Relationships Among COVID-19-Related Service Uptake, HIV Status, Drug Use, and COVID-19 Antibody Status Among HIV Testing Intervention Participants in KwaZulu-Natal, South Africa
Abstract
:1. Introduction
- Are key sociodemographic characteristics (e.g., gender and/or age) associated with COVID-19-related service uptake (i.e., vaccination and testing)?
- Do HIV status or drug use predict COVID-19-related service uptake?
- Do drug use and/or HIV status (including having uncontrolled/previously undiagnosed HIV) moderate the relationship between COVID-19 vaccine status and COVID-19 IgG antibody status?
2. Methods
2.1. Sample and Procedures
2.2. Measures
2.3. Analyses
3. Results
3.1. Descriptive Statistics
3.2. Associations between Sociodemographic Characteristics and COVID-19 Service Uptake
3.3. Associations between HIV Status, Hard Drug Use, and COVID-19 Service Uptake
3.4. Associations among HIV Status, Hard Drug Use, Vaccine Uptake, and COVID-19 IgG Antibody Status
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Artificial-Intelligence-Assisted Technologies
Acknowledgments
Conflicts of Interest
References
- Danwang, C.; Noubiap, J.J.; Robert, A.; Yombi, J.C. Outcomes of patients with HIV and COVID-19 co-infection: A systematic review and meta-analysis. AIDS Res. Ther. 2022, 19, 3. [Google Scholar] [CrossRef] [PubMed]
- Sachdev, D.; Mara, E.; Hsu, L.; Scheer, S.; Rutherford, G.; Enanoria, W.; Gandhi, M. COVID-19 susceptibility and outcomes among people living with HIV in San Francisco. J. Acquir. Immune Defic. Syndr. 2021, 86, 19–21. [Google Scholar] [CrossRef] [PubMed]
- Venturas, J.; Zamparini, J.; Shaddock, E.; Stacey, S.; Murray, L.; Richards, G.A.; Kalla, I.; Mahomed, A.; Mohamed, F.; Mer, M.; et al. Comparison of outcomes in HIV-positive and HIV-negative patients with COVID-19. J. Infect. 2021, 83, 217–227. [Google Scholar] [CrossRef] [PubMed]
- Mirzaei, H.; McFarland, W.; Karamouzian, M.; Sharifi, H. COVID-19 among people living with HIV: A systematic review. AIDS Behav. 2021, 25, 85–92. [Google Scholar] [CrossRef]
- Ssentongo, P.; Heilbrunn, E.S.; Ssentongo, A.E.; Advani, S.; Chinchilli, V.M.; Nunez, J.J.; Du, P. Epidemiology and outcomes of COVID-19 in HIV-infected individuals: A systematic review and meta-analysis. Sci. Rep. 2021, 11, 6283. [Google Scholar] [CrossRef]
- Chun, H.M.; Milligan, K.; Agyemang, E.; Ford, N.; Rangaraj, A.; Desai, S.; Wilder-Smith, A.; Vitoria, M.; Zulu, I. A systematic review of COVID-19 vaccine antibody responses in people with HIV. Open Forum Infect. Dis. 2022, 9, ofac579. [Google Scholar] [CrossRef]
- Lapointe, H.R.; Mwimanzi, F.; Cheung, P.K.; Sang, Y.; Yaseen, F.; Umviligihozo, G.; Kalikawe, R.; Speckmaier, S.; Moran-Garcia, N.; Datwani, S.; et al. People with HIV receiving suppressive antiretroviral therapy show typical antibody durability after dual COVID-19 vaccination, and strong third dose responses. medRxiv 2022. [Google Scholar] [CrossRef]
- Hassold, N.; Brichler, S.; Ouedraogo, E.; Leclerc, D.; Carroue, S.; Gater, Y.; Alloui, C.; Carbonnelle, E.; Bouchaud, O.; Mechai, F.; et al. Impaired antibody response to COVID-19 vaccination in advanced HIV infection. AIDS 2022, 36, F1–F5. [Google Scholar] [CrossRef]
