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Kapaon D, Riumallo-Herl C, Jennings E, Abrahams-Gessel S, Makofane K, Kabudula CW, Harling G. Social support receipt as a predictor of mortality: A cohort study in rural South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003683. [PMID: 39250457 PMCID: PMC11383236 DOI: 10.1371/journal.pgph.0003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 08/13/2024] [Indexed: 09/11/2024]
Abstract
The mechanisms connecting various types of social support to mortality have been well-studied in high-income countries. However, less is known about how these relationships function in different socioeconomic contexts. We examined how four domains of social support-emotional, physical, financial, and informational-impact mortality within a sample of older adults living in a rural and resource-constrained setting. Using baseline survey and longitudinal mortality data from HAALSI, we assessed how social support affects mortality in a cohort of 5059 individuals aged 40 years or older in rural Mpumalanga, South Africa. Social support was captured as the self-reported frequency with which close social contacts offered emotional, physical, financial, and informational support to respondents, standardized across the sample to increase interpretability. We used Cox proportional hazard models to evaluate how each support type affected mortality controlling for potential confounders, and assessed potential effect-modification by age and sex. Each of the four support domains had small positive associations with mortality, ranging from a hazard ratio per standard deviation of support of 1.04 [95% CI: 0.95,1.13] for financial support to 1.09 [95% CI: 0.99,1.18] for informational support. Associations were often stronger for females and younger individuals. We find baseline social support to be positively associated with mortality in rural South Africa. Possible explanations include that insufficient social support is not a strong driver of mortality risk in this setting, or that social support does not reach some necessary threshold to buffer against mortality. Additionally, it is possible that the social support measure did not capture more relevant aspects of support, or that our social support measures captured prior morbidity that attracted support before the study began. We highlight approaches to evaluate some of these hypotheses in future research.
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Affiliation(s)
- David Kapaon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Carlos Riumallo-Herl
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elyse Jennings
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shafika Abrahams-Gessel
- Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Keletso Makofane
- FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts, United States of America
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy Harling
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Zwane NS, De Wet H, Van Vuuren SF. Blood purification practices: Some ethnopharmacological insight from a rural community in KwaZulu-Natal, South Africa. JOURNAL OF ETHNOPHARMACOLOGY 2024; 324:117795. [PMID: 38244952 DOI: 10.1016/j.jep.2024.117795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/22/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Blood purification practices, also referred to as blood cleansing or detoxification, is an ancient concept which is widespread within African traditional medicine. There is, however, limited consolidated information about the selection of plant species, the purpose of use and how the preparation is made. An in-depth examination of how regional communities use medicinal plants for blood purification is needed to better understand this ethnopharmacological practice. AIM OF THE STUDY To gather knowledge on the traditional use of medicinal plants used for the purpose of blood purification by laypersons in northern Maputaland, KwaZulu-Natal, South Africa. METHODS An ethnobotanical survey was conducted on medicinal plants used in the rural areas of northern Maputaland for blood purification. Interviews were conducted in 55 homesteads, where the most knowledgeable participant per household was interviewed using structured questionnaires. Information collected included knowledge of the concept of blood purification, purpose for medicating, plant selection, and mode of preparation. The most important species and families were identified through indices. RESULTS Sixty-four plant species from 35 families were recorded as blood purifiers for the treatment of ailments linked to the need for blood purification. Terminalia sericea Burch. ex DC. was the most used plant species (mentioned by 39% of the people interviewed). The conditions that were mostly associated with blood purification were skin complaints, gastro-intestinal disorders, and overall improvement of general health. Blood purification is also commonly used for non-medical purposes such as granting good luck or as a love charm. Six new plant species and five new Zulu vernacular names had not previously been documented for blood purification. CONCLUSION The frequently mentioned use of medicinal plants for blood purification by the rural community of northern Maputaland clearly emphasises the importance of this cultural practice. There is no doubt that when examining African traditional medicine, holistic terms such as "blood cleansing" cannot be ignored. Future studies may provide a better understanding of this often misunderstood and undocumented practice.
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Affiliation(s)
- N S Zwane
- Department of Botany, University of Zululand, Private Bag 1001, KwaDlangezwa, 3886, South Africa
| | - H De Wet
- Department of Botany, University of Zululand, Private Bag 1001, KwaDlangezwa, 3886, South Africa
| | - S F Van Vuuren
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, 2193, South Africa.
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Klabbers RE, Parrish C, Iraguha P, Ntuyenabo MK, Ajidiru S, Nshimiyimana V, Caroline K, Faustin Z, Sveum EM, Muwonge TR, O’Laughlin KN. Characterizing Mobility and its Association with HIV Outcomes in Refugee Settlements in Uganda. Ann Glob Health 2024; 90:23. [PMID: 38550610 PMCID: PMC10976981 DOI: 10.5334/aogh.4367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/10/2024] [Indexed: 04/02/2024] Open
Abstract
Background A better understanding of refugee mobility is needed to optimize HIV care in refugee settlements. Objectives We aimed to characterize mobility patterns among people living with HIV in refugee settlements in Uganda and evaluate the association between mobility and retention in HIV care. Methods Refugees and Ugandan nationals accessing HIV services at seven health centers in refugee settlements across Uganda, with access to a phone, were recruited and followed for six months. Participants received an intake survey and monthly phone surveys on mobility and HIV. Clinic visit and viral suppression data were extracted from clinic registers. Mobility and HIV data were presented descriptively, and an alluvial plot was generated characterizing mobility for participants' most recent trip. Bivariate Poisson regression models were used to describe the associations between long-term mobility (≥1 continuous month away in the past year) and demographic characteristics, retention (≥1 clinic visit/6 months) and long-term mobility, and retention and general mobility (during any follow-up month: ≥2 trips, travel outside the district or further, or spending >1-2 weeks (8-14 nights) away). Findings Mobility data were provided by 479 participants. At baseline, 67 participants (14%) were considered long-term mobile. Male sex was associated with an increased probability of long-term mobility (RR 2.02; 95%CI: 1.30-3.14, p < 0.01). In follow-up, 185 participants (60% of respondents) were considered generally mobile. Reasons for travel included obtaining food or supporting farming activities (45% of trips) and work or trade (33% of trips). Retention in HIV care was found for 417 (87%) participants. Long-term mobility was associated with a 14% (RR 0.86; 95%CI: 0.75-0.98) lower likelihood of retention (p = 0.03). Conclusions Refugees and Ugandan nationals accessing HIV care in refugee settlements frequently travel to support their survival needs. Mobility is associated with inferior retention and should be considered in interventions to optimize HIV care.
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Affiliation(s)
- Robin E. Klabbers
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Canada Parrish
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
| | - Patient Iraguha
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Scovia Ajidiru
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Kampire Caroline
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Zikama Faustin
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Elinor M. Sveum
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
| | | | - Kelli N. O’Laughlin
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
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McLean E, Dube A, Kalobekamo F, Slaymaker E, Crampin AC, Sear R. Local and long-distance migration among young people in rural Malawi: importance of age, sex and family. Wellcome Open Res 2024; 8:211. [PMID: 38779043 PMCID: PMC11109702 DOI: 10.12688/wellcomeopenres.19309.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 05/25/2024] Open
Abstract
Background In sub-Saharan Africa, migration of young people is common and occurs for a variety of reasons. Research focus is often on international or long-distance internal migration; however, shorter moves also affect people's lives and can reveal important information about cultures and societies. In rural sub-Saharan Africa, migration may be influenced by cultural norms and family considerations: these may be changing due to demographic shifts, urbanisation, and increased media access. Methods We used longitudinal data from a Health and Demographic Surveillance Site in rural northern Malawi to present a detailed investigation of migration in young people between 2004-2017. Our focus is on the cultural effects of gender and family, and separate migrations into short and long distance, and independent and accompanied, as these different move types are likely to represent very different events in a young person's life. We use descriptive analyses multi-level multinomial logistic regression modelling. Results & conclusions We found two key periods of mobility 1) in very young childhood and 2) in adolescence/young adulthood. In this traditionally patrilocal area, we found that young women move longer distances to live with their spouse, and also were more likely to return home after a marriage ends, rather than remain living independently. Young people living close to relatives tend to have lower chances of moving, and despite the local patrilineal customs, we found evidence of the importance of the maternal family. Female and male children may be treated differently from as young as age 4, with girls more likely to migrate long distances independently, and more likely to accompany their mothers in other moves.
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Affiliation(s)
- Estelle McLean
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Emma Slaymaker
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amelia C Crampin
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Rebecca Sear
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Johnson-Peretz J, Chamie G, Kakande E, Christian C, Kamya MR, Akatukwasa C, Atwine F, Havlir DV, Camlin CS. Geographical, social, and political contexts of tuberculosis control and intervention, as reported by mid-level health managers in Uganda: 'The activity around town'. Soc Sci Med 2023; 338:116363. [PMID: 37944344 PMCID: PMC10878310 DOI: 10.1016/j.socscimed.2023.116363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/29/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Training district-level health officers and other mid-level health system managers revealed multiple contextual factors across political, administrative, and social axes affecting tuberculosis (TB) and TB control in Uganda. Individual relationships between local health, political, and media leaders affect efforts to inform the public and provide services, yet greater administrative coordination between national-level logistics, implementing partner funding, and local needs is required. Social challenges to TB control include high population mobility, local industries, poverty with high-density living and social venues, and misinformation about TB. Capitalizing on implementation knowledge and sharing data can overcome social geographic challenges to TB-prevention planning through strategic healthcare capacity-building at the district level.
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Affiliation(s)
- Jason Johnson-Peretz
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco (UCSF), ANSIRH Program, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
| | - Gabriel Chamie
- Department of Medicine, Division of HIV, Infectious Diseases & Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Elijah Kakande
- Infectious Diseases Research Collaboration (IDRC), 2C Nakasero Hill Road, Kampala, Uganda.
| | - Canice Christian
- Department of Medicine, University of California, San Francisco, CA, USA.
| | - Moses R Kamya
- Infectious Diseases Research Collaboration (IDRC), 2C Nakasero Hill Road, Kampala, Uganda; Department of Medicine, Makerere University College of Health Sciences, Old Mulago Hill Road, New Mulago Hospital Complex, P.O Box 7051, Kampala, Uganda.
| | - Cecilia Akatukwasa
- Infectious Diseases Research Collaboration (IDRC), 2C Nakasero Hill Road, Kampala, Uganda.
| | - Fred Atwine
- Infectious Diseases Research Collaboration (IDRC), 2C Nakasero Hill Road, Kampala, Uganda.
| | - Diane V Havlir
- Department of Medicine, Division of HIV, Infectious Diseases & Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Carol S Camlin
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco (UCSF), ANSIRH Program, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA; Department of Medicine, University of California, San Francisco (UCSF), Center for AIDS Prevention Studies, San Francisco, CA, USA.
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Ayieko J, Charlebois ED, Maeri I, Owino L, Thorp M, Bukusi EA, Petersen ML, Kamya MR, Havlir DV, Camlin CS. Improving care engagement for mobile people living with HIV in rural western Kenya. PLoS One 2023; 18:e0288087. [PMID: 37992063 PMCID: PMC10664942 DOI: 10.1371/journal.pone.0288087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/20/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) assures major gains in health outcomes among people living with HIV, however, this benefit may not be realized by all due to care interruptions. Mobile populations comprise a subgroup that is likely to have sub-optimal care engagement, resulting in discontinuation of ART. We sought to evaluate the barriers to care engagement among highly mobile individuals living with HIV and explore options aimed at improving engagement in care for this group. METHODS Qualitative in-depth interviews were conducted in 2020 among a purposive sample of twelve persons living with HIV and eight health care providers in western Kenya, within a mixed methods study of mobility in communities participating in the SEARCH trial (NCT01864603). We explored the barriers to care engagement among mobile individuals living with HIV and explored different options aimed at enhancing care engagement. These included options such as a coded card containing treatment details, alternative drug packaging to conceal drug identity, longer refills to cover travel period, wrist bands with data storage capability to enable data transfer and "warm handoff" by providers to new clinics upon transfer. Data were inductively analyzed to understand the barriers and acceptability of potential interventions to address them. RESULTS Stigma and lack of disclosure, rigid work schedules, and unpredictability of travel were major barriers to care engagement for highly mobile individuals living with HIV. Additionally, lack of flexibility in clinic schedules and poor provider attitude were identified as health-system-associated barriers to care engagement. Options that enhance flexibility, convenience and access to care were viewed as the most effective means of addressing the barriers to care by both patients and providers. The most preferred option was a coded card with treatment details followed by alternative drug packaging to conceal drug identity due to stigma and longer refills to cover travel periods. CONCLUSION Highly mobile individuals living with HIV desire responsive, flexible, convenient and patient-centered care delivery models to enhance care engagement. They embraced simple health delivery improvements such as coded cards, alternative drug packaging and longer refills to address challenges of mobility.
