Determinants of the risk of dying of HIV/AIDS in a rural South African community over the period of the decentralised roll-out of antiretroviral therapy: a longitudinal study

摘要: Background : Antiretroviral treatment (ART) has significantly reduced HIV mortality in South Africa. The benefits have not been experienced by all groups. Here we investigate the factors associated with these inequities. Design This study was located a rural African setting and used data collected from 2007 to 2010, period when decentralised ART became available. Approximately one-third of population were Mozambican origin. There pattern repeated circular migration between urban areas this community. Survival analysis models developed identify demographic, socioeconomic, spatial risk for mortality. Results Among 105,149 individuals, there 2,890 deaths. HIV/TB rate decreased 27% 2007–2008 2009–2010. For other causes death, reduction 10%. Bivariate found that lower for: those living within 5 km Bhubezi Community Health Centre; women; young adults; in-migrants longer residence; permanent residents; members households owning motorised transport, holding higher socioeconomic positions, levels education. Multivariate modelling showed, addition, Africa as their country origin had an increased compared origins. males, origin, recent in-migrants, death greater than due causes. Conclusions In community, combination dying over roll-out ART. is evidence presence barriers successful particular sub-groups population, which must be addressed if improvements population-level are maintained. Keywords : HIV; mortality; determinants; global health; healthcare access; (Published: 20 November 2014) Citation Glob Action 2014,  7 24826 -  http://dx.doi.org/10.3402/gha.v7.24826 SUPPLEMENTARY FILES To access supplementary material article, please see  Supplementary files  under Article Tools