- Williams, L.D.; Aber, J.L.; SIZE Research Group. Using a multi-level framework to test empirical relationships among HIV/AIDS-related stigma, health service barriers, and HIV outcomes in South Africa. AIDS Behav. 2019, 24, 81–94. [Google Scholar] [CrossRef]
- Madiba, S.; Ralebona, E.; Lowane, M. Perceived stigma as a contextual barrier to early uptake of HIV testing, treatment initiation, and disclosure; the case of patients admitted with AIDS-related illness in a rural hospital in South Africa. Healthcare 2021, 9, 962. [Google Scholar] [CrossRef]
- Mall, S.; Middelkoop, K.; Mark, D.; Wood, R.; Bekker, L.G. Changing patterns in HIV/AIDS stigma and uptake of voluntary counselling and testing services: The results of two consecutive community surveys conducted in the Western Cape, South Africa. AIDS Care 2013, 25, 194–201. [Google Scholar] [CrossRef] [PubMed]
- van Heerden, A.; Msweli, S.; van Rooyen, H. “Men don’t want things to be seen or known about them”: A mixed-methods study to locate men in a home based counselling and testing programme in KwaZulu-Natal, South Africa. Afr. J. AIDS Res. 2015, 14, 353–359. [Google Scholar] [CrossRef]
- Parry, C.D.H.; Plüddemann, A.; Myers, B.; Wechsberg, W.M.; Flisher, A.J. Methamphetamine use and sexual risk behaviour in Cape Town, South Africa: A review of data from 8 studies conducted between 2004 and 2007. Afr. J. Psychiatry 2011, 14, 372–376. [Google Scholar] [CrossRef] [PubMed]
- Wechsberg, W.M.; Myers, B.; Kline, T.L.; Carney, T.; Browne, F.A.; Novak, S.P. The relationship of alcohol and other drug use typologies to sex risk behaviors among vulnerable women in Cape Town, South Africa. J. AIDS Clin. Res. 2012, (Suppl. S1), 015. [Google Scholar] [CrossRef]
- Benotsch, E.G.; Koester, S.; Luckman, D.; Martin, A.M.; Cejka, A. Non-medical use of prescription drugs and sexual risk behavior in young adults. Addict. Behav. 2011, 36, 152–155. [Google Scholar] [CrossRef]
- Friedman, M.S.; Marshal, M.P.; Stall, R.; Kidder, D.P.; Henny, K.D.; Courtenay-Quirk, C.; Study Group The Project START; Aidala, A.; Royal, S.; Holtgrave, D.R. Associations between substance use, sexual risk taking and HIV treatment adherence among homeless people living with HIV. AIDS Care 2009, 21, 692–700. [Google Scholar] [CrossRef]
- Iversen, J.; Long, P.; Lutnick, A.; Maher, L. Patterns and epidemiology of illicit drug use among sex workers globally: A systematic review. In Sex Work, Health, and Human Rights; Goldenberg, S.M., Thomas, R.M., Forbes, A., Baral, S., Eds.; Springer Nature: Cham, Switzerland, 2021; pp. 95–118. [Google Scholar]
- Benoit, C.; McCarthy, B.; Jansson, M. Stigma, sex work, and substance use: A comparative analysis. Sociol. Health Illn. 2015, 37, 437–451. [Google Scholar] [CrossRef]
- Hedden, S.L.; Hulbert, A.; Cavanaugh, C.E.; Parry, C.D.; Moleko, A.G.; Latimer, W.W. Alcohol, drug, and sexual risk behavior correlates of recent transactional sex among female black South African drug users. J. Subst. Use 2011, 16, 57–67. [Google Scholar] [CrossRef]
- von Hippel, C.; Brener, L.; Horwitz, R. Implicit and explicit internalized stigma: Relationship with risky behaviors, psychosocial functioning and healthcare access among people who inject drugs. Addict. Behav. 2018, 76, 305–311. [Google Scholar] [CrossRef]
