Mukoswa Grace Musanse, Charalambous Salome, Nelson Gill
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
The Aurum Institute, Johannesburg, South Africa.
PLoS One. 2017 Nov 9;12(11):e0184140. doi: 10.1371/journal.pone.0184140. eCollection 2017.
BACKGROUND: HIV treatment has reduced morbidity and mortality. By 2012, it was estimated that 60.4% of eligible South Africans accessed antiretroviral treatment; however, treatment adherence and retention remain the greatest challenges. There is a growing belief that social capital, seen as "the features of social organization that facilitate cooperation for mutual benefit", is important in promoting HIV treatment retention. The aim of this study was to establish whether social capital is associated with HIV treatment outcomes. METHODS AND FINDINGS: This was a cross-sectional analysis of data from a cohort study that investigated how patient outcomes were linked to clinical characteristics, and included exploratory factor and logistic regression analysis. Data from 943 patients were analyzed. Outcomes for the analysis were visit non-adherence, unsuppressed viral load, and treatment failure. Sixteen percent of patients (n = 118) had unsuppressed viral loads; 19% (n = 179) were non-adherent; and 32% (n = 302) experienced treatment failure. Social capital had two dimensions that were described by two factors. There was no association between either factor and visit non-adherence. Social capital factor 1 was marginally associated with lower risks of unsuppressed viral load and treatment failure at 12 months (OR = 0.78; 95% CI = 0.58-1.03 and OR = 0.76; 95% CI = 0.62-0.93, respectively); but not with visit non-adherence (OR = 0.93; 95% CI = 0.71-1.22). After controlling for confounders, the odds of both unsuppressed viral load and treatment failure decreased with an increase in social capital factor 1. CONCLUSION: This study suggests that social capital, in terms of the number of groups to which an HIV-infected person belongs, the diversity of the groups, availability of child support, and time available for community projects, is protective against poor HIV treatment outcomes. Implementers and policy makers in the areas of HIV treatment and prevention need to consider the inclusion of social capital in the design of HIV/AIDS treatment program.
背景：艾滋病病毒治疗已降低了发病率和死亡率。到2012年，据估计60.4%符合条件的南非人接受了抗逆转录病毒治疗；然而，治疗依从性和持续性仍然是最大的挑战。越来越多的人认为，被视为“促进互利合作的社会组织特征”的社会资本，在促进艾滋病病毒治疗持续性方面很重要。本研究的目的是确定社会资本是否与艾滋病病毒治疗结果相关。 方法与结果：这是一项对队列研究数据的横断面分析，该队列研究调查了患者结果如何与临床特征相关联，包括探索性因素分析和逻辑回归分析。对943名患者的数据进行了分析。分析的结果包括就诊不依从、病毒载量未被抑制和治疗失败。16%的患者（n = 118）病毒载量未被抑制；19%（n = 179）不依从；32%（n = 302）经历了治疗失败。社会资本有两个维度，由两个因素描述。两个因素与就诊不依从均无关联。社会资本因素1与12个月时病毒载量未被抑制和治疗失败风险较低存在微弱关联（OR = 0.78；95%CI = 0.58 - 1.03和OR = 0.76；95%CI = 0.62 - 0.93）；但与就诊不依从无关（OR = 0.93；95%CI = 0.71 - 1.22）。在控制混杂因素后，病毒载量未被抑制和治疗失败的几率均随着社会资本因素1的增加而降低。 结论：本研究表明，就感染艾滋病病毒者所属群体的数量、群体的多样性、儿童抚养的可得性以及可用于社区项目的时间而言，社会资本对不良的艾滋病病毒治疗结果具有保护作用。艾滋病病毒治疗和预防领域的实施者和政策制定者需要考虑在艾滋病病毒/艾滋病治疗项目设计中纳入社会资本。
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