HIV/AIDS, STI and TB (HAST), Human Sciences Research Council, South Africa.
SAHARA J. 2012;9(1):6-14. doi: 10.1080/17290376.2012.665253.
The aim of this study was to assess the predictors of the receipt of a disability grant (DG) status and the impact of the DG on health outcomes of HIV patients and on antiretroviral therapy (ART) in a longitudinal study over 20 months in KwaZulu-Natal, South Africa. Consecutive patients, 735 (29.8% males and 70.2% females), who attended three HIV clinics completed the assessments (with a structured questionnaire and medical file review) prior to antiretroviral initiation, 519 after 6 months, 557 after 12 months and 499 after 20 months on ART. The results indicate that a large number of HIV or ART patients were found to be in receipt of a DG, which declined significantly over the time of being on ART (from 52.3% at 6 months on ART to 9.8% at 20 months on ART). At various stages, being in receipt of a DG was found to be associated with not being employed, higher quality of life (QoL), older age, higher alcohol use score, no formal salary as household income and higher subjective health status in multivariable analyses. A significant number of patients lost their DG status over the assessment period, which was not found to be associated with major health outcomes (CD4 cell counts, adherence to ART and HIV symptoms). In a multiple regression generalized estimating equation model, not being in receipt of a DG, health-related QoL, lower HIV symptoms and lower depression scores were associated with CD4 counts. HIV patients who no longer qualify for the DG and yet do not have adequate financial means to meet basic necessities should be put on a nutritional support programme.
本研究旨在评估残疾津贴（DG）的接受预测因素，以及 DG 对南非夸祖鲁-纳塔尔省 20 个月纵向研究中 HIV 患者的健康结果和抗逆转录病毒治疗（ART）的影响。连续的患者（735 例，男性占 29.8%，女性占 70.2%），在开始接受抗逆转录病毒治疗前，参加了三个 HIV 诊所的评估（采用结构化问卷和病历回顾），在接受 6 个月、12 个月和 20 个月的 ART 后，有 519 人、557 人和 499 人完成了评估。结果表明，大量 HIV 或 ART 患者被发现正在领取 DG，在接受 ART 的过程中，这一比例显著下降（从接受 ART 6 个月时的 52.3%下降到接受 ART 20 个月时的 9.8%）。在不同阶段，领取 DG 与未就业、较高的生活质量（QoL）、年龄较大、较高的酒精使用评分、无正规工资作为家庭收入和较高的主观健康状况有关，这些都在多变量分析中得到了证实。在评估期间，相当数量的患者失去了 DG 资格，但这与主要健康结果（CD4 细胞计数、ART 依从性和 HIV 症状）无关。在多元回归广义估计方程模型中，未领取 DG、与健康相关的 QoL、较低的 HIV 症状和较低的抑郁评分与 CD4 计数相关。那些不再符合 DG 资格，但又没有足够的经济手段来满足基本生活需求的 HIV 患者，应该被纳入营养支持计划。
