Gender-specific risk factors for virologic failure in KwaZulu-Natal: automobile ownership and financial insecurity.

We sought to examine which socioeconomic indicators are risk factors for virologic failure among HIV-1 infected patients receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. A case-control study of virologic failure was conducted among patients recruited from the outpatient clinic at McCord Hospital in Durban, South Africa between October 1, 2010 and June 30, 2012. Cases were those failing first-line ART, defined as viral load >1,000 copies/mL. Univariate logistic regression was performed on sociodemographic data for the outcome of virologic failure. Variables found significant (p < 0.05) were used in multivariate models and all models were stratified by gender. Of 158 cases and 300 controls, 35 % were male and median age was 40 years. Gender stratification of models revealed automobile ownership was a risk factor among males, while variables of financial insecurity (unemployment, non-spouse family paying for care, staying with family) were risk factors for women. In this cohort, financial insecurity among women and automobile ownership among men were risk factors for virologic failure. Risk factor differences between genders demonstrate limitations of generalized risk factor analysis.

Early warning indicators for first-line virologic failure independent of adherence measures in a South African urban clinic.

We sought to develop individual-level Early Warning Indicators (EWI) of virologic failure (VF) for clinicians to use during routine care complementing WHO population-level EWI. A case-control study was conducted at a Durban clinic. Patients after ≥ 5 months of first-line antiretroviral therapy (ART) were defined as cases if they had VF [HIV-1 viral load (VL)>1000 copies/mL] and controls (2:1) if they had VL ≤ 1000 copies/mL. Pharmacy refills and pill counts were used as adherence measures. Participants responded to a questionnaire including validated psychosocial and symptom scales. Data were also collected from the medical record. Multivariable logistic regression models of VF included factors associated with VF (p<0.05) in univariable analyses. We enrolled 158 cases and 300 controls. In the final multivariable model, male gender, not having an active religious faith, practicing unsafe sex, having a family member with HIV, not being pleased with the clinic experience, symptoms of depression, fatigue, or rash, low CD4 counts, family recommending HIV care, and using a TV/radio as ART reminders (compared to mobile phones) were associated with VF independent of adherence measures. In this setting, we identified several key individual-level EWI associated with VF including novel psychosocial factors independent of adherence measures.

Factors related to choosing an academic career track among spine fellowship applicants.

STUDY DESIGN: Retrospective review. OBJECTIVE: To identify factors associated with the likelihood of spine surgery fellowship applicants choosing an academic job upon fellowship completion. SUMMARY OF BACKGROUND DATA: Training academic spine surgeons is an important goal of many spine fellowships. However, there are no established criteria associated with academic job choice to guide selection committees. METHODS: Two hundred three consecutive applications of candidates who were granted an interview to a single spine surgical fellowship from 2005 to 2010 were analyzed. Factors investigated included the following: membership in honor societies; number of publications, presentations, and book chapters; age; completion of an additional degree; completion of a research fellowship; teaching experience; marital status; graduation from a top-20 school; attendance in a residency with a spine fellowship; and comments made in personal statements and letters of recommendation. The job taken upon graduation from fellowship was determined. The χ2 test or Fisher exact test was used to estimate the strength of the association between the covariates and response. Significant variables were selected for further multivariate analysis. RESULTS: The following were significantly associated in a univariable analysis with academia: 5 or more national presentations; completion of a research fellowship; attendance in a top-20 medical school; stated desire in the personal statement to become an academic surgeon; and letters of reference stating likelihood of pursuing academics on hiring the applicant. When significant variables were selected for multivariable analysis, completion of a research fellowship, graduation from a top-20 medical school, and stated desire in the personal statement to become an academic surgeon were most strongly associated with choice of academia. CONCLUSION: Although job choice is multifactorial, the present study demonstrates that there are objective factors listed on spine fellowship applications associated with a significantly higher likelihood of academic job choice. Analyzing these factors may help selection committees evaluate spine fellowship applicants consistent with the academic missions of their programs.