- Vetrova, M.V.; Cheng, D.M.; Bendiks, S.; Gnatienko, N.; Lloyd-Travaglini, C.; Jiang, W.; Luoma, J.; Blokhina, E.; Krupitsky, E.; Lioznov, D.; et al. HIV and substance use stigma, intersectional stigma and healthcare among HIV-positive PWID in Russia. AIDS Behav. 2021, 25, 2815–2826. [Google Scholar] [CrossRef]
- Meyerson, B.E.; Russell, D.M.; Kichler, M.; Atkin, T.; Fox, G.; Coles, H.B. I don’t even want to go to the doctor when I get sick now: Healthcare experiences and discrimination reported by people who use drugs, Arizona 2019. Int. J. Drug Policy 2021, 93, 103112. [Google Scholar] [CrossRef] [PubMed]
- Biancarelli, D.L.; Biello, K.B.; Childs, E.; Drainoni, M.; Salhaney, P.; Edeza, A.; Mimiaga, M.J.; Saitz, R.; Bazzi, A.R. Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug Alcohol. Depend. 2019, 198, 80–86. [Google Scholar] [CrossRef]
- Muncan, B.; Walters, S.M.; Ezell, J.; Ompad, D.C. “They look at us like junkies”: Influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City. Harm Reduct. J. 2020, 17, 53. [Google Scholar] [CrossRef]
- Deren, S.; Cleland, C.M.; Lee, H.; Mehandru, S.; Markowitz, M. Brief report: The relationship between injection drug use risk behaviors and markers of immune activation. J. Acquir. Immune Defic. Syndr. 2017, 75, e8–e12. [Google Scholar] [CrossRef]
- Tomescu, C.; Seaton, K.E.; Smith, P.; Taylor, M.; Tomaras, G.D.; Metzger, D.S.; Montaner, L.J. Innate activation of MDC and NK cells in high-risk HIV-1-exposed seronegative IV-drug users who share needles when compared with low-risk nonsharing IV-drug user controls. J. Acquir. Immune Defic. Syndr. 2015, 68, 264–273. [Google Scholar] [CrossRef]
- Mehandru, S.; Deren, S.; Kang, S.Y.; Banfield, A.; Garg, A.; Garmon, D.; LaMar, M.; Evering, T.H.; Markowitz, M. Behavioral, mucosal and systemic immune parameters in HIV-infected and uninfected injection drug users. J. Addict. Res. Ther. 2015, 6, 257. [Google Scholar] [CrossRef]
- Kapadia, F.; Vlahov, D.; Donahoe, R.M.; Friedland, G. The role of substance abuse in HIV disease progression: Reconciling differences from laboratory and epidemiologic investigations. Clin. Infect. Dis. 2005, 41, 1027–1034. [Google Scholar] [CrossRef]
- Markowitz, M.; Deren, S.; Cleland, C.; L Mar, M.; Silva, E. Chronic hepatitis C infection and the pro-inflammatory effects of injection drug use. J. Infect. Dis. 2016, 214, 1376–1382. [Google Scholar] [CrossRef]
- Donahoe, R.M.; Vlahov, D. Opiates as potential cofactors in progression of HIV-1 infections to AIDS. J. Neuroimmunol. 1998, 83, 77–87. [Google Scholar] [CrossRef]
- Williams, L.D.; van Heerden, A.; Friedman, S.R.; Chibi, B.; Avila Rodriguez, W.; Memela, P. Changes in stigma and social support among participants in a randomized trial of a novel expanded social network-based HIV testing intervention in KwaZulu-Natal, South Africa. AIDS Behav. 2024, 28, 2619–2629. [Google Scholar] [CrossRef]
- Orient Gene. Product Description Product 176. Orient Gene. 2020. Available online: https://www.orientgene.com/index.php/product/info/176.html (accessed on 15 May 2024).
