study population, men and women separately.


158 cases and 300 controls were enrolled in the study. The sample was predominantly female (64.6%), black Zulu (92%), and Christian (85.8%). In multivariate analysis for the full sample, male gender (OR=2.42, 95% CI 1.51-3.88), younger age (OR=0.83, 95% CI 0.72-0.94), shorter duration of treatment (OR=3.83, 95% CI 2.06-7.13 shortest vs. longest quartile) reporting any depressive symptoms (OR=2.21, 95% CI 1.35-3.61), being not active or having no faith compared to being somewhat or very active in faith (OR=1.60, 95% CI 1.02-2.50), having unsafe sex in prior 6 months (OR=2.50, 95% CI 1.17-5.32), having one or more HIV positive partner or family member (OR=1.70, 95% CI 1.03-2.82), having a treatment supporter (OR=2.02, 95% CI 1.13-3.64), and disclosing HIV status to friends (OR=2.02, 95% CI 1.23-3.33) were associated with virological failure. Among men, having at least one family member who died of HIV (OR=2.98, 95% CI 1.29-6.91) was also significantly associated with virological failure.


Several psychosocial factors are associated with virological failure in this setting. Patients experiencing failure were more likely to have a treatment supporter and family members with HIV, depressive symptoms, have no active faith, have unsafe sex and disclose their status to friends. Future studies should employ a longitudinal design to assess causality and ideally improve screening and identification of virological failure.

Table of Contents

Chapter I: Background/Literature Review 1
Introduction 2
Background on McCord Hospital 3
HIV Treatment in South Africa 4
Defining Treatment Failure and Virological Failure 6
Prevalence of Virological Failure 8
Diagnosing and Managing Virological Failure 9
Causes of Virological Failure 11
Risk Factors for Virological Failure 14
Gender, Age, and Duration of Antiretroviral Therapy 14
Psychosocial Factors 16
Social Support and Stigma 16
Faith and Spirituality 20
Alcohol and Drug Use 20
Depression 21
Chapter II: Manuscript 25
Title/Authors/Abstract 26
Introduction 28
Methods 30
RFVF Study Methods 30
Study Location 32
Statistical Analysis 32
Results 33
Characteristics of Study Population 33
Univariate Analysis 34
Multivariate Analysis 35
Discussion 36
Limitations 40
Conclusion 41
References 42
Appendices 49
Tables 49
Table 1. Characteristics of study population overall and by case control status, McCord Hospital, Durban, SA, 2010-2012 49
Table 2. Characteristics of female study population overall and by case control status, McCord Hospital, Durban, SA, 2010-2012 51
Table 3. Characteristics of male study population overall and by case control status, McCord Hospital, Durban, SA, 2010-2012 53
Table 4. Partner characteristics and sex practices among study participants who report a current partner, McCord Hospital, Durban, SA, 2010-2012 55
Table 5. Psychosocial characteristics associated with HIV virological failure, McCord Hospital, Durban, SA, 2010-2012 56
IRB Letter 57

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