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Affiliation(s)
- James Ayieko
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edwin D. Charlebois
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Irene Maeri
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lawrence Owino
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Marguerite Thorp
- Department of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Elizabeth A. Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maya L. Petersen
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Diane V. Havlir
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Carol S. Camlin
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
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Ayieko J, Thorp M, Getahun M, Gandhi M, Maeri I, Gutin SA, Okiring J, Kamya MR, Bukusi EA, Charlebois ED, Petersen M, Havlir DV, Camlin CS, Murnane PM. Geographic Mobility and HIV Care Engagement among People Living with HIV in Rural Kenya and Uganda. Trop Med Infect Dis 2023; 8:496. [PMID: 37999615 PMCID: PMC10675546 DOI: 10.3390/tropicalmed8110496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Human mobility is a critical aspect of existence and survival, but may compromise care engagement among people living with HIV (PLHIV). We examined the association between various forms of human mobility with retention in HIV care and antiretroviral treatment (ART) interruptions. METHODS In a cohort of adult PLHIV in Kenya and Uganda, we collected surveys in 2016 about past 6-month travel and lifetime migration histories, including reasons and locations, and engagement in HIV care defined as (1) discontinuation of care, and (2) history of a treatment interruption among those who remained in care. We estimated associations between mobility and these care engagement outcomes via logistic regression, adjusted for sex, prior mobility, age, region, marital status, household wealth, and education. RESULTS Among 1081 participants, 56 (5%) reported having discontinued care; among those in care, 104 (10%) reported treatment interruption. Past-year migration was associated with a higher risk of discontinuation of care (adjusted odds ratio [aOR] 1.98, 95% CI 1.08-3.63). In sex-stratified models, the association was somewhat attenuated in women, but remained robust among men. Past-year migration was associated with reduced odds of having a treatment interruption among men (aOR 0.51, 95% CI 0.34-0.77) but not among women (aOR 2.67, 95% CI 0.78, 9.16). Travel in the past 6 months was not associated with discontinuation of care or treatment interruptions. CONCLUSIONS We observed both negative and protective effects of recent migration on care engagement and ART use that were most pronounced among men in this cohort. Migration can break ties to ongoing care, but for men, who have more agency in the decision to migrate, may foster new care and treatment strategies. Strategies that enable health facilities to support individuals throughout the process of transferring care could alleviate the risk of care disengagement.
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Affiliation(s)
- James Ayieko
- Kenya Medical Research Institute, Center for Microbiology Research, Nairobi 00200, Kenya
| | - Marguerite Thorp
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Irene Maeri
- Kenya Medical Research Institute, Center for Microbiology Research, Nairobi 00200, Kenya
| | - Sarah A. Gutin
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA 94143, USA
| | - Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Moses R. Kamya
- School of Medicine, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Elizabeth A. Bukusi
- Kenya Medical Research Institute, Center for Microbiology Research, Nairobi 00200, Kenya
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Maya Petersen
- Division of Biostatistics, University of California, Berkeley, CA 94720, USA
| | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA
| | - Pamela M. Murnane
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA
- Institute for Global Health Sciences, University of California, San Francisco, CA 94143, USA
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Madhavan S, Kim SW, White M, Gomez‐Olive X. Parenting in place: Young children's living arrangement and migrants' sleep health in South Africa. POPULATION, SPACE AND PLACE 2023; 29:e2692. [PMID: 38440063 PMCID: PMC10909522 DOI: 10.1002/psp.2692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 03/06/2024]
Abstract
Migration research tends to treat childrearing as a secondary role for migrants. By prioritising the economic objectives of migration, most models present migrants as either delaying childbearing or, if they have young children, not living with them. However, migration has become increasingly feminised, the types of mobility more varied, while the returns to migration remain uncertain at best. At the same time, norms around childrearing are shifting, and the capacity of kin to take care of children may be weakening. In such contexts, migrants may not want to or be able to be separated from their children. Confronting such difficult decisions and their consequences may be reflected in poor sleep health for the migrant parent. We draw on data from the Migration and Health Follow-Up Study (MHFUS) in South Africa to examine the following questions: (i) To what extent is children's coresidence associated with sleep health for migrant parents? (ii) Do effects vary by sex of migrant? and (iii) Do effects vary by location of migrant? Results from propensity score matching confirm that migrants who coreside with all their young children are more likely to experience healthy sleep compared to those who have nonresident or no young children. However, stratified analysis shows that these effects are only significant for women and those not living in Gauteng province. The value of these findings is underscored by the need for research on the well-being of migrant parents who are negotiating multiple agendas in economically precarious and physically insecure destinations.
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Affiliation(s)
- Sangeetha Madhavan
- Departments of African American Studies and SociologyUniversity of MarylandCollege ParkMarylandUSA
| | - Seung Wan Kim
- Department of SociologyUniversity of MarylandCollege ParkMarylandUSA
| | - Michael White
- Population Studies and Training CenterBrown UniversityProvidenceRhode IslandUSA
| | - Xavier Gomez‐Olive
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
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Pheiffer CF, McGarvey ST, Ginsburg C, White MJ. Urban residence and elevated blood pressure among migrant women in South Africa. Health Place 2023; 83:103071. [PMID: 37421693 PMCID: PMC10528937 DOI: 10.1016/j.healthplace.2023.103071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 07/10/2023]
Abstract
This paper demonstrates that internal migration may be contributing to rising non-communicable disease risk in low- and middle-income countries in gendered and geographically differentiated ways. With 2018 baseline data from the Migrant Health Follow-Up Study, we investigate the relationship between internal migration and elevated blood pressure (BP) among 2163 rural-origin men and women in South Africa, testing for sex differences. To examine the influence of place, we test whether the migration-BP relationship differs by migrants' destination locations, controlling for household composition, social support, prior migration, and housing quality. We find that migration is associated with elevated BP only among women, and that this association is greatest for migrants living in Tembisa township. Our research underscores that gender and migration are important social determinants of noncommunicable disease risk in low-resource, rapidly-urbanizing settings.
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Affiliation(s)
| | | | | | - Michael J White
- Brown University, United States; University of the Witwatersrand, South Africa
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Thorp M, Ayieko J, Hoffman RM, Balakasi K, Camlin CS, Dovel K. Mobility and HIV care engagement: a research agenda. J Int AIDS Soc 2023; 26:e26058. [PMID: 36943731 PMCID: PMC10029995 DOI: 10.1002/jia2.26058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/10/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Mobility is common and an essential livelihood strategy in sub-Saharan Africa (SSA). Mobile people suffer worse outcomes at every stage of the HIV care cascade compared to non-mobile populations. Definitions of mobility vary widely, and research on the role of temporary mobility (as opposed to permanent migration) in HIV treatment outcomes is often lacking. In this article, we review the current landscape of mobility and HIV care research to identify what is already known, gaps in the literature, and recommendations for future research. DISCUSSION Mobility in SSA is closely linked to income generation, though caregiving, climate change and violence also contribute to the need to move. Mobility is likely to increase in the coming decades, both due to permanent migration and increased temporary mobility, which is likely much more common. We outline three central questions regarding mobility and HIV treatment outcomes in SSA. First, it is unclear what aspects of mobility matter most for HIV care outcomes and if high-risk mobility can be identified or predicted, which is necessary to facilitate targeted interventions for mobile populations. Second, it is unclear what groups are most vulnerable to mobility-associated treatment interruption and other adverse outcomes. And third, it is unclear what interventions can improve HIV treatment outcomes for mobile populations. CONCLUSIONS Mobility is essential for people living with HIV in SSA. HIV treatment programmes and broader health systems must understand and adapt to human mobility, both to promote the rights and welfare of mobile people and to end the HIV pandemic.
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Affiliation(s)
- Marguerite Thorp
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - James Ayieko
- Center for Microbiology ResearchKenya Medical Research InstituteKisumuKenya
| | - Risa M. Hoffman
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | | | - Carol S. Camlin
- Department of ObstetricsGynecology & Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Kathryn Dovel
- Division of Infectious DiseasesDavid Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Partners in HopeLilongweMalawi
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11
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Akowuah KA, Akuffo RA, Boateng AT, Asigbee TW, Bonney JHK, Lamptey H, Adusei-Poku MA, Obodai E, Asante IA, Adjei S, Aboagye JO, Adu-Amankwah S, Partey FD, Kyei GB, Ampofo WK, Odoom JK, Bonney EY. SARS-CoV-2 infections among asymptomatic individuals contributed to COVID-19 cases: A cross-sectional study among prospective air travelers from Ghana. Front Public Health 2022; 10:1035763. [PMID: 36589973 PMCID: PMC9795010 DOI: 10.3389/fpubh.2022.1035763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022] Open
Abstract
Background The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by asymptomatic individuals has been reported since the early stages of the coronavirus disease 2019 (COVID-19) outbreak in various parts of the world. However, there are limited data regarding SARS-CoV-2 among asymptomatic individuals in Ghana. The aim of the study was to use test data of prospective travelers from Ghana as a proxy to estimate the contribution of asymptomatic cases to the spread of COVID-19. Methods The study analyzed the SARS-CoV-2 PCR test data of clients whose purpose for testing was classified as "Travel" at the COVID-19 walk-in test center of the Noguchi Memorial Institute for Medical Research (NMIMR) from July 2020 to July 2021. These individuals requesting tests for travel generally had no clinical symptoms of COVID-19 at the time of testing. Data were processed and analyzed using Microsoft Excel office 16 and STATA version 16. Descriptive statistics were used to summarize data on test and demographic characteristics. Results Out of 42,997 samples tested at the center within that period, 28,384 (66.0%) were classified as "Travel" tests. Of these, 1,900 (6.7%) tested positive for SARS-CoV-2. The majority (64.8%) of the "Travel" tests were requested by men. The men recorded a SARS-CoV-2 positivity of 6.9% compared to the 6.4% observed among women. Test requests for SARS-CoV-2 were received from all regions of Ghana, with a majority (83.3%) received from the Greater Accra Region. Although the Eastern region recorded the highest SARS-CoV-2 positivity rate of 8.35%, the Greater Accra region contributed 81% to the total number of SARS-CoV-2 positive cases detected within the period of study. Conclusion Our study found substantial SARS-CoV-2 positivity among asymptomatic individuals who, without the requirement for a negative SARS-CoV-2 result for travel, would have no reason to test. These asymptomatic SARS-CoV-2-infected individuals could have traveled to other countries and unintentionally spread the virus. Our findings call for enhanced tracing and testing of asymptomatic contacts of individuals who tested positive for SARS-CoV-2.
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Affiliation(s)
- Kwasi A. Akowuah
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Richard A. Akuffo
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana,Medical and Scientific Research Centre, University of Ghana Medical Centre, Accra, Ghana
| | - Anthony T. Boateng
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Theodore W. Asigbee
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joseph H. K. Bonney
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Helena Lamptey
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Mildred A. Adusei-Poku
- Department of Medical Microbiology, School of Medicine, University of Ghana, Accra, Ghana
| | - Evangeline Obodai
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ivy A. Asante
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Samuel Adjei
- Department of Animal Experimentation, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - James O. Aboagye
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana,Medical and Scientific Research Centre, University of Ghana Medical Centre, Accra, Ghana
| | - Susan Adu-Amankwah
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Frederica D. Partey
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - George B. Kyei
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana,Medical and Scientific Research Centre, University of Ghana Medical Centre, Accra, Ghana
| | - William K. Ampofo
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - John K. Odoom
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Evelyn Y. Bonney
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana,*Correspondence: Evelyn Y. Bonney
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12
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Myroniuk TW, White MJ, Madhavan S. Post-migration emotional well-being among Black South Africans. SSM - MENTAL HEALTH 2022; 2:100173. [PMID: 36776725 PMCID: PMC9910329 DOI: 10.1016/j.ssmmh.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Internal migration has been an institutionalized part of life for Black South Africans from the 1800s, when men left their rural homes to work in mines, through apartheid and into the present. Like other settings in the Global South, we know surprisingly little about the emotional well-being of migrants, especially in sub-Saharan African contexts. We investigate changes in the emotional well-being of 2281 working-age Black South Africans after migration, drawing on four waves of data, from 2008 to 2015, from the nationally representative National Income Dynamics Study. Fixed-effects regressions show that migrants exhibit changes in life satisfaction as well as proclivity towards depression but that these outcomes vary by distance of move and type of move-moving within or between provinces. As South Africa's health policies expand beyond addressing infectious diseases, it is important to consider mental health particularly of those who face the necessity of migration to sustain a livelihood.
