Rein, Sophia Marie;
(2022)
Sociodemographic disparities in hospitalisation among people living with HIV in high-income countries during the current antiretroviral therapy era.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
In the recent combination antiretroviral therapy (cART) era, morbidity in people living with HIV (PLHIV) is dominated by non-AIDS conditions. Hospitalisation is an important marker of both AIDS and non-AIDS morbidity and a significant contributor to healthcare costs. However, recent research on hospitalisation among PLHIV in high-income countries is limited. This thesis aimed to describe current rates and causes of hospitalisation, and investigate the association of demographic, socioeconomic, mental health and lifestyle factors (termed ‘sociodemographic’ factors) with subsequent hospitalisation in PLHIV in the UK and the broader European and North American regions, from 2007 onwards. Additional analysis explored how causal inference methods could be used to investigate the effect on hospitalisation of a hypothetical intervention to eliminate socioeconomic disparities in HIV viral suppression, a potential driver of disparities in hospitalisation. The analyses used three observational studies: The Royal Free HIV Cohort Study (RFHCS); the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study (both UK); the Antiretroviral Therapy Cohort Collaboration (ART-CC) (Europe and North America). Compared to men who have sex with men (MSM), hospitalisation risk was higher for women and men who have sex with women (MSW); compared to white individuals, it was higher in some individuals with minority ethnicity, though not in migrants. Having children, no stable partner, socioeconomic disadvantage, depression symptoms/treatment, anxiety symptoms, smoking, high alcohol intake and injection drug use predicted subsequent hospitalisation. There was a broad spectrum of admission causes, predominantly non-AIDS. Results suggested a hypothetical intervention to eliminate socioeconomic disparities in viral suppression could reduce hospitalisation, though with wide uncertainty around effect estimates. In conclusion, significant sociodemographic disparities in hospitalisation exist among PLHIV in high income countries in the current cART era. This highlights the need for differentiated care, targeted interventions and prevention, early detection and treatment of common chronic conditions.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Sociodemographic disparities in hospitalisation among people living with HIV in high-income countries during the current antiretroviral therapy era |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10143041 |
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