Effect of ART scale-up and female migration intensity on risk of HIV acquisition: results from a population-based cohort in KwaZulu-Natal, South Africa

Dzomba, A., Tomita, A., Vandormael, A., Govender, K. and Tanser, F.

BACKGROUND: Despite increased antiretroviral therapy (ART) coverage, the incidence of HIV infection among women in rural South Africa remains high. While many socio-demographic and behavioral factors have been identified, the effect of female migration intensity on the risk of HIV acquisition before and after ART scale-up has not been evaluated in the country.

METHODS: We followed 13,315 female participants aged 15-49 who were HIV-uninfected at baseline and recorded their migration events between 2004 and 2015. Using a Cox proportional hazard model, we estimated the time to HIV acquisition among the women, adjusting for annual migration intensity (high: >/=2 events/year, moderate = 1 event/year, and low = 0 event/year) before and after ART scale-up in 2010.

RESULTS: 1998 (15%) new HIV-infection events were recorded during the observation period. Overall, high migration intensity was associated with an increased HIV acquisition risk among women when compared with low migration intensity (HR = 2.88, 95% CI: 1.56-5.53). Among those with high migration intensity, the risk of HIV acquisition was significantly lower in the post-ART period compared to the pre-ART period, after controlling for key socio-demographic and behavioural covariates (aHR = 0.18, 95% CI 0.04-0.83).

CONCLUSIONS: Women who migrated frequently after ART scale-up had a significantly reduced HIV acquisition risk compared to those before its implementation. While this reduction is encouraging, women who migrate frequently remain at high risk of HIV acquisition. In the era of ART, there remains a critical need for public health interventions to reduce the risk of HIV acquisition in this highly vulnerable population.

April 12, 2019
Year of publication
2019
Resource types
Journal and research articles
Countries
Tags
ART scale-up, migration, HIV acquisition risks

Similar Resources

Many countries are working to reduce or eliminate mother-to-child transmission (MTCT) of HIV. Prevention efforts have been conceptualized as steps in a cascade but cascade completion rates during and after pregnancy are low.

Past endeavours to deal with the obstacle of expensive Cluster of Difference 4 (CD4(+)) count diagnostics in resource-limited settings have left a long trail of suggested continuous CD4(+) count clinical covariates that turned out to be a potentially important integral part of the human…

The Partnership for HIV-Free Survival (PHFS) was designed to use basic quality improvement practices to reduce mother-to-child transmission of HIV and increase child survival through improvements in (1) antiretroviral therapy uptake and retention among HIV-positive pregnant women and mothers, (2)

This supplement to Acta Paediatrica presents a series of meta-analyses and systematic literature reviews examining a variety of health effects potentially related to breastfeeding.

This issue of the Southern African HIV Clinicians Society's "HIV Nursing Matters" online magazine focuses on vulnerable populations, including TB in prisons and intimate partner violence in the context of HIV.

This issue of the Southern African HIV Clinicians Society's "HIV Nursing Matters" online magazine focuses on key populations.

Studies of Malawi's option B+ programme for HIV-positive pregnant and breastfeeding women have reported high loss to follow-up during pregnancy and at the start of antiretroviral therapy (ART), but few data exist about retention during breastfeeding and after weaning.

Despite the widespread implementation of Option B+ (lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women regardless of CD4 cell count) postpartum HIV-positive women remain at higher risk of loss to follow-up and death, studies from South Africa and Botswana presented at the…

We conducted a retrospective study to investigate the effectiveness of an mHealth messaging intervention aiming to improve maternal health and HIV outcomes.

This paper documents the development of the global and national monitoring and reporting systems for PMTCT and paediatric HIV care and treatment programmes, achievements and remaining challenges.