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Affiliation(s)
| | - Michael J. White
- Brown University, Department of Sociology, Population Studies & Training Center, USA
| | - Sangeetha Madhavan
- University of Maryland, Department of African American Studies, Department of Sociology, Maryland Population Research Center, USA
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13
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Mkwananzi S. The association between internal migration and teenage fertility control: A South African study. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.1080/14330237.2022.2121037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sibusiso Mkwananzi
- Institute for Gender Studies, University of South Africa, Pretoria, South Africa
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14
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Manderson L, Brear M, Rusere F, Farrell M, Gómez-Olivé FX, Berkman L, Kahn K, Harling G. Protocol: the complexity of informal caregiving for Alzheimer's disease and related dementias in rural South Africa. Wellcome Open Res 2022; 7:220. [PMID: 37538406 PMCID: PMC10394391 DOI: 10.12688/wellcomeopenres.18078.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND With aging, many people develop Alzheimer's disease or related dementias (ADRD) as well as chronic physical health problems. The consequent care needs can be complicated, with heavy demands on families, households and communities, especially in resource-constrained settings with limited formal care services. However, research on ADRD caregiving is largely limited to primary caregivers and high-income countries. Our objectives are to analyse in a rural setting in South Africa: (1) how extended households provide care to people with ADRD; and (2) how the health and wellbeing of all caregivers are affected by care roles. METHODS The study will take place at the Agincourt health and socio-demographic surveillance system site of the MRC/Wits Rural Public Health and Health Transitions Research Unit in Mpumalanga Province, northeast South Africa. We will recruit 100 index individuals predicted to currently have ADRD or cognitive impairment using data from a recent dementia survey. Quantitative surveys will be conducted with each index person's nominated primary caregiver, all other household members aged over 12, and caregiving non-resident kin and non-kin to determine how care and health are patterned across household networks. Qualitative data will be generated through participant observation and in-depth interviews with caregivers, select community health workers and key informants. Combining epidemiological, demographic and anthropological methods, we will build a rich picture of households of people with ADRD, focused on caregiving demands and capacity, and of caregiving's effects on health. DISCUSSION Our goal is to identify ways to mitigate the negative impacts of long-term informal caregiving for ADRD when formal supports are largely absent. We expect our findings to inform the development of locally relevant and community-oriented interventions to improve the health of caregivers and recipients, with implications for other resource-constrained settings in both higher- and lower-income countries.
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Affiliation(s)
- Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Social Sciences, Monash University, Clayton, Australia
| | - Michelle Brear
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Social Sciences, Monash University, Clayton, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Farirai Rusere
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Meagan Farrell
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Berkman
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Guy Harling
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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15
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Dzomba A, Kim HY, Tomita A, Vandormael A, Govender K, Tanser F. Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005-2017). BMC Public Health 2022; 22:1141. [PMID: 35672845 PMCID: PMC9175358 DOI: 10.1186/s12889-022-13526-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
Globally, South Africa hosts the highest number of people living with HIV (PLHIV) and the unique legacy of internal labour migration continues to be a major driver of the regional epidemic, interrupting treatment-as-prevention efforts. The study examined levels, trends, and predictors of migration in rural KwaZulu-Natal Province, South Africa, using population-based surveillance data from 2005 through 2017. We followed 69 604 adult participants aged 15-49 years and recorded their migration events (i.e., out-migration from the surveillance area) in 423 038 person-years over 525 397 observations. Multiple failure Cox-regression models were used to measure the risk of migration by socio-demographic factors: age, sex, educational status, marital status, HIV, and community antiretroviral therapy (ART) coverage. Overall, 69% of the population cohort experienced at least one migration event during the follow-up period. The average incidence rate of migration was 9.96 events and 13.23 events per 100 person-years in women and men, respectively. Migration rates declined from 2005 to 2008 then peaked in 2012 for both women and men. Adjusting for other covariates, the risk of migration was 3.4-times higher among young women aged 20-24 years compared to those aged ≥ 40 years (adjusted Hazard Ratio [aHR] = 3.37, 95% Confidence Interval [CI]: 3:19-3.57), and 2.9-times higher among young men aged 20-24 years compared to those aged ≥ 40 years (aHR = 2.86, 95% CI:2.69-3.04). There was a 9% and 27% decrease in risk of migration among both women (aHR = 0.91, 95% CI: 0.83 - 0.99) and men (aHR = 0.73, 95% CI 0.66 - 0.82) respectively per every 1% increase in community ART coverage. Young unmarried women including those living with HIV, migrated at a magnitude similar to that of their male counterparts, and lowered as ART coverage increased over time, reflecting the role of improved HIV services across space in reducing out-migration. A deeper understanding of the characteristics of a migrating population provides critical information towards identifying and addressing gaps in the HIV prevention and care continuum in an era of high mobility.
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Affiliation(s)
- Armstrong Dzomba
- Discipline of Public Health Medicine, Africa Health Research Institute(AHRI), University of KwaZulu-Natal, KwaZulu-Natal Province, K-RITH Tower Building, 719 Umbilo Road, Private Bag X7, Congella, Durban, South Africa.
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa.
- Medical Research Council (MRC)/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Acornhoek, South Africa.
| | - Hae-Young Kim
- Discipline of Public Health Medicine, Africa Health Research Institute(AHRI), University of KwaZulu-Natal, KwaZulu-Natal Province, K-RITH Tower Building, 719 Umbilo Road, Private Bag X7, Congella, Durban, South Africa
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, USA
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alain Vandormael
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
- Department of Medicine, Stanford University, Stanford, USA
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Discipline of Public Health Medicine, Africa Health Research Institute(AHRI), University of KwaZulu-Natal, KwaZulu-Natal Province, K-RITH Tower Building, 719 Umbilo Road, Private Bag X7, Congella, Durban, South Africa
- Centre for Rural Health, 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
- Lincoln Institute for Health, University of Lincoln, Lincoln, LN6 7TS, UK
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16
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Murnane PM, Gandhi M, Bacchetti P, Getahun M, Gutin SA, Okochi H, Maeri I, Eyul P, Omoding D, Okiring J, Tallerico R, Louie A, Akullian A, Kamya MR, Bukusi EA, Charlebois ED, Camlin CS. Distinct forms of migration and mobility are differentially associated with HIV treatment adherence. AIDS 2022; 36:1021-1030. [PMID: 35652674 PMCID: PMC9178682 DOI: 10.1097/qad.0000000000003213] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined whether human mobility was associated with antiretroviral treatment adherence, measured via antiretroviral hair concentrations. DESIGN This is a cross-sectional analysis of adults on antiretroviral treatment in East Africa at baseline in an observational cohort study. METHODS Participants reported recent mobility (overnight travel) and histories of migration (changes of residence), including reasons, frequency/duration, and locations. Hair antiretroviral concentrations were analyzed using validated methods. We estimated associations between mobility and antiretroviral concentrations via linear regression adjusted for age, sex, region, years on treatment. RESULTS Among 383 participants, half were women and the median age was 40. Among men, 25% reported recent work-related mobility, 30% nonwork mobility, and 11% migrated in the past year (mostly across district boundaries); among women, 6 and 57% reported work-related and nonwork mobility, respectively, and 8% recently migrated (mostly within district). Those reporting work-related trips 2 nights or less had 72% higher hair antiretroviral levels (P = 0.02) than those who did not travel for work; in contrast, nonwork mobility (any duration, vs. none) was associated with 24% lower levels (P = 0.06). Intra-district migrations were associated with 59% lower antiretroviral levels than nonmigrants (P = 0.003) while inter-district migrations were not (27% higher, P = 0.40). CONCLUSION We found that localized/intra-district migration and nonwork travel-more common among women-were associated with lower adherence, potentially reflecting care interruptions or staying with family/friends unaware of the participants' status. In contrast, short work-related trips-more common among men-were associated with higher adherence, perhaps reflecting higher income. Adherence interventions may require tailoring by sex and forms of mobility.
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Affiliation(s)
- Pamela M Murnane
- Department of Epidemiology and Biostatistics
- Institute for Global Health Sciences
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine
- UCSF-Hair Analytical Laboratory
| | | | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences
| | - Sarah A Gutin
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
| | - Hideaki Okochi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine
- UCSF-Hair Analytical Laboratory
| | - Irene Maeri
- Centre For Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patrick Eyul
- Infectious Diseases Research Collaboration, Makerere University
| | - Daniel Omoding
- Infectious Diseases Research Collaboration, Makerere University
| | - Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Regina Tallerico
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine
- UCSF-Hair Analytical Laboratory
| | - Alexander Louie
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine
- UCSF-Hair Analytical Laboratory
| | - Adam Akullian
- Institute for Disease Modeling, Bellevue, Washington, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Makerere University
- School of Medicine, Makerere University, Kampala, Uganda
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences
- Centre For Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edwin D Charlebois
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
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17
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Correa-Agudelo E, Kim HY, Musuka GN, Mukandavire Z, Akullian A, Cuadros DF. Associated health and social determinants of mobile populations across HIV epidemic gradients in Southern Africa. J Migr Health 2021; 3:100038. [PMID: 34405186 PMCID: PMC8352162 DOI: 10.1016/j.jmh.2021.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 11/05/2022] Open
Abstract
Background Growing travel connectivity and economic development have dramatically increased the magnitude of human mobility in Africa. In public health, vulnerable population groups such as mobile individuals are at an elevated risk of sexually transmitted diseases, including HIV. Methods The population-based Demographic Health Survey data of five Southern African countries with different HIV epidemic intensities (Angola, Malawi, South Africa, Zambia, and Zimbabwe) were used to investigate the association between HIV serostatus and population mobility adjusting for socio-demographic, sexual behavior and spatial covariates. Results Mobility was associated with HIV seropositive status only in Zimbabwe (adjusted odds ratio [AOR] = 1.37 [95% confidence interval [CI]: 1.01–1.67]). These associations were not significant in Angola, Malawi, South Africa, and Zambia. Females had higher odds of mobility than males in Zimbabwe (AOR = 1.37, CI: 1.10–1.69). The odds of mobility decreased with age in all five countries. Conclusions Our findings highlight the heterogeneity of the social and health determinants of mobile populations in several countries with different HIV epidemic intensities. Effective interventions using precise geographic focus combined with detailed attribute characterization of mobile populations can enhance their impact especially in areas with high density of mobile individuals and high HIV prevalence.
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Affiliation(s)
- Esteban Correa-Agudelo
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH, 45221, USA.,Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA
| | - Hae-Young Kim
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP) KwaZulu-Natal, South Africa.,Department of Population Health, New York University Grossman School of Medicine, USA
| | | | - Zindoga Mukandavire
- Centre for Data Science, Coventry University, UK.,School of Computing, Electronics and Mathematics, Coventry University, UK
| | - Adam Akullian
- Institute for Disease Modeling, Global Good Fund, Bellevue, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Diego F Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH, 45221, USA.,Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA
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18
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Ginsburg C, Bocquier P, Menashe-Oren A, Collinson MA. Migrant health penalty: evidence of higher mortality risk among internal migrants in sub-Saharan Africa. Glob Health Action 2021; 14:1930655. [PMID: 34134611 PMCID: PMC8550177 DOI: 10.1080/16549716.2021.1930655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Despite the greater attention given to international migration, internal migration accounts for the majority of movements globally. However, research on the effects of internal migration on health is limited, with this relationship examined predominantly in urban settings among working-age adults, neglecting rural populations and younger and older ages. Objectives: Using longitudinal data from 29 mostly rural sub-Saharan African Health and Demographic Surveillance Systems (HDSS), this study aims to explore life-course differences in mortality according to migration status and duration of residence. MethodsCox proportional hazards models are employed to analyse the relationship between migration and mortality in the 29 HDSS areas. The analytical sample includes 3 836,173 people and the analysis spans 25 years, from 1990 to 2015. We examine the risk of death by sex across five broad age groups (from ages 1 to 80), and consider recent and past in- and return migrants. Results: In-migrants have a higher risk of mortality compared to permanent rural residents, with return migrants at greater risk than in-migrants across all age-groups. Female migrants have lower survival chances than males, with greater variability by age. Risk of dying is highest among recent return migrant females aged 30–59: 1.86 (95% CI 1.69–2.06) times that of permanent residents. Only among males aged 15–29 who move to urban areas is there evidence of a ‘healthy migrant’ effect (HR = 0.62, 95% CI 0.51–0.77). There is clear evidence of an adaptation effect across all ages, with the risk of mortality reducing with duration following migration. Conclusions: Findings suggest that adult internal migrants, particularly females, suffer greater health disadvantages associated with migration. Policy makers should focus on improving migrant’s interface with health services, and support the development of health education and promotion interventions to create awareness of localised health risks for migrants.
