BMC Public Health
Volume 19, Issue 1, 2019

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 (Article) (Open Access)

Dzomba A.* , Tomita A. , Vandormael A. , Govender K. , Tanser F.
  • a Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa, KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa
  • b Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa, KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
  • c Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa, KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa
  • d Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
  • e Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa, Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, Research Department of Infection and Population Health, University College London, London, United Kingdom

Abstract

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. © 2019 The Author(s).

Author Keywords

female migrants Risk of HIV acquisition Migration intensity New HIV infections South Africa Universal test and treat ART scale-up

Index Keywords

HIV Infections Human immunodeficiency virus infection human middle aged Cohort Studies statistics and numerical data rural population Anti-Retroviral Agents antiretrovirus agent South Africa Young Adult Humans Adolescent female Incidence adult migration cohort analysis Transients and Migrants
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85061548045&doi=10.1186%2fs12889-019-6494-x&partnerID=40&md5=cd158fa682ea8a884b220aaabe620383
DOI: 10.1186/s12889-019-6494-x
ISSN: 14712458
Cited by: 1
Original Language: English