HIV infection increases the risk of developing cervical cancer; however, longitudinal studies in ... more HIV infection increases the risk of developing cervical cancer; however, longitudinal studies in sub‐Saharan Africa comparing cervical cancer rates between women living with HIV (WLWH) and women without HIV are scarce. To address this gap, we compared cervical precancer and cancer incidence rates between WLWH and women without HIV in South Africa using reimbursement claims data from a medical insurance scheme from January 2011 to June 2020. We used Royston‐Parmar flexible parametric survival models to estimate cervical precancer and cancer incidence rates as a continuous function of age, stratified by HIV status. Our study population consisted of 518 048 women, with exclusions based on the endpoint of interest. To analyse cervical cancer incidence, we included 517 312 women, of whom 564 developed cervical cancer. WLWH had an ~3‐fold higher risk of developing cervical precancer and cancer than women without HIV (adjusted hazard ratio for cervical cancer: 2.99; 95% confidence interval...
ImportancePeople with mental illness have a reduced life expectancy, but the extent of the mortal... more ImportancePeople with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown.ObjectiveTo quantify excess mortality due to natural and unnatural causes associated with mental illness.Design, setting and participantsCohort study using reimbursement claims and vital registration of beneficiaries of a South African medical insurance scheme, aged 15-84 years and covered by medical insurance at any point between January 1, 2011, and June 30, 2020.ExposuresICD-10 diagnoses of mental disorders including organic, substance use, psychotic, mood, anxiety, eating, personality, and developmental disorders.OutcomesMortality from natural, unnatural, unknown and all causes, as measured by the life-years lost (LYL) metric.ResultsWe followed 1 070 183 beneficiaries (51.7% female, median age 36.1 years for a median duration of 3.0 years, of w...
We followed adolescents and adults living with HIV aged older than 15 years who enrolled in a Sou... more We followed adolescents and adults living with HIV aged older than 15 years who enrolled in a South African private-sector HIV programme to examine adherence and viral non-suppression (viral load > 400 copies/mL) of participants with (20,743, 38%) and without (33,635, 62%) mental health diagnoses. Mental health diagnoses were associated with unfavourable adherence patterns. The risk of viral non-suppression was higher among patients with organic mental disorders [adjusted risk ratio (aRR) 1.55, 95% confidence interval (CI) 1.22–1.96], substance use disorders (aRR 1.53, 95% CI 1.19–1.97), serious mental disorders (aRR 1.30, 95% CI 1.09–1.54), and depression (aRR 1.19, 95% CI 1.10–1.28) when compared with patients without mental health diagnoses. The risk of viral non-suppression was also higher among males, adolescents (15–19 years), and young adults (20–24 years). Our study highlights the need for psychosocial interventions to improve HIV treatment outcomes—particularly of adoles...
Socioeconomic predictors and consequences of depression among primary care attenders with non-com... more Socioeconomic predictors and consequences of depression among primary care attenders with non-communicable diseases in the
To describe the receipt of a diagnosis, referral and treatment for depression in people receiving... more To describe the receipt of a diagnosis, referral and treatment for depression in people receiving antiretroviral therapy (ART), with depressive symptoms and attending primary care clinics in South Africa, and investigate factors associated with receiving these components of care.
Aim South African adults with hypertension often have comorbid physical and mental health problem... more Aim South African adults with hypertension often have comorbid physical and mental health problems and disabilities, which can influence each other in complex ways. We modelled potential causal pathways connecting multimorbidity, depression, stress, disability and cardiovascular risks. Methods The study analysed observational data on 1043 adults with treated hypertension and with symptoms of depression (Patient Health Questionnaire-9 score > 9) who participated in a randomised trial in 20 primary health care clinics. A structural equation path model using cross-sectional baseline data estimated direct and indirect effects of sociodemographic variables and comorbidities on depression, stress and disability scores, and their further direct and indirect effects on smoking, body mass index and blood pressure. A cross-lagged structural equation model using longitudinal data estimated effects of depression symptoms, disability and blood pressure on each other over time. Results At base...
The scale-up of antiretroviral treatment (ART) programmes has seen HIV/AIDS transition to a chron... more The scale-up of antiretroviral treatment (ART) programmes has seen HIV/AIDS transition to a chronic condition characterised by high rates of comorbidity with tuberculosis, non-communicable diseases (NCDs) and mental health disorders. Depression is one such disorder that is associated with higher rates of non-adherence, progression to AIDS and greater mortality. Detection and treatment of comorbid depression is critical to achieve viral load suppression in more than 90% of those on ART and is in line with the recent 90-90-90 Joint United Nations Programme on HIV/AIDS (UNAIDS) targets. The CobALT trial aims to provide evidence on the effectiveness and cost-effectiveness of scalable interventions to reduce the treatment gap posed by the growing burden of depression among adults on lifelong ART. The study design is a pragmatic, parallel group, stratified, cluster randomised trial in 40 clinics across two rural districts of the North West Province of South Africa. The unit of randomisati...