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Affiliation(s)
- Carren Ginsburg
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philippe Bocquier
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Institut d'analyse du changement dans l'histoire et les sociétés contemporaines (IACCHOS), Centre De Recherches En Démographie, Université Catholique De Louvain, Louvain-la-Neuve, Belgium
| | - Ashira Menashe-Oren
- Institut d'analyse du changement dans l'histoire et les sociétés contemporaines (IACCHOS), Centre De Recherches En Démographie, Université Catholique De Louvain, Louvain-la-Neuve, Belgium
| | - Mark A Collinson
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Innovation/South African Medical Research Council, South African Population Research Infrastructure Network, South Africa
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19
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Bourgeault IL, Runnels V, Atanackovic J, Spitzer D, Walton-Roberts M. Hiding in plain sight: the absence of consideration of the gendered dimensions in 'source' country perspectives on health worker migration. HUMAN RESOURCES FOR HEALTH 2021; 19:40. [PMID: 33761939 PMCID: PMC7992834 DOI: 10.1186/s12960-021-00571-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 02/18/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can lead to inadequate policy responses. METHODS A Canadian-led research team partnered with co-investigators in the Philippines, South Africa, and India to examine the causes, consequences and policy responses to the international migration of health workers from these 'source' countries. Multiple-methods combined an initial documentary analysis, interviews and surveys with health workers and country-based stakeholders. We undertook an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the published literature and policy documents from the decade 2005 to 2015; in-depth interviews with 117 stakeholders; and surveys conducted with 3580 health workers. RESULTS The documentary analysis of health worker emigration from South Africa, India and the Philippines reveal that gender can mediate access to and participation in health worker training, employment, and ultimately migration. Our analysis of survey data from nurses, physicians and other health workers in South Africa, India and the Philippines and interviews with policy stakeholders, however, reveals a curious absence of how gender might mediate health worker migration. Stereotypical views were evident amongst stakeholders; for example, in South Africa female health workers were described as "preferred" for "innate" personal characteristics and cultural reasons, and in India men are directed away from nursing roles particularly because they are considered only for women. The finding that inadequate remuneration was as a key migration driver amongst survey respondents in India and the Philippines, where nurses predominated in our sample, was not necessarily linked to underlying gender-based pay inequity. The documentary data suggest that migration may improve social status of female nurses, but it may also expose them to deskilling, as a result of the intersecting racism and sexism experienced in destination countries. Regardless of these underlying influences in migration decision-making, gender is rarely considered either as an important contextual influence or analytic category in the policy responses. CONCLUSION An explicit gender-based analysis of health worker emigration, which may help to emphasize important equity considerations, could offer useful insights for the health and social policy responses adopted by source countries.
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Affiliation(s)
- Ivy Lynn Bourgeault
- School of Sociology and Anthropology, University of Ottawa, Ottawa, ON K1N 6N5 Canada
| | - Vivien Runnels
- Gender, Work & Health Lab, University of Ottawa, Ottawa, ON K1N 6N5 Canada
| | - Jelena Atanackovic
- Gender, Work & Health Lab, University of Ottawa, Ottawa, ON K1N 6N5 Canada
| | - Denise Spitzer
- School of Public Health Sciences, University of Alberta, Edmonton, AB Canada
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20
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Ginsburg C, Collinson MA, Gómez-Olivé FX, Gross M, Harawa S, Lurie MN, Mukondwa K, Pheiffer CF, Tollman S, Wang R, White MJ. Internal migration and health in South Africa: determinants of healthcare utilisation in a young adult cohort. BMC Public Health 2021; 21:554. [PMID: 33743663 PMCID: PMC7981972 DOI: 10.1186/s12889-021-10590-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In South Africa, human geographic mobility is high as people engage in both permanent and temporary relocation, predominantly from rural to urban areas. Such mobility can compromise healthcare access and utilisation. The objective of this paper is to explore healthcare utilisation and its determinants in a cohort of internal migrants and permanent residents (non-migrants) originating from the Agincourt sub-district in South Africa's rural northeast. METHODS A 5-year cohort study of 3800 individuals aged 18 to 40 commenced in 2017. Baseline data have been collected from 1764 Agincourt residents and 1334 temporary, mostly urban-based, migrants, and are analysed using bivariate analyses, logistic and multinomial regression models, and propensity score matching analysis. RESULTS Health service utilisation differs sharply by migrant status and sex. Among those with a chronic condition, migrants had 0.33 times the odds of non-migrants to have consulted a health service in the preceding year, and males had 0.32 times the odds of females of having used health services. Of those who utilised services, migration status was further associated with the type of healthcare utilised, with 97% of non-migrant rural residents having accessed government facilities, while large proportions of migrants (31%) utilised private health services or consulted traditional healers (25%) in migrant destinations. The multinomial logistic regression analysis indicated that, in the presence of controls, migrants had 8.12 the relative risk of non-migrants for utilising private healthcare (versus the government-services-only reference category), and 2.40 the relative risk of non-migrants for using a combination of public and private sector facilities. These findings of differential utilisation hold under statistical adjustment for relevant controls and for underlying propensity to migrate. CONCLUSIONS Migrants and non-migrants in the study population in South Africa were found to utilise health services differently, both in overall use and in the type of healthcare consulted. The study helps improve upon the limited stock of knowledge on how migrants interface with healthcare systems in low and middle-income country settings. Findings can assist in guiding policies and programmes to be directed more effectively to the populations most in need, and to drive locally adapted approaches to universal health coverage.
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Affiliation(s)
- Carren Ginsburg
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Mark A. Collinson
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- Department of Science and Innovation/ Medical Research Council, South African Population Research Infrastructure Network, Johannesburg, South Africa
| | - F. Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Mark Gross
- Population Studies and Training Centre, Brown University, Providence, RI, USA
| | - Sadson Harawa
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Mark N. Lurie
- Population Studies and Training Centre, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University, School of Public Health, Providence, RI, USA
| | - Keith Mukondwa
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
| | - Chantel F. Pheiffer
- Population Studies and Training Centre, Brown University, Providence, RI, USA
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- Department of Science and Innovation/ Medical Research Council, South African Population Research Infrastructure Network, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Rebecca Wang
- Population Studies and Training Centre, Brown University, Providence, RI, USA
| | - Michael J. White
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- Population Studies and Training Centre, Brown University, Providence, RI, USA
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21
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Pheiffer CF. Internal migration, urban living, and non-communicable disease risk in South Africa. Soc Sci Med 2021; 274:113785. [PMID: 33684701 DOI: 10.1016/j.socscimed.2021.113785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/04/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
This paper offers theoretical and substantive contributions to migration-health scholarship by employing rich panel data with biomarkers to estimate the effect of migration and urban living on non-communicable disease risk in South Africa. Internal migration and urbanization continue to be pervasive demographic and socio-economic phenomena that structure daily life in low- and middle- income countries (LMICs). Yet, how these processes affect illness and disease in low-resource settings is still not well understood. Five waves (2008-2017) of South Africa's National Income Dynamics Study data and fixed-effects modeling are used to estimate the relationship between urban residence, migration, and health. Results indicate that the migration-health relationship differs by gender: urban living for men is associated with lower blood pressure. While urban residence appears to convey a health advantage when men reside in urban compared with rural places, there is no evidence of an urban health advantage among women. Migration does, however, negatively affect women's health through higher blood pressure (BP). These findings highlight the need for further interrogation of the ways in which processes and health consequences of migration and urban living are structured by gender in LMICs. Given the importance of urbanization and the prevalence of migration in LMICs, the gendered determinants of blood pressure may be key to understanding rising hypertension incidence in contexts like South Africa.
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22
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Groene EA, Kristiansen D. Unmet Need for Family Planning after Internal Migration: Analysis of Ethiopia 2017-2018 PMA Survey Data. POPULATION, SPACE AND PLACE 2021; 27:e2376. [PMID: 34220371 PMCID: PMC8248275 DOI: 10.1002/psp.2376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/10/2020] [Indexed: 06/13/2023]
Abstract
Internal migration's effect on family planning behavior depends upon migration circumstances. While many studies describe instability and displacement's effect on family planning access, fewer studies consider the positive association between internal migration and family planning behavior. Using Performance Monitoring for Action (PMA) survey data, we examine the relationship between internal migration and unmet need for family planning in Ethiopia from 2017-2018. We describe determinants of family planning behavior by migrant status and model migration's effect on unmet need for family planning using multilevel logistic regression. Internal migrants studied tend to be more educated and wealthier and have less unmet need than non-migrants, likely due to different fertility preferences and human capital. This contributes to existing research by illustrating how rural-urban migration in Ethiopia relates to family planning behaviour. Findings will be of interest to social scientists and policymakers evaluating family planning resource allocation to reduce unmet need in African contexts.
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Affiliation(s)
- Emily A Groene
- University of Minnesota, School of Public Health, Minneapolis, Minnesota, USA
| | - Devon Kristiansen
- IPUMS, Institute for Social Research and Data Innovation, Minneapolis, Minnesota, USA
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23
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Sikombe K, Mody A, Kadota J, Pry J“J, Simbeza S, Eshun-Wilson I, Situmbeko SR, Bukankala C, Beres L, Mukamba N, Wa Mwanza M, Bolton- Moore C, Holmes CB, Geng EH, Sikazwe I. Understanding patient transfers across multiple clinics in Zambia among HIV infected adults. PLoS One 2020; 15:e0241477. [PMID: 33147250 PMCID: PMC7641414 DOI: 10.1371/journal.pone.0241477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/15/2020] [Indexed: 12/30/2022] Open
Abstract
Many patients in HIV care in Africa considered lost to follow up (LTFU) at one facility are reportedly accessing care in another. The success of these unofficial transfers as measured by time to re-entry at the new-facility, prevalence of treatment interruptions, speed of ART-initiation, and overall continuity of care is not well characterized but may reveal opportunities for improvement. We traced a random sample of LTFU HIV-infected patients in Zambia. Among those found alive and reported in care at a new-facility, we reviewed records at the receiving facility to verify transfer; and when verified, documented the transfer experience. We used Kaplan-Meier methods to examine incidence of ART-initiation after transfer to new clinic. We assessed demographic and clinical characteristics, official and cross-provincial transfer for associations with HIV treatment re-engagement using Poisson regression models and associations between official-transfer and same-day ART initiation at the new-facility. Among 350 LTFU-patients, 178 (51%) were successfully verified through chart review at the new-facility. 132 (74.2%) were female, 72 (40.4%) aged 25-35, and 51% were ever recorded as previously being on ART. 110 patients (61.8%) were registered under new ART-IDs and 97 (54.5%) received a new HIV test. 54% of those previously on ART-initiated on the same-day. Using the same ART-ID was associated with same-day initiation compared to those receiving a new ART-ID (p = 0.07). 80% (n = 91) of those ever on ART had evidence of medication initiation at new clinic. Among these, initiation reached 66% (95% CI: 56-75) by 30 days, 77.5% (95% CI: 68-86) by 90 days after new-facility presentation. Many patients use new identifiers at new facilities, indicative of inefficiencies. Re-entry into new facilities among the unofficial-transfer population is often delayed and timely treatment initiation is inconsistent, suggesting interruptions in treatment. Health systems innovations to ensure smooth and safe transfers are needed to maintain quality HIV care.
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Affiliation(s)
- Kombatende Sikombe
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Jillian Kadota
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
| | - Jesse “Jake” Pry
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Sandra Simbeza
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | | | - Chama Bukankala
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura Beres
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Njekwa Mukamba
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Mwanza Wa Mwanza
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Carolyn Bolton- Moore
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, University of Alabama, Birmingham, Alabama, United States of America
| | - Charles B. Holmes
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Center for Global Health and Quality, Georgetown University, Washington, District of Columbia, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Izukanji Sikazwe
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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24
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Cudahy PGT, Wilson D, Cohen T. Risk factors for recurrent tuberculosis after successful treatment in a high burden setting: a cohort study. BMC Infect Dis 2020; 20:789. [PMID: 33097000 PMCID: PMC7585300 DOI: 10.1186/s12879-020-05515-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND People successfully completing treatment for tuberculosis remain at elevated risk for recurrent disease, either from relapse or reinfection. Identifying risk factors for recurrent tuberculosis may help target post-tuberculosis screening and care. METHODS We enrolled 500 patients with smear-positive pulmonary tuberculosis in South Africa and collected baseline data on demographics, clinical presentation and sputum mycobacterial cultures for 24-loci mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. We used routinely-collected administrative data to identify recurrent episodes of tuberculosis occurring over a median of six years after successful treatment completion. RESULTS Of 500 patients initially enrolled, 333 (79%) successfully completed treatment for tuberculosis. During the follow-up period 35 patients with successful treatment (11%) experienced a bacteriologically confirmed tuberculosis recurrence. In our Cox proportional hazards model, a 3+ AFB sputum smear grade was significantly associated with recurrent tuberculosis with a hazard ratio of 3.33 (95% CI 1.44-7.7). The presence of polyclonal M. tuberculosis infection at baseline had a hazard ratio for recurrence of 1.96 (95% CI 0.86-4.48). CONCLUSION Our results indicate that AFB smear grade is independently associated with tuberculosis recurrence after successful treatment for an initial episode while the association between polyclonal M. tuberculosis infection and increased risk of recurrence appears possible.