- Colvin, C.J. Strategies for engaging men in HIV services. Lancet HIV 2019, 6, e191–e200. [Google Scholar] [CrossRef] [PubMed]
- April, M.D.; Walensky, R.P.; Chang, Y.; Pitt, J.; Freedberg, K.A.; Losina, E.; Paltiel, A.D.; Wood, R. HIV testing rates and outcomes in a South African community, 2001–2006: Implications for expanded screening policies. JAIDS 2009, 51, 310. [Google Scholar] [CrossRef] [PubMed]
- van Rooyen, H.; McGrath, N.; Chirowodza, A.; Joseph, P.; Fiamma, A.; Gray, G.; Richter, L.; Coates, T. Mobile VCT: Reaching men and young people in urban and rural South African pilot studies (NIMH Project Accept, HPTN 043). AIDS Behav. 2013, 17, 2946–2953. [Google Scholar] [CrossRef] [PubMed]
- Burch, A.E.; Lee, E.; Shackelford, P.; Schmidt, P.; Bolin, P. Willingness to Vaccinate Against COVID-19: Predictors of Vaccine Uptake Among Adults in the US. J. Prim. Prev. 2022, 43, 83–93. [Google Scholar] [CrossRef]
- Ruiz, J.B.; Bell, R.A. Predictors of intention to vaccinate against COVID-19: Results of a nationwide survey. Vaccine 2021, 39, 1080–1086. [Google Scholar] [CrossRef]
- Sewpaul, R.; Sifunda, S.; Gaida, R.; Mokhele, T.; Naidoo, I.; Reddy, S.P. Vaccine hesitancy and related factors among South African adults in 2021: Unpacking uncertainty versus unwillingness. Front. Public Health 2023, 11, 1233031. [Google Scholar] [CrossRef]
- Engelbrecht, M.; Heunis, C.; Kigozi, G. COVID-19 vaccine hesitancy in South Africa: Lessons for future pandemics. Int. J. Environ. Res. Public Health 2022, 19, 6694. [Google Scholar] [CrossRef]
- Rosenstock, I.M. The health belief model and preventive health behavior. Health Educ. Monogr. 1974, 2, 354–386. [Google Scholar] [CrossRef]
- Ewart, C.K. Social action theory for a public health psychology. Am. Psychol. 1991, 46, 931. [Google Scholar] [CrossRef]
- Piltch-Loeb, R.; Mazibuko, L.; Stanton, E.; Mngomezulu, T.; Gareta, D.; Nxumalo, S.; Kraemer, J.D.; Herbst, K.; Siedner, M.J.; Harling, G. COVID-19 vaccine uptake, confidence and hesitancy in rural KwaZulu-Natal, South Africa between April 2021 and April 2022: A continuous cross-sectional surveillance study. PLoS Glob. Public Health 2023, 3, e0002033. [Google Scholar] [CrossRef]
- Madhi, S.A.; Koen, A.L.; Izu, A.; Fairlie, L.; Cutland, C.L.; Baillie, V.; Padayachee, S.D.; Dheda, K.; Barnabas, S.L.; Bhorat, Q.E.; et al. Safety and immunogenicity of the ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 in people living with and without HIV in South Africa: An interim analysis of a randomised, double-blind, placebo-controlled, phase 1B/2A trial. Lancet HIV 2021, 8, e568–e580. [Google Scholar] [CrossRef]
Variable | Category | Number | % |
---|---|---|---|
Gender | Man | 287 | 61.1% |
Woman | 183 | 38.9% | |
Age | 18–31 years old | 260 | 55.3% |
32 years or older | 210 | 44.7% | |
Hard drug use in the last 6 months | Yes | 51 | 10.9% |
No | 419 | 89.1% | |
HIV status | PLWH (already aware) | 180 | 38.3% |
NDH (previously unaware) | 53 | 11.3% | |
