Association Between WASH Factors and Viral Loads in ART Experienced Persons Living with HIV in South Africa Restricted; Files Only

Abstract

Human Immunodeficiency Virus (HIV) is a disease that weakens the immune system making it more susceptible to other opportunistic diseases (16). 39 million people are living with HIV worldwide in 2022 (2). HIV is more prevalent in lower income areas, which in many cases translates to lack of access to safe WASH (8). We aim to examine potential association between various WASH with viral failure in medicine adherent people with HIV (PWH) living in KwaZulu-Natal, South Africa.

A secondary analysis was performed using de-identified data from a parent nested case-control study conducted in South Africa during the years of 2014 to 2018. A matched 1:2 case control study was conducted on patients recruited from a rural and peri-urban hospital in KwaZulu-Natal, with cases defined as individuals who experienced viral failure. WASH related questions were asked at baseline and examined to extrapolate the effects of WASH factors to an individual’s viral load status.

The resulting data subset consisted of 98 cases and 199 controls. The univariate analysis showed no statistically significant association between drinking water and viral failure. Surface and unimproved drinking water had odds ratios of [OR = 1.40, 95% CI (0.40, 4.54)] and [OR = 0.82, 95% CI (0.47, 1.43)] respectively. Sanitation [OR = 1.84, 95% CI (0.63, 5.27)], drinking water contamination [OR = 1.14, 95% CI (0.58, 2.20)], lack of water treatment [OR = 0.95, 95% CI (0.33, 3.13)], and unimproved access to handwashing [OR = 0.82, 95% CI (0.50, 1.34)] was also statistically nonsignificant to viral failure. A multivariate analysis was then conducted with the new model producing higher odds ratios for unimproved drinking water source [aOR = 0.84, 95% CI (0.45, 1.51)] , lack of water treatment [aOR = 0.97, 95% CI (0.32, 3.29)], drinking water contamination by hand [aOR = 1.24, 95% CI (0.59, 2.53)], and unimproved sanitation [aOR = 1.90, 95% CI (0.61, 5.76)]. Odds ratios for Surface Water [aOR = 1.37, 95% CI (0.36, 4.79) and unimproved hand washing access [aOR = 0.73, 95% CI (0.42, 1.26)] decreased. All results remained nonsignificant, but odds ratios of greater than one is present in three of the variables. Although no significant association between viral failure and WASH were found, further research is needed to ascertain the effects of safe WASH against viral failure amongst PWH.

Table of Contents

Introduction 1

Literature Review 2

Methods 6

           Data 6

           Analysis 7

Results 8

           Demographics 8

           WASH Factors 8

           Univariate Analysis 9

           Multivariate Analysis 10

Discussion 11

Limitations 12

Conclusion 13

Public Health Implications13

Appendix 15

Reference 21

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	HIV South Africa WASH
Committee Chair / Thesis Advisor	Jonathan Edwards, Emory University Dr. Vincent Marconi, Emory University
Committee Members	Chad Robichaux, Emory University

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