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Affiliation(s)
- Patrick George Tobias Cudahy
- Section of Infectious Disease, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
- Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, 5th Floor, Private Bag X 509, Plessislaer, KZN, Pietermaritzburg, 3216, South Africa.
| | - Douglas Wilson
- Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, 5th Floor, Private Bag X 509, Plessislaer, KZN, Pietermaritzburg, 3216, South Africa.
| | - Ted Cohen
- Department of Epidemiology (Microbial Diseases), Yale University School of Public Health, New Haven, CT, USA
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25
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Harling G, Morris KA, Manderson L, Perkins JM, Berkman LF. Age and Gender Differences in Social Network Composition and Social Support Among Older Rural South Africans: Findings From the HAALSI Study. J Gerontol B Psychol Sci Soc Sci 2020; 75:148-159. [PMID: 29590472 PMCID: PMC6909436 DOI: 10.1093/geronb/gby013] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 03/05/2018] [Indexed: 01/05/2023] Open
Abstract
Objectives Drawing on the “Health and Aging in Africa: A Longitudinal Study of an INDEPTH community in South Africa” (HAALSI) baseline survey, we present data on older adults’ social networks and receipt of social support in rural South Africa. We examine how age and gender differences in social network characteristics matched with patterns predicted by theories of choice- and constraint-based network contraction in older adults. Method We used regression analysis on data for 5,059 South African adults aged 40 and older. Results Older respondents reported fewer important social contacts and less frequent communication than their middle-aged peers, largely due to fewer nonkin connections. Network size difference between older and younger respondents was greater for women than for men. These gender and age differences were explicable by much higher levels of widowhood among older women compared to younger women and older men. There was no evidence for employment-related network contraction or selective retention of emotionally supportive ties. Discussion Marriage-related structural constraints impacted on older women’s social networks in rural South Africa, but did not explain choice-based network contraction. These findings suggest that many older women in rural Africa, a growing population, may have an unmet need for social support.
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Affiliation(s)
- Guy Harling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Institute for Global Health, University College London, UK
| | | | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
| | - Jessica M Perkins
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts.,Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee
| | - Lisa F Berkman
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee.,MRC/Wits Rural Public Health and Heath Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts
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26
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Vandormael A, Cuadros D, Dobra A, Bärnighausen T, Tanser F. HIV incidence declines in a rural South African population: a G-imputation approach for inference. BMC Public Health 2020; 20:1205. [PMID: 32762668 PMCID: PMC7409400 DOI: 10.1186/s12889-020-09193-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ad hoc assumptions about the unobserved infection event, which is known only to occur between the latest-negative and earliest-positive test dates, can lead to biased HIV incidence rate estimates. Using a G-imputation approach, we infer the infection dates from covariate data to estimate the HIV incidence rate in a hyper-endemic South African setting. METHODS A large demographic surveillance system has annually tested a cohort of HIV-uninfected participants living in the KwaZulu-Natal province. Using this data, we estimated a cumulative baseline hazard function and the effects of time-dependent covariates on the interval censored infection dates. For each HIV-positive participant in the cohort, we derived a cumulative distribution function and sampled multiple infection dates conditional on the unique covariate values. We right censored the data at the imputed dates, calculated the annual HIV incidence rate per 100 person-years, and used Rubin's rules to obtain the 95% confidence intervals. RESULTS A total of 20,011 uninfected individuals with a repeat HIV test participated in the incidence cohort between 2005 and 2018. We observed 2,603 infections per 58,769 person-years of follow-up among women and 845 infections per 41,178 person-years of follow-up among men. Conditional on age and circumcision status (men only), the female HIV incidence rate declined by 25%, from 5.0 to 3.7 infections per 100 person-years between 2014 and 2018. During this period, the HIV incidence rate among men declined from 2.1 to 1.1 infections per 100 person-years-a reduction of 49%. We observed similar reductions in male and female HIV incidence conditional on condom-use, marital status, urban residential status, migration history, and the HIV prevalence in the surrounding community. CONCLUSION We have followed participants in one of the world's largest and longest running HIV cohorts to estimate long-term trends in the population-wide incidence of infection. Using a G-imputation approach, we present further evidence for HIV incidence rate declines in this hyper-endemic South African setting.
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Affiliation(s)
- Alain Vandormael
- Africa Health Research Institute (AHRI), Durban, South Africa. .,Heidelberg Institute of Global Health, University of Heidelberg, 130.3 Im Neuenheimer Feld, Heidelberg, 69115, Germany. .,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal (UKZN), Durban, South Africa.
| | - Diego Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, USA
| | - Adrian Dobra
- Department of Statistics, Center for Statistics and the Social Sciences, and Center for Studies in Demography and Ecology, University of Washington, Seattle, USA
| | - Till Bärnighausen
- Africa Health Research Institute (AHRI), Durban, South Africa.,Heidelberg Institute of Global Health, University of Heidelberg, 130.3 Im Neuenheimer Feld, Heidelberg, 69115, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Frank Tanser
- Africa Health Research Institute (AHRI), Durban, South Africa.,Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK.,School of Nursing and Public Health, UKZN, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
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27
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Mobility and its Effects on HIV Acquisition and Treatment Engagement: Recent Theoretical and Empirical Advances. Curr HIV/AIDS Rep 2020; 16:314-323. [PMID: 31256348 DOI: 10.1007/s11904-019-00457-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW We reviewed literature across multiple disciplines to describe issues with the measurement of population mobility in HIV research and to summarize evidence of causal pathways linking mobility to HIV acquisition risks and treatment engagement, with a focus on sub-Saharan Africa. RECENT FINDINGS While the literature on mobility and HIV remains hampered by problems and inconsistency in measures of mobility, the recent research reveals a turn towards a greater attentiveness to measurement and gender. Theoretical and heuristic models for the study of mobility and HIV acquisition and treatment outcomes have been published, but few studies have used longitudinal designs with clear ascertainment of exposures and outcomes for measurement of causal pathways. Notwithstanding these limitations, evidence continues to accumulate that mobility is linked to higher HIV incidence, and that it challenges optimal treatment engagement. Gender continues to be important: while men are more mobile than women, women's mobility particularly heightens their HIV acquisition risks. Recent large-scale efforts to find, test, and treat the individuals in communities who are most at risk of sustaining local HIV transmission have been severely challenged by mobility. Novel interventions, policies, and health systems improvements are urgently needed to fully engage mobile individuals in HIV care and prevention. Interventions targeting the HIV prevention and care needs of mobile populations remain few in number and urgently needed.
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28
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Kim HY, Dobra A, Tanser F. Migration and first-year maternal mortality among HIV-positive postpartum women: A population-based longitudinal study in rural South Africa. PLoS Med 2020; 17:e1003085. [PMID: 32231390 PMCID: PMC7108693 DOI: 10.1371/journal.pmed.1003085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/26/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In South Africa, within-country migration is common. Mobility affects many of the factors in the pathway for entry to or retention in care among people living with HIV. We characterized the patterns of migration (i.e., change in residency) among peripartum women from rural South Africa and their association with first-year postpartum mortality. METHODS AND FINDINGS All pregnant women aged ≥15 years were followed-up during pregnancy and the first year postpartum in a population-based longitudinal demographic and HIV surveillance program in KwaZulu-Natal, South Africa, from 2000 to 2016. During the household surveys (every 4-6 months), each household head was interviewed to record demographic components of the household, including composition, migration, and mortality. External migration was defined as moving (i.e., change in residency) into or out of the study area. For women of reproductive age, detailed information on new pregnancy and birth was recorded. Maternal death was ascertained via verbal autopsy and HIV status at delivery via annual HIV surveys. We fitted mixed-effects Cox regression models adjusting for multiple pregnancies per individual. Overall, 19,334 women had 30,291 pregnancies: 3,339 were HIV-positive, 10,958 were HIV-negative, and 15,994 had unknown HIV status at delivery. The median age was 24 (interquartile range: 20-30) years. During pregnancy and the first year postpartum, 64% (n = 19,344) and 13% (n = 3,994) did not migrate and resided within and outside the surveillance area, respectively. Of the 23% who had externally migrated at least once, 39% delivered outside the surveillance area. Overall, the mortality rate was 5.8 per 1,000 person-years (or 831 deaths per 100,000 live births) in the first year postpartum. The major causes of deaths were AIDS- or tuberculosis-related conditions both within 42 days of delivery (53%) and during the first year postpartum (62%). In this study, we observed that HIV-positive peripartum women who externally migrated and delivered outside the surveillance area had a hazard of mortality more than two times greater (hazard ratio = 2.74; 95% confidence interval 1.01-7.40, p-value = 0.047)-after adjusting for age, time period (before or after 2010), and sociodemographic status-compared to that of HIV-positive women who continuously resided within the surveillance area. Study limitations include lack of data on access to antiretroviral therapy (ART) care and social or clinical context at the destinations among mobile participants, which could lead to unmeasured confounding. Further information on how mobile postpartum women access and remain in care would be instructive. CONCLUSIONS In this study, we found that a substantial portion of peripartum women moved within the country around the time of delivery and experienced a significantly higher risk of mortality. Despite the scale-up of universal ART and declining trends in maternal mortality, there is an urgent need to derive a greater understanding of the mechanisms underlying this finding and to develop targeted interventions for mobile HIV-positive peripartum women.
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Affiliation(s)
- Hae-Young Kim
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), KwaZulu-Natal, South Africa
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
| | - Adrian Dobra
- Department of Statistics, University of Washington, Seattle, Washington, United States of America
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Lincoln Institute for Health, University of Lincoln, Lincoln, United Kingdom
- 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, KwaZulu-Natal, South Africa
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29
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Kate Grabowski M, Lessler J, Bazaale J, Nabukalu D, Nankinga J, Nantume B, Ssekasanvu J, Reynolds SJ, Ssekubugu R, Nalugoda F, Kigozi G, Kagaayi J, Santelli JS, Kennedy C, Wawer MJ, Serwadda D, Chang LW, Gray RH. Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda. Nat Commun 2020; 11:976. [PMID: 32080169 PMCID: PMC7033206 DOI: 10.1038/s41467-020-14636-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/18/2020] [Indexed: 01/11/2023] Open
Abstract
HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas.
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Affiliation(s)
- Mary Kate Grabowski
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA.
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda.
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA
| | - Jeremiah Bazaale
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Dorean Nabukalu
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Justine Nankinga
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Betty Nantume
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA
| | - Steven J Reynolds
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Robert Ssekubugu
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Fred Nalugoda
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - John S Santelli
- Heilbrunn Department of Population and Family Health, Columbia University, 60 Haven Avenue, New York, NY, 10032, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
| | - David Serwadda
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Larry W Chang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 627 North Washington St., Baltimore, MD, 21205, USA
- Rakai Health Sciences Program, Old Bukoba Road, P.O. Box 279, Kalisizo, Uganda
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Shui Y, Xu D, Liu Y, Liu S. Work-family balance and the subjective well-being of rural women in Sichuan, China. BMC WOMENS HEALTH 2020; 20:1. [PMID: 31898500 PMCID: PMC6941245 DOI: 10.1186/s12905-019-0871-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Due to the great burden of family and the conflicts among family, society and career roles resulting from migrant working, rural women suffer more conflicts between work and family and need more social attention. Previous studies of the conflicts between family and work mainly focus on the group of career women, and there is a lack of the research on the conflicts between work and family of rural women, which needs to be systematically and further studied. METHODS This study used a sample survey of 380 rural women in rural areas of Sichuan Province to measure rural women's cognition of work-family, coordination and handling of conflicts, post-conflict choices, and subjective well-being; the study constructs an ordered multi-class logistic regression model to explore the impact of work-family conflict on the subjective well-being of rural women in rural regions. RESULTS The study result shows that: (1) The level of subjective well-being of rural women is generally high, and 70% of women feel satisfied or very satisfied. (2) The factor which impacts the subjective well-being among rural women most is work-interfering-with-family conflict, followed by work-family balance and confidence in conflict coordination. CONCLUSION This study can enhance our understanding of rural women in rural areas, and provide a reference for formulating policies to improve people's life satisfaction.