HIV infection increases the risk of developing cervical cancer; however, longitudinal studies in ... more HIV infection increases the risk of developing cervical cancer; however, longitudinal studies in sub‐Saharan Africa comparing cervical cancer rates between women living with HIV (WLWH) and women without HIV are scarce. To address this gap, we compared cervical precancer and cancer incidence rates between WLWH and women without HIV in South Africa using reimbursement claims data from a medical insurance scheme from January 2011 to June 2020. We used Royston‐Parmar flexible parametric survival models to estimate cervical precancer and cancer incidence rates as a continuous function of age, stratified by HIV status. Our study population consisted of 518 048 women, with exclusions based on the endpoint of interest. To analyse cervical cancer incidence, we included 517 312 women, of whom 564 developed cervical cancer. WLWH had an ~3‐fold higher risk of developing cervical precancer and cancer than women without HIV (adjusted hazard ratio for cervical cancer: 2.99; 95% confidence interval...
ImportancePeople with mental illness have a reduced life expectancy, but the extent of the mortal... more ImportancePeople with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown.ObjectiveTo quantify excess mortality due to natural and unnatural causes associated with mental illness.Design, setting and participantsCohort study using reimbursement claims and vital registration of beneficiaries of a South African medical insurance scheme, aged 15-84 years and covered by medical insurance at any point between January 1, 2011, and June 30, 2020.ExposuresICD-10 diagnoses of mental disorders including organic, substance use, psychotic, mood, anxiety, eating, personality, and developmental disorders.OutcomesMortality from natural, unnatural, unknown and all causes, as measured by the life-years lost (LYL) metric.ResultsWe followed 1 070 183 beneficiaries (51.7% female, median age 36.1 years for a median duration of 3.0 years, of w...
We followed adolescents and adults living with HIV aged older than 15 years who enrolled in a Sou... more We followed adolescents and adults living with HIV aged older than 15 years who enrolled in a South African private-sector HIV programme to examine adherence and viral non-suppression (viral load > 400 copies/mL) of participants with (20,743, 38%) and without (33,635, 62%) mental health diagnoses. Mental health diagnoses were associated with unfavourable adherence patterns. The risk of viral non-suppression was higher among patients with organic mental disorders [adjusted risk ratio (aRR) 1.55, 95% confidence interval (CI) 1.22–1.96], substance use disorders (aRR 1.53, 95% CI 1.19–1.97), serious mental disorders (aRR 1.30, 95% CI 1.09–1.54), and depression (aRR 1.19, 95% CI 1.10–1.28) when compared with patients without mental health diagnoses. The risk of viral non-suppression was also higher among males, adolescents (15–19 years), and young adults (20–24 years). Our study highlights the need for psychosocial interventions to improve HIV treatment outcomes—particularly of adoles...
Socioeconomic predictors and consequences of depression among primary care attenders with non-com... more Socioeconomic predictors and consequences of depression among primary care attenders with non-communicable diseases in the
To describe the receipt of a diagnosis, referral and treatment for depression in people receiving... more To describe the receipt of a diagnosis, referral and treatment for depression in people receiving antiretroviral therapy (ART), with depressive symptoms and attending primary care clinics in South Africa, and investigate factors associated with receiving these components of care.
Aim South African adults with hypertension often have comorbid physical and mental health problem... more Aim South African adults with hypertension often have comorbid physical and mental health problems and disabilities, which can influence each other in complex ways. We modelled potential causal pathways connecting multimorbidity, depression, stress, disability and cardiovascular risks. Methods The study analysed observational data on 1043 adults with treated hypertension and with symptoms of depression (Patient Health Questionnaire-9 score > 9) who participated in a randomised trial in 20 primary health care clinics. A structural equation path model using cross-sectional baseline data estimated direct and indirect effects of sociodemographic variables and comorbidities on depression, stress and disability scores, and their further direct and indirect effects on smoking, body mass index and blood pressure. A cross-lagged structural equation model using longitudinal data estimated effects of depression symptoms, disability and blood pressure on each other over time. Results At base...
The scale-up of antiretroviral treatment (ART) programmes has seen HIV/AIDS transition to a chron... more The scale-up of antiretroviral treatment (ART) programmes has seen HIV/AIDS transition to a chronic condition characterised by high rates of comorbidity with tuberculosis, non-communicable diseases (NCDs) and mental health disorders. Depression is one such disorder that is associated with higher rates of non-adherence, progression to AIDS and greater mortality. Detection and treatment of comorbid depression is critical to achieve viral load suppression in more than 90% of those on ART and is in line with the recent 90-90-90 Joint United Nations Programme on HIV/AIDS (UNAIDS) targets. The CobALT trial aims to provide evidence on the effectiveness and cost-effectiveness of scalable interventions to reduce the treatment gap posed by the growing burden of depression among adults on lifelong ART. The study design is a pragmatic, parallel group, stratified, cluster randomised trial in 40 clinics across two rural districts of the North West Province of South Africa. The unit of randomisati...
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Papers by Naomi Folb