Page 274 - HIVMED_v21_i1.indb

Page 2 of 10 Original Research

These include multiple pathologies: drug-drug interactions Research methods and design
and the predisposition to drug-toxicity (renal and liver),
greater likelihood of neurovascular impairment, frailty and Study design and study population
fractures, limited immune recovery (especially CD4 cell This was a retrospective study of OPLWH undertaken to
count), less social security (finances and support) and cover the period 01 May 2017 to 30 April 2018 at three
greater dependency on the state and local health services. healthcare sites in Tlokwe (Potchefstroom), a town in the
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On the other hand, OPLWH are usually adherent to NWP of SA. The study subjects were aged ≥ 60 years and
treatment and likely to follow up at their health care centres. were on ART for a minimum of one year prior to the period
They are likely to remain in their current residence and, under review, hence, they had to be initiated on ART prior to
thus, are generally contactable. In light of the above, it is 30 April 2017. The three clinics were chosen to represent, as
necessary for researchers in SA to understand this cohort in closely as possible, the diversity of people who utilise the
all settings in order to develop feasible and sustainable care public health service in the town.
packages. There is a paucity of data for OPLWH in the SA
context. Clinic A: a primary care clinic situated close to the municipal
hospital that serves residents and patients referred from
Identifying HIV in the elderly is important. Benefits include hospital clinics. Services provided by the clinic include
reducing the risk of transmission as many are still sexually counselling, HIV testing and the initiation of treatment of
active and practise poor prevention strategies. Early entry HIV. Afrikaans and Setswana are spoken by the majority of
into care will reduce the risk of opportunistic conditions and patients accessing clinic services.
aid in the timely diagnosis of co-morbidities. In the SA public
sector, OPLWH have access to specialised healthcare and ART Clinic B: a community health centre serving a predominantly
at minimal cost. If retained in-care, costs such as hospitalisation Setswana-speaking population.
and end-of-life care are more readily anticipated and
mitigated. Nonetheless, immune reconstitution is often Clinic C: a community health centre serving both Afrikaans
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incomplete in this group, despite ART and viral suppression, and Setswana-speaking residents.
particularly where presenting nadir CD4 levels, were low.
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Inclusion criteria
Two regional studies provide data on the prevalence and
outcome of HIV infection in SA-OPLWH. A retrospective • Older persons living with HIV aged ≥ 60 years at their
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study of 7295 OPLWH (study-total n = 83 566 PLWH) who last birthday and with the time of their latest clinic visit
started ART between 2004 and 2013 found that those ≥ 50 years being between 01 May 2017 and 30 April 2018.
of age increased from 6% in 2004 to 10% in 2012/2013. These • Older persons living with HIV who had been on ART for
finally constituted 9% of the entire cohort. This study assessed at least 12 months prior to the study census that is to
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only three of SA’s nine provinces and, in particular, excluded include as a minimum a second VL test whilst on ART.
the North West Province (NWP). A second study confirmed a • Confirmation as an adherence measure, that the patient
significantly higher prevalence of diabetes mellitus (DM) and or a nominated representative of the patient, had collected
hypertension (HPT) in its OPLWH: DM, n = 16/262 (6.3%) treatment on their behalf, at the regular three-monthly
versus 24/3741 (0.7%) and HPT, n = 55/262 (21.5%) versus medicines collection visits in the year under study.
79/3741 (2.2%), p < 0.001, respectively. 10
Exclusion criteria
The prevalence of HIV infection in Tlokwe’s older citizens is
unknown. Those aged ≥ 65 years comprise 5.7% of the • Patient clinic file ‘missing’ for the study period under
population of the town. Data from the 2019 mid-year review.
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population census described only the 15–49 year age group. 12 • Patients who did not meet the inclusion criteria.
In 2012, the Human Sciences Research Council (HSRC)
reported the general prevalence of HIV in South Africans of Data collection
≥ 50 years to be 7.6% (95% CI 6.5–8.8). A collection sheet developed by the researcher was used to
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capture data as per the study’s objectives. All information
The objectives of this study were the following: was captured manually and patient identifiers were removed.
• To describe the demographic characteristics of the study Data were then transferred to Excel 2016 (Microsoft, US).
population Study subjects comprised all available patients recruited
• To describe their co-morbidities from the study sites who fulfilled entry criteria. A prior
• To assess viral load (VL) suppression rates calculation of the ‘sample size’ was not undertaken. All files
• To determine the relationship, if any, of patient were retrieved with the help of data capturers and clerks
characteristics to the following four outcomes viz.: VL at the research sites. TIER.Net., an electronic patient
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suppression and immune (CD4 cell count) recovery on management system, was used to access additional (missing)
ART, loss to follow-up (LTFU) and death. patient information. Further laboratory data were located on
the TrakCare service of the SA National Health Laboratory

http://www.sajhivmed.org.za 266 Open Access