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Affiliation(s)
- Yue Shui
- Institute of Mountain Hazards and Environment, Chinese Academy of Sciences, #9, Block 4, Renminnan Road, Chengdu, 610041, China.,University of Chinese Academy of Sciences, #19, Yuquan Road, Shijingshan District, Beijing, 100049, China
| | - Dingde Xu
- Sichuan Center for Rural Development Research, College of Management of Sichuan Agricultural University, Chengdu, 611130, China
| | - Yi Liu
- College of resources, Sichuan Agricultural University, # 211, Huimin Road, Wenjiag District, Chengdu, 611130, China
| | - Shaoquan Liu
- Institute of Mountain Hazards and Environment, Chinese Academy of Sciences, #9, Block 4, Renminnan Road, Chengdu, 610041, China.
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Retention in Care Trajectories of HIV-Positive Individuals Participating in a Universal Test-and-Treat Program in Rural South Africa (ANRS 12249 TasP Trial). J Acquir Immune Defic Syndr 2019; 80:375-385. [PMID: 30570525 PMCID: PMC6410969 DOI: 10.1097/qai.0000000000001938] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Supplemental Digital Content is Available in the Text. Objective: To study retention in care (RIC) trajectories and associated factors in
patients eligible for antiretroviral therapy (ART) in a universal
test-and-treat setting (TasP trial, South Africa, 2012–2016). Design: A cluster-randomized trial whereby individuals identified HIV positive after
home-based testing were invited to initiate ART immediately (intervention)
or following national guidelines (control). Methods: Exiting care was defined as ≥3 months late for a clinic appointment,
transferring elsewhere, or death. Group-based trajectory modeling was
performed to estimate RIC trajectories over 18 months and associated factors
in 777 ART-eligible patients. Results: Four RIC trajectory groups were identified: (1) group 1
“remained” in care (reference, n = 554, 71.3%), (2) group
2 exited care then “returned” after [median (interquartile
range)] 4 (3–9) months (n = 40, 5.2%), (3) group 3
“exited care rapidly” [after 4 (4–6) months, n =
98, 12.6%], and (4) group 4 “exited care later” [after 11
(9–13) months, n = 85, 10.9%]. Group 2 patients were less likely
to have initiated ART within 1 month and more likely to be male, young
(<29 years), without a regular partner, and to have a CD4 count
>350 cells/mm3. Group 3 patients were more likely to be
women without social support, newly diagnosed, young, and less likely to
have initiated ART within 1 month. Group 4 patients were more likely to be
newly diagnosed and aged 39 years or younger. Conclusions: High CD4 counts at care initiation were not associated with a higher risk of
exiting care. Prompt ART initiation and special support for young and newly
diagnosed patients with HIV are needed to maximize RIC.
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Solitary living in South Africa: what is driving the pattern and change? JOURNAL OF POPULATION RESEARCH 2019. [DOI: 10.1007/s12546-019-09222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Effects of Migration on Risky Sexual Behavior and HIV Acquisition in South Africa: A Systematic Review and Meta-analysis, 2000-2017. AIDS Behav 2019; 23:1396-1430. [PMID: 30547333 DOI: 10.1007/s10461-018-2367-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
While human mobility has been implicated in fueling the HIV epidemic in South Africa, the link between migration and HIV has not been systematically reviewed and quantified. We conducted a systematic review of the role of migration in HIV risk acquisition and sexual behaviour based on 29 studies published between 2000 and 2017. Furthermore, we performed a meta-analysis of the association between migration and HIV risk acquisition in four of the studies that used HIV incidence as an outcome measure. The systematic review results show that HIV acquisition and risky sexual behavior were more prevalent among both male and female migrants compared to their non-migrant counterparts. The meta-analysis results demonstrate that migration was significantly associated with increased HIV acquisition risk (aOR = 1.69, 95% CI 1.33-2.14; I2 = 35.0%). There is an urgent need for effective combination HIV prevention strategies (comprising biomedical, behavioral and structural interventions) that target migrant populations.
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Camlin CS, Akullian A, Neilands TB, Getahun M, Bershteyn A, Ssali S, Geng E, Gandhi M, Cohen CR, Maeri I, Eyul P, Petersen ML, Havlir DV, Kamya MR, Bukusi EA, Charlebois ED. Gendered dimensions of population mobility associated with HIV across three epidemics in rural Eastern Africa. Health Place 2019; 57:339-351. [PMID: 31152972 DOI: 10.1016/j.healthplace.2019.05.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 11/18/2022]
Abstract
Mobility in sub-Saharan Africa links geographically-separate HIV epidemics, intensifies transmission by enabling higher-risk sexual behavior, and disrupts care. This population-based observational cohort study measured complex dimensions of mobility in rural Uganda and Kenya. Survey data were collected every 6 months beginning in 2016 from a random sample of 2308 adults in 12 communities across three regions, stratified by intervention arm, baseline residential stability and HIV status. Analyses were survey-weighted and stratified by sex, region, and HIV status. In this study, there were large differences in the forms and magnitude of mobility across regions, between men and women, and by HIV status. We found that adult migration varied widely by region, higher proportions of men than women migrated within the past one and five years, and men predominated across all but the most localized scales of migration: a higher proportion of women than men migrated within county of origin. Labor-related mobility was more common among men than women, while women were more likely to travel for non-labor reasons. Labor-related mobility was associated with HIV positive status for both men and women, adjusting for age and region, but the association was especially pronounced in women. The forms, drivers, and correlates of mobility in eastern Africa are complex and highly gendered. An in-depth understanding of mobility may help improve implementation and address gaps in the HIV prevention and care continua.
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Affiliation(s)
- Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA; Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, UCSF Mail Code 0886, San Francisco, CA 94158, USA.
| | - Adam Akullian
- Institute for Disease Modeling, 3150 139th Ave SE, Bellevue, WA 98005, USA; Department of Global Health, University of Washington, Seattle, USA.
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, UCSF Mail Code 0886, San Francisco, CA 94158, USA.
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA.
| | - Anna Bershteyn
- Institute for Disease Modeling, 3150 139th Ave SE, Bellevue, WA 98005, USA; Department of Global Health, University of Washington, Seattle, USA.
| | - Sarah Ssali
- School of Medicine, Makerere University College of Health Sciences, Upper Mulago Hill Road, New Mulago Hospital Complex, P.O Box 7072, Kampala, Uganda.
| | - Elvin Geng
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., San Francisco, CA 94110, USA.
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., San Francisco, CA 94110, USA.
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA.
| | - Irene Maeri
- Kenya Medical Research Institute, Centre for Microbiology Research, Box 19464, Post Code 00202, Nairobi, Kenya.
| | - Patrick Eyul
- The Infectious Diseases Research Collaboration (IDRC), Plot 2C Nakasero Hill Road, P.O Box 7475, Kampala, Uganda.
| | - Maya L Petersen
- University of California, Berkeley, 101 Haviland Hall, Suite 102; School of Public Health, UC Berkeley, Berkeley, CA 94720-7358, USA.
| | - Diane V Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., San Francisco, CA 94110, USA.
| | - Moses R Kamya
- School of Medicine, Makerere University College of Health Sciences, Upper Mulago Hill Road, New Mulago Hospital Complex, P.O Box 7072, Kampala, Uganda.
| | - Elizabeth A Bukusi
- Kenya Medical Research Institute, Centre for Microbiology Research, Box 19464, Post Code 00202, Nairobi, Kenya.
| | - Edwin D Charlebois
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, UCSF Mail Code 0886, San Francisco, CA 94158, USA.
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Yotebieng KA, Fakult N, Awah PK, Syvertsen JL. Precarious hope and reframing risk behavior from the ground up: insight from ethnographic research with Rwandan urban refugees in Yaoundé, Cameroon. Confl Health 2019; 13:18. [PMID: 31139249 PMCID: PMC6530091 DOI: 10.1186/s13031-019-0206-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Theoretical and methodological research on risk-taking practices often frames risk as an individual choice. While risk does occur at individual level, it is determined by aspirations which are connected to others and society. For many displaced women globally, these aspirations are often linked to the well-being of their children and other household members. This article explores the links between aspirations for the future, gendered household dynamics, and health risk-taking behavior among the Rwandan urban refugee community. METHODS This analysis drew from participant observation, focus group discussions, and in-depth interviews with 49 male and 42 female household members from 36 Rwandan refugee households in Yaoundé, Cameroon. The fieldwork was conducted over 12 months between May-August 2016, May-August 2017, and February-August 2018. RESULTS We observed that while there was considerable convergence among household members in aspirations, there was considerable difference in risk-taking practices engaged to achieve them with women often assuming the greatest risks. These gendered realities of risk were not only related to structural concerns including access to different forms of capital, but also to socio-cultural gendered expectations of women, how risks were defined and justified, and household dynamics that drove the gendered reality of observed risk-behavior. CONCLUSIONS Humanitarian programs and policies are distinctly finite in nature; focused on the short-term needs of persons affected by conflict. However, many humanitarian situations in the world are protracted. In the midst of these challenges, themes of future-orientation, possibilities, and shared aspirations for a better future emerge. These aspirations and the practices, including risk-taking practices that stem from them are central to understand if we are to ensure a just peace and stability in displaced communities throughout the developing world. Our analysis highlights the need to examine sociocultural dimensions related to hopes for the future, gender, and household dynamics as a way to understand risk behavior. We propose this can be done through a framework of precarious hope which we put forward in this paper, in which hope, agency, sociocultural and political economic contexts situate risk as a gendered practice of hope amidst constraint.
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Affiliation(s)
| | - Nathan Fakult
- Ohio State University, Department of Anthropology, Columbus, OH USA
| | - Paschal Kum Awah
- Department of Anthropology, Faculty of Arts, Letters and Social Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Centre for Population Studies and Health Promotion, Yaoundé, Cameroon
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36
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Ambia J, Kabudula C, Risher K, Xavier Gómez-Olivé F, Rice BD, Etoori D, Reniers G. Outcomes of patients lost to follow-up after antiretroviral therapy initiation in rural north-eastern South Africa. Trop Med Int Health 2019; 24:747-756. [PMID: 30920699 PMCID: PMC6563456 DOI: 10.1111/tmi.13236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective The vital status of patients lost to follow‐up often remains unknown in antiretroviral therapy (ART) programmes in sub‐Saharan Africa because medical records are no longer updated once the patient disengages from care. Thus, we aimed to assess the outcomes of patients lost to follow‐up after ART initiation in north‐eastern South Africa. Methods Using data from a rural area in north‐eastern South Africa, we estimated the cumulative incidence of patient outcomes (i) after treatment initiation using clinical records, and (ii) after loss to follow‐up (LTFU) using data from clients that have been individually linked to Agincourt Health and Demographic Surveillance System (AHDSS) database. Aside from LTFU, we considered mortality, re‐engagement and migration out of the study site. Cox proportional hazards regression was used to identify covariates of these patient outcomes. Results Between April 2014 and July 2017, 3700 patients initiated ART and contributed a total of 6818 person‐years of follow‐up time. Three years after ART initiation, clinical record‐based estimates of LTFU, mortality and documented transfers were 41.0% (95% CI: 38.5–43.4%), 1.9% (95% CI 1.0–3.2%) and 0.1% (95% CI 0.0–0.9%), respectively. Among those who were LTFU, the cumulative incidence of re‐engagement, out‐migration and mortality at 3 years were 38.1% (95% CI 33.1–43.0%), 49.4% (95% CI 43.1–55.3%) and 4.7% (95% CI 3.5–6.2%), respectively. Pregnant or breastfeeding women, foreigners and those who initiated ART most recently were at an increased risk of LTFU. Conclusion LTFU among patients starting ART in north‐eastern South Africa is relatively high and has increased in recent years as more asymptomatic patients have initiated treatment. Even though this tendency is of concern in light of the prevention of onwards transmission, we also found that re‐engagement in care is common and mortality among persons LTFU relatively low.