HIV-negative | 237 | 50.4% | |
COVID-19 testing uptake | At least one test | 247 | 52.6% |
Never | 223 | 47.4% | |
COVID-19 vaccination status | At least one dose | 223 | 47.4% |
None | 247 | 52.6% | |
Most recent COVID-19 vaccine dose (N = 223) | More than 6 months ago | 190 | 85.2% |
Within the last 6 months | 33 | 14.8% | |
Number of COVID-19 vaccine doses (N = 223) | One | 88 | 39.5% |
Two | 133 | 59.6% | |
Unsure | 2 | 0.9% | |
COVID-19 IgG antibody test result | Positive | 279 | 59.4% |
Negative | 191 | 40.6% | |
Employed (part-time or full-time) | Yes | 73 | 15.5% |
No | 397 | 84.5% | |
Completed high school (standard 12 grades) | Yes | 226 | 48.1% |
No | 244 | 51.9% |
COVID-19 Testing Uptake | COVID-19 Vaccination Status | |||||
---|---|---|---|---|---|---|
Χ2 | Odds Ratio † | 95% C.I. | Χ2 | Odds Ratio † | 95% C.I. | |
Woman | 10.16 ** | 1.84 ** | 1.26, 2.69 | 9.39 ** | 1.79 ** | 1.23, 2.61 |
32 years or older | 1.10 | 1.22 | 0.84, 1.75 | 4.46 * | 1.48 * | 1.03, 2.14 |
Hard drug use | 0.29 | 0.85 | 0.48, 1.53 | 1.55 | 0.69 | 0.38, 1.24 |
PLWH (or not) | 0.08 | 1.05 | 0.73, 1.05 | 1.01 | 1.21 | 0.84, 1.73 |
NDH (or not) | 0.69 | 0.78 | 0.44, 1.39 | 0.39 | 0.83 | 0.47, 1.48 |
Odds Ratio † | S.E. | 95% C.I. | ||
---|---|---|---|---|
Model 1 | PLWH | 0.82 | 0.26 | 0.49, 1.37 |
Vaccinated for COVID-19 | 8.01 *** | 0.32 | 4.24, 15.11 | |
PLWH × Vaccination Interaction | 0.78 | 0.44 | 0.33, 1.85 | |
Model 2 | NDH | 0.63 | 0.42 | 0.28, 1.44 |
Vaccinated for COVID-19 | 6.68 *** | 0.23 | 4.25, 10.49 | |
NDH × Vaccination Interaction | 1.26 | 0.68 | 0.33, 4.80 | |
Model 3 | Hard Drug Use | 0.60 | 0.42 | 0.26, 1.35 |
Vaccinated for COVID-19 | 6.11 *** | 0.23 | 3.93, 9.52 | |
Hard Drug Use × Vaccination Interaction | 3.60 | 0.87 | 0.65, 19.93 |
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Williams, L.D.; Memela, P.; van Heerden, A.; Friedman, S.R.; Joseph, P.; Chibi, B. Relationships Among COVID-19-Related Service Uptake, HIV Status, Drug Use, and COVID-19 Antibody Status Among HIV Testing Intervention Participants in KwaZulu-Natal, South Africa. Int. J. Environ. Res. Public Health 2024, 21, 1411. https://doi.org/10.3390/ijerph21111411
Williams LD, Memela P, van Heerden A, Friedman SR, Joseph P, Chibi B. Relationships Among COVID-19-Related Service Uptake, HIV Status, Drug Use, and COVID-19 Antibody Status Among HIV Testing Intervention Participants in KwaZulu-Natal, South Africa. International Journal of Environmental Research and Public Health. 2024; 21(11):1411. https://doi.org/10.3390/ijerph21111411
Chicago/Turabian StyleWilliams, Leslie D., Phumlani Memela, Alastair van Heerden, Samuel R. Friedman, Phillip Joseph, and Buyisile Chibi. 2024. "Relationships Among COVID-19-Related Service Uptake, HIV Status, Drug Use, and COVID-19 Antibody Status Among HIV Testing Intervention Participants in KwaZulu-Natal, South Africa" International Journal of Environmental Research and Public Health 21, no. 11: 1411. https://doi.org/10.3390/ijerph21111411