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Affiliation(s)
- Julie Ambia
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn Risher
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian D Rice
- MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Etoori
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Georges Reniers
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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37
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Research on Role Cognition and Employment Strategy of Rural Female Laborers in Sichuan, China. SUSTAINABILITY 2019. [DOI: 10.3390/su11061708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Paying attention to role cognition and the employment strategies of female rural laborers has great significance for the improvement of the status of women and the rational transfer of labor forces. However, there are few studies of role cognition amongst the rural female labor workforce. There is even less research on the relationship between role cognition and employment transfer strategies. In this study, a survey of 425 female rural laborers in the Sichuan Province, China, was conducted to construct a role-based cognitive scale in order to measure the cognitive levels of subjective ability, self-role expectations and role conflicts. This paper divides employment strategy into four aspects: Actual workplaces, workplace preferences, actual industries, and industry preferences. An unorganized multi-classification logistic regression model was constructed in order to explore the relationship between the role cognition and employment strategy selections. The results indicated that there was a significant difference between employment expectations and realities. Rural females with more equal modern role cognition had a higher expectation of employment. Meanwhile, those who had a strong feeling of role conflicts, tended to work in other places and choose secondary and tertiary industries. However, in reality, most were unemployed. The conflict of roles clearly restricts employment options of the rural female workforce. This study enhances our understanding of the relationship between the perceptions of the Chinese female labor workforce and the employment strategies used. The findings can help to provide a reference for guiding employment policies and the flow of the female labor workforce.
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38
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Dzomba A, Tomita A, Vandormael A, Govender K, Tanser F. 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. BMC Public Health 2019; 19:196. [PMID: 30764786 PMCID: PMC6376673 DOI: 10.1186/s12889-019-6494-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/29/2019] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Armstrong Dzomba
- 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.
| | - Andrew Tomita
- 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
| | - Alain Vandormael
- 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
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- 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 & Population Health, University College London, London, UK
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Harling G, Payne CF, Davies JI, Gomez-Olive FX, Kahn K, Manderson L, Mateen FJ, Tollman SM, Witham MD. Impairment in Activities of Daily Living, Care Receipt, and Unmet Needs in a Middle-Aged and Older Rural South African Population: Findings From the HAALSI Study. J Aging Health 2019; 32:296-307. [PMID: 30600746 PMCID: PMC6675676 DOI: 10.1177/0898264318821220] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: The objective of this study is to analyze the degree to which care needs are met in an aging rural African population. Method: Using data from the Health and Aging in Africa: Longitudinal Study of an INDEPTH Community (HAALSI) baseline survey, which interviewed 5,059 adults aged older than 40 years in rural South Africa, we assessed the levels of limitations in activities of daily living (ADLs) and in unmet care for these ADLs, and evaluated their association with sociodemographic and health characteristics. Results: ADL impairment was reported by 12.2% of respondents, with the proportion increasing with age. Among those with ADL impairment, 23.9% reported an unmet need and 51.4% more a partially met need. Relatives provided help most often; formal care provision was rare. Unmet needs were more frequent among younger people and women, and were associated with physical and cognitive deficits, but not income or household size. Discussion: Unmet care needs in rural South Africa are often found among individuals less expected to require care.
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Affiliation(s)
- Guy Harling
- University College London, UK
- Harvard University, Cambridge, MA, USA
| | - Collin F. Payne
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Justine I. Davies
- King’s College London, UK
- University of the Witwatersrand, Johannesburg, South Africa
| | - F. Xavier Gomez-Olive
- Harvard University, Cambridge, MA, USA
- University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå University, Sweden
| | - Lenore Manderson
- University of the Witwatersrand, Johannesburg, South Africa
- Brown University, Providence, RI, USA
| | - Farrah J. Mateen
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephen M. Tollman
- University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå University, Sweden
| | - Miles D. Witham
- University of the Witwatersrand, Johannesburg, South Africa
- Newcastle University, Newcastle upon Tyne, UK
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40
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Contemporary female migration in Ghana: Analyses of the 2000 and 2010 Censuses. DEMOGRAPHIC RESEARCH 2018. [DOI: 10.4054/demres.2018.39.44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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41
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Camlin CS, Akullian A, Neilands TB, Getahun M, Eyul P, Maeri I, Ssali S, Geng E, Gandhi M, Cohen CR, Kamya MR, Odeny T, Bukusi EA, Charlebois ED. Population mobility associated with higher risk sexual behaviour in eastern African communities participating in a Universal Testing and Treatment trial. J Int AIDS Soc 2018; 21 Suppl 4:e25115. [PMID: 30027668 PMCID: PMC6053476 DOI: 10.1002/jia2.25115] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/08/2018] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION There are significant knowledge gaps concerning complex forms of mobility emergent in sub-Saharan Africa, their relationship to sexual behaviours, HIV transmission, and how sex modifies these associations. This study, within an ongoing test-and-treat trial (SEARCH, NCT01864603), sought to measure effects of diverse metrics of mobility on behaviours, with attention to gender. METHODS Cross-sectional data were collected in 2016 from 1919 adults in 12 communities in Kenya and Uganda, to examine mobility (labour/non-labour-related travel), migration (changes of residence over geopolitical boundaries) and their associations with sexual behaviours (concurrent/higher risk partnerships), by region and sex. Multilevel mixed-effects logistic regression models, stratified by sex and adjusted for clustering by community, were fitted to examine associations of mobility with higher-risk behaviours, in past 2 years/past 6 months, controlling for key covariates. RESULTS The population was 45.8% male and 52.4% female, with mean age 38.7 (median 37, IQR: 17); 11.2% had migrated in the past 2 years. Migration varied by region (14.4% in Kenya, 11.5% in southwestern and 1.7% in eastern and Uganda) and sex (13.6% of men and 9.2% of women). Ten per cent reported labour-related travel and 45.9% non-labour-related travel in past 6 months-and varied by region and sex: labour-related mobility was more common in men (18.5%) than women (2.9%); non-labour-related mobility was more common in women (57.1%) than men (32.6%). In 2015 to 2016, 24.6% of men and 6.6% of women had concurrent sexual partnerships; in past 6 months, 21.6% of men and 5.4% of women had concurrent partnerships. Concurrency in 2015 to 2016 was more strongly associated with migration in women [aRR = 2.0, 95% CI(1.1 to 3.7)] than men [aRR = 1.5, 95% CI(1.0 to 2.2)]. Concurrency in past 6 months was more strongly associated with labour-related mobility in women [aRR = 2.9, 95% CI(1.0 to 8.0)] than men [aRR = 1.8, 95% CI(1.2 to 2.5)], but with non-labour-related mobility in men [aRR = 2.2, 95% CI(1.5 to 3.4)]. CONCLUSIONS In rural eastern Africa, both longer-distance/permanent, and localized/shorter-term forms of mobility are associated with higher-risk behaviours, and are highly gendered: the HIV risks associated with mobility are more pronounced for women. Gender-specific interventions among mobile populations are needed to combat HIV in the region.
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Affiliation(s)
- Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive SciencesUniversity of CaliforniaSan Francisco (UCSF)San FranciscoCAUSA
- Department of MedicineCenter for AIDS Prevention StudiesUCSFSan FranciscoCAUSA
| | - Adam Akullian
- Institute for Disease ModelingUniversity of WashingtonSeattleWashingtonUSA
| | - Torsten B Neilands
- Department of MedicineCenter for AIDS Prevention StudiesUCSFSan FranciscoCAUSA
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive SciencesUniversity of CaliforniaSan Francisco (UCSF)San FranciscoCAUSA
| | - Patrick Eyul
- Infectious Diseases Research Collaboration (IDRC)Makerere University (MU‐UCSF)KampalaUganda
| | - Irene Maeri
- Kenya Medical Research Institute (KEMRI)NairobiKenya
| | - Sarah Ssali
- Infectious Diseases Research Collaboration (IDRC)Makerere University (MU‐UCSF)KampalaUganda
| | - Elvin Geng
- Department of MedicineDivision of HIV, Infectious Diseases and Global MedicineUCSFSan FranciscoCAUSA
| | - Monica Gandhi
- Department of MedicineDivision of HIV, Infectious Diseases and Global MedicineUCSFSan FranciscoCAUSA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive SciencesUniversity of CaliforniaSan Francisco (UCSF)San FranciscoCAUSA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration (IDRC)Makerere University (MU‐UCSF)KampalaUganda
| | - Thomas Odeny
- Kenya Medical Research Institute (KEMRI)NairobiKenya
| | | | - Edwin D Charlebois
- Department of MedicineCenter for AIDS Prevention StudiesUCSFSan FranciscoCAUSA
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Camlin CS, Cassels S, Seeley J. Bringing population mobility into focus to achieve HIV prevention goals. J Int AIDS Soc 2018; 21 Suppl 4:e25136. [PMID: 30027588 PMCID: PMC6053544 DOI: 10.1002/jia2.25136] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Carol S Camlin
- Department of Obstetrics, Gynecology and Reproductive SciencesDepartment of MedicineUniversity of CaliforniaSan FranciscoUSA
| | - Susan Cassels
- Department of GeographyUniversity of CaliforniaSanta BarbaraUSA
| | - Janet Seeley
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
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Iwuji C, McGrath N, Calmy A, Dabis F, Pillay D, Newell M, Baisley K, Porter K. Universal test and treat is not associated with sub-optimal antiretroviral therapy adherence in rural South Africa: the ANRS 12249 TasP trial. J Int AIDS Soc 2018; 21:e25112. [PMID: 29890048 PMCID: PMC5995313 DOI: 10.1002/jia2.25112] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/26/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION HIV treatment guidelines now recommend antiretroviral therapy (ART) initiation regardless of CD4 count to maximize benefit both for the individual and society. It is unknown whether the initiation of ART at higher CD4 counts would affect adherence levels. We investigated whether initiating ART at higher CD4 counts was associated with sub-optimal adherence (<95%) during the first 12 months of ART. METHODS A prospective cohort study nested within a two-arm cluster-randomized trial of universal test and treat was implemented from March 2012 to June 2016 to measure the impact of ART on HIV incidence in rural KwaZulu-Natal. ART was initiated regardless of CD4 count in the intervention arm and according to national guidelines in the control arm. ART adherence was measured monthly using a visual analogue scale (VAS) and pill counts (PC). HIV viral load was measured at ART initiation, three and six months, and six-monthly thereafter. We pooled data from participants in both arms and used random-effects logistic regression models to examine the association between CD4 count at ART initiation and sub-optimal adherence, and assessed if adherence levels were associated with virological suppression. RESULTS Among 900 individuals who initiated ART ≥12 months before study end, median (IQR) CD4 at ART initiation was 350 cells/mm3 (234, 503); median age was 34.6 years (IQR 27.4 to 46.4) and 71.7% were female. Adherence was sub-optimal in 14.7% of visits as measured by VAS and 20.7% by PC. In both the crude analyses and after adjusting for potential confounders, adherence was not significantly associated with CD4 count at ART initiation (adjusted OR for linear trend in sub-optimal adherence with every 100 cells/mm3 increase in CD4 count: 1.00, 95% CI 0.95 to 1.05, for VAS, and 1.03, 95% CI 0.99 to 1.07, for PC). Virological suppression at 12 months was 97%. Optimal adherence by both measures was significantly associated with virological suppression (p < 0.001 for VAS; p = 0.006 for PC). CONCLUSIONS We found no evidence that higher CD4 counts at ART initiation were associated with sub-optimal ART adherence in the first 12 months. Our findings should alleviate concerns about adherence in individuals initiating ART at higher CD4 counts, however long-term outcomes are needed. ClinicalTrials.gov NCT01509508.
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Affiliation(s)
- Collins Iwuji
- Department of Global Health and InfectionBrighton and Sussex Medical SchoolBrightonUK
- Africa Health Research InstituteDurbanSouth Africa
- Institute for Global HealthUniversity College LondonLondonUK
| | - Nuala McGrath
- Africa Health Research InstituteSchool of Nursing & Public HealthUniversity of KwaZulu‐ NatalKwaZulu‐NatalSouth Africa
- Faculty of Medicine and Faculty of Human, Social and Mathematical SciencesUniversity of SouthamptonSouthamptonUK
- Research Department of Epidemiology & Public HealthUniversity College LondonLondonUK
| | - Alexandra Calmy
- Service des Maladies InfectieusesHIV UnitHôpitaux Universitaires de GenèveGenevaSwitzerland
| | - Francois Dabis
- Centre INSERM U1219Bordeaux Population HealthUniversité de BordeauxBordeauxFrance
| | - Deenan Pillay
- Department of Global Health and InfectionBrighton and Sussex Medical SchoolBrightonUK
- Division of Infection and ImmunityUniversity College LondonLondonUK
| | - Marie‐Louise Newell
- Human Development and Health and Global Health Research InstituteFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Kathy Baisley
- Department of Global Health and InfectionBrighton and Sussex Medical SchoolBrightonUK
- Department of Infectious Disease EpidemiologyFaculty of Epidemiology & Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Kholoud Porter
- Institute for Global HealthUniversity College LondonLondonUK
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Rethinking Rural–Urban Migration and Women’s Empowerment in the Era of the SDGs: Lessons from Ghana. SUSTAINABILITY 2018. [DOI: 10.3390/su10041075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Agadjanian V, Gorina E. Economic Swings, Political Instability and Migration in Kyrgyzstan. EUROPEAN JOURNAL OF POPULATION-REVUE EUROPEENNE DE DEMOGRAPHIE 2018; 35:285-304. [PMID: 31105500 DOI: 10.1007/s10680-018-9482-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
Individual-level migration responses to economic fluctuations and political instability remain poorly understood. Using nationally representative survey data from Kyrgyzstan, we look at variations in levels and propensities of internal and temporary international migration and relate them to changes in the economic and political environment in that Central Asian nation in the first decade of the century. A multinomial event history model predicting yearly risks of both types of migration detects no clear association of internal migration risks with episodes of heightened political instability but shows a decrease in those risks in response to the strongest economic shock of the observation period. In comparison, international migration risks, while also insensitive to political turmoil, appear to increase at the time of the most pronounced economic downturn. The results also point to instructive patterns in migration propensities by type of area of residence, education, gender, and ethnicity. These findings are interpreted in light of complex intersections of demography with politics, economy, and culture in this transitional Eurasian setting.
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Affiliation(s)
- Victor Agadjanian
- 1Department of Sociology, University of Kansas, Lawrence, KS 66045 USA
| | - Evgenia Gorina
- 2School of Economic, Political and Policy Sciences, University of Texas at Dallas, Dallas, USA
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Leidich A, Achiro L, Kwena ZA, McFarland W, Neilands TB, Cohen CR, Bukusi EA, Camlin CS. Methods for sampling geographically mobile female traders in an East African market setting. PLoS One 2018; 13:e0190395. [PMID: 29324780 PMCID: PMC5764273 DOI: 10.1371/journal.pone.0190395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/14/2017] [Indexed: 11/20/2022] Open
Abstract
Background The role of migration in the spread of HIV in sub-Saharan Africa is well-documented. Yet migration and HIV research have often focused on HIV risks to male migrants and their partners, or migrants overall, often failing to measure the risks to women via their direct involvement in migration. Inconsistent measures of mobility, gender biases in those measures, and limited data sources for sex-specific population-based estimates of mobility have contributed to a paucity of research on the HIV prevention and care needs of migrant and highly mobile women. This study addresses an urgent need for novel methods for developing probability-based, systematic samples of highly mobile women, focusing on a population of female traders operating out of one of the largest open air markets in East Africa. Our method involves three stages: 1.) identification and mapping of all market stall locations using Global Positioning System (GPS) coordinates; 2.) using female market vendor stall GPS coordinates to build the sampling frame using replicates; and 3.) using maps and GPS data for recruitment of study participants. Results The location of 6,390 vendor stalls were mapped using GPS. Of these, 4,064 stalls occupied by women (63.6%) were used to draw four replicates of 128 stalls each, and a fifth replicate of 15 pre-selected random alternates for a total of 527 stalls assigned to one of five replicates. Staff visited 323 stalls from the first three replicates and from these successfully recruited 306 female vendors into the study for a participation rate of 94.7%. Mobilization strategies and involving traders association representatives in participant recruitment were critical to the study’s success. Conclusion The study’s high participation rate suggests that this geospatial sampling method holds promise for development of probability-based samples in other settings that serve as transport hubs for highly mobile populations.
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Affiliation(s)
- Aimee Leidich
- mSurvey, San Francisco, CA, United States of America
- * E-mail:
| | - Lillian Achiro
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Zachary A. Kwena
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Willi McFarland
- Global Health Sciences, University of California at San Francisco (UCSF), San Francisco, CA, United States of America
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California at San Francisco (UCSF), San Francisco, CA, United States of America
| | - Craig R. Cohen
- Global Health Sciences, University of California at San Francisco (UCSF), San Francisco, CA, United States of America
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Carol S. Camlin
- Center for AIDS Prevention Studies, University of California at San Francisco (UCSF), San Francisco, CA, United States of America
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
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Camlin CS, El Ayadi AM, Kwena ZA, McFarland W, Johnson MO, Neilands TB, Bukusi EA, Cohen CR. High Mobility and HIV Prevalence Among Female Market Traders in East Africa in 2014. J Acquir Immune Defic Syndr 2017; 74:e121-e128. [PMID: 27875361 PMCID: PMC5340599 DOI: 10.1097/qai.0000000000001252] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The contribution of women's mobility to the HIV/AIDS epidemic in Africa is poorly understood, despite women's high mobility and evidence that it is associated with higher-risk sexual behavior. We sought to measure levels of mobility, HIV prevalence, and related risk behaviors among female traders in Kisumu, Kenya. METHODS We used global positioning system mapping to develop a probability-based sample and recruited 305 female market traders for participation in a survey and voluntary HIV counseling and testing in 2014. We estimated HIV prevalence and fitted logistic regression models to measure associations between mobility, risk behaviors, and HIV infection. RESULTS HIV prevalence was 25.6% (95% confidence interval: 21.0 to 30.8); 11.5% had migrated (changed residence, over county, or national boundary) in the past year and 39.3% in the past 5 years. More than one-third (38.3%) spent nights away from main residence in the past month, with 11.4% spending more than a week away. Multiple partners were reported by 13.1% of women in the last year; 16% of married women reported a concurrent partnership. Mobility was not significantly associated with HIV prevalence, although recent short-term mobility was significantly correlated with higher numbers of sexual partners in the past year. CONCLUSIONS Female market traders were highly mobile, and HIV prevalence among traders was higher than in the general population of women of reproductive age in Kisumu (15.3% in 2013), and Nyanza Province, Kenya (16.1% in 2012). High HIV prevalence and risk behavior among women in this study warrant accelerated attention to HIV prevention and care needs of mobile women, including market traders.
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Affiliation(s)
- Carol S Camlin
- *Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA; †Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA; ‡Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA; §Centre for Microbiology Research, Kenya Medical Research Institute, Kwale, Kenya; and ‖Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA
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Abstract
Objective: To quantify the space-time dimensions of human mobility in relationship to the risk of HIV acquisition. Methods: We used data from the population cohort located in a high HIV prevalence, rural population in KwaZulu-Natal, South Africa (2000–2014). We geolocated 8006 migration events (representing 1 028 782 km traveled) for 17 743 individuals (≥15 years of age) who were HIV negative at baseline and followed up these individuals for HIV acquisition (70 395 person-years). Based on the complete geolocated residential history of every individual in this cohort, we constructed two detailed time-varying migration indices. We then used interval-censored Cox proportional hazards models to quantify the relationship between the migration indices and the risk of HIV acquisition. Results: In total, 17.4% of participants migrated at least once outside the rural study community during the period of observation (median migration distance = 107.1 km, interquartile range 18.9–387.5). The two migration indices were highly predictive of hazard of HIV acquisition (P < 0.01) in both men and women. Holding other factors equal, the risk of acquiring HIV infection increased by 50% for migration distances of 40 km (men) and 109 km (women). HIV acquisition risk also increased by 50% when participants spent 44% (men) and 90% (women) of their respective time outside the rural study community. Conclusion: This in-depth analysis of a population cohort in a rural sub-Saharan African population has revealed a clear nonlinear relationship between distance migrated and HIV acquisition. Our findings show that even relatively short-distance migration events confer substantial additional risk of acquisition.
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Hickey MD, Omollo D, Salmen CR, Mattah B, Blat C, Ouma GB, Fiorella KJ, Njoroge B, Gandhi M, Bukusi EA, Cohen CR, Geng EH. Movement between facilities for HIV care among a mobile population in Kenya: transfer, loss to follow-up, and reengagement. AIDS Care 2016; 28:1386-93. [PMID: 27145451 PMCID: PMC5697146 DOI: 10.1080/09540121.2016.1179253] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HIV treatment is life-long, yet many patients travel or migrate for their livelihoods, risking treatment interruption. We examine timely reengagement in care among patients who transferred-out or were lost-to-follow-up (LTFU) from a rural HIV facility. We conducted a cohort study among 369 adult patients on antiretroviral therapy between November 2011 and November 2013 on Mfangano Island, Kenya. Patients who transferred or were LTFU (i.e., missed a scheduled appointment by ≥90 days) were traced to determine if they reengaged or accessed care at another clinic. We report cumulative incidence and time to reengagement using Cox proportional hazards models adjusted for patient demographic and clinical characteristics. Among 369 patients at the clinic, 23(6%) requested an official transfer and 78(21%) were LTFU. Among official transfers, cumulative incidence of linkage to their destination facility was 91% at three months (95%CI (confidence intervals) 69-98%). Among LTFU, cumulative incidence of reengagement in care at the original or a new clinic was 14% at three months (95%CI 7-23%) and 60% at six months (95%CI 48-69%). In the adjusted Cox model, patients who left with an official transfer reengaged in care six times faster than those who did not (adjusted hazard ratio 6.2, 95%CI 3.4-11.0). Patients who left an island-based HIV clinic in Kenya with an official transfer letter reengaged in care faster than those who were LTFU, although many in both groups had treatment gaps long enough to risk viral rebound. Better coordination of transfers between clinics, such as assisting patients with navigating the process or improving inter-clinic communication surrounding transfers, may reduce delays in treatment during transfer and improve overall clinical outcomes.
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Affiliation(s)
- Matthew D Hickey
- a Division of General Internal Medicine , University of California, San Francisco (UCSF) , San Francisco , CA , USA
- b Mfangano Island Research Group, Organic Health Response , Homa Bay County , Kenya
- c Microclinic International (MCI) , San Francisco , CA , USA
| | - Dan Omollo
- b Mfangano Island Research Group, Organic Health Response , Homa Bay County , Kenya
| | - Charles R Salmen
- b Mfangano Island Research Group, Organic Health Response , Homa Bay County , Kenya
- c Microclinic International (MCI) , San Francisco , CA , USA
- d Department of Family and Community Medicine , University of Minnesota , Minneapolis , MN , USA
| | - Brian Mattah
- b Mfangano Island Research Group, Organic Health Response , Homa Bay County , Kenya
| | - Cinthia Blat
- e Global Health Sciences , University of California, San Francisco (UCSF) , San Francisco , CA , USA
| | - Gor Benard Ouma
- b Mfangano Island Research Group, Organic Health Response , Homa Bay County , Kenya
| | - Kathryn J Fiorella
- b Mfangano Island Research Group, Organic Health Response , Homa Bay County , Kenya
- f Atkinson Center for a Sustainable Future , Cornell University , Ithaca , NY , USA
| | - Betty Njoroge
- g Centre for Microbial Research, Kenya Medical Research Institute , Nairobi , Kenya
| | - Monica Gandhi
- h HIV-ID-Global Medicine Division , University of California, San Francisco (UCSF) , San Francisco , CA , USA
| | - Elizabeth A Bukusi
- g Centre for Microbial Research, Kenya Medical Research Institute , Nairobi , Kenya
| | - Craig R Cohen
- e Global Health Sciences , University of California, San Francisco (UCSF) , San Francisco , CA , USA
- i Department of Obstetrics, Gynecology and Reproductive Sciences , University of California, San Francisco (UCSF) , San Francisco , CA , USA
| | - Elvin H Geng
- h HIV-ID-Global Medicine Division , University of California, San Francisco (UCSF) , San Francisco , CA , USA
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Lerch M. Internal and International Migration Across the Urban Hierarchy in Albania. POPULATION RESEARCH AND POLICY REVIEW 2016; 35:851-876. [PMID: 27867240 PMCID: PMC5088220 DOI: 10.1007/s11113-016-9404-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/21/2016] [Indexed: 12/03/2022]
Abstract
The interactions between the processes of urbanization and international migration in less developed and transition countries have important repercussions for socioeconomic development, but are not well understood. Based on the retrospective data from the Albanian Living Standards Measurement Survey 2008, we first assess the geography of migration in terms of the rural-urban continuum, the urban hierarchy and the outside world since 1990. We then investigate the spatio-temporal diffusion of rural-to-urban and international movements using survival models. Results reveal an immediate onset of large-scale rural exodus, despite the post-communist crisis. Internal migrants mainly moved to the capital, bypassing secondary cities, and were predominantly female. Initially, international migrants were primarily men who tended to originate from the main urban agglomerations. The diffusion of opportunities to emigrate down the urban hierarchy and across the sexes then redirected the rural exodus abroad, despite domestic economic development. This evolution in population mobility is related to the gendered patterns and interlinkages of the two flows, as well as to rising inequalities within the urban hierarchy.
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Affiliation(s)
- Mathias Lerch
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057 Rostock, Germany
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