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Ekerin O, Shomuyiwa DO, Lucero-Prisno DE, Agboola OO, Damilola AS, Onoja SO, Chikwendu CF, Manirambona E. Restrictive migration policies and their impact on HIV prevention, care and treatment services. Health Res Policy Syst 2024; 22:91. [PMID: 39103822 DOI: 10.1186/s12961-024-01172-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/23/2024] [Indexed: 08/07/2024] Open
Abstract
Migration policies have a significant impact on population health, particularly for individuals living with human immunodeficiency virus (HIV). These policies not only determine who is allowed to enter a country but also influence which immigrants can access services provided by the government. Some countries continue to impose restrictions on HIV-positive individuals, justifying these measures as necessary to protect public health and mitigate healthcare and economic concerns. However, these restrictions lack a valid public health rationale. Due to social, economic and political constraints, restrictive migration laws hinder access to HIV prevention, care and treatment services for immigrants living with HIV. Immigrants face numerous challenges in accessing medication, adhering to treatment regimens and benefitting from HIV preventive efforts. This situation increases the risk of HIV infection and adverse health outcomes due to limited access to preventive programmes, social stigma and engagement in risky behaviours. Additionally, these restrictive migration rules negatively affect immigrants' mental health. To improve the health of both immigrants and host communities, inclusive and evidence-based migration policies that address healthcare through public health and human rights lenses are required.
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Affiliation(s)
- Olabode Ekerin
- School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria
- The WiseUp Initiative for Good Health and Community Development, Kaduna, Nigeria
| | | | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oluwafemi Oluwaseun Agboola
- State AIDS, Hepatitis and STI control Program, Department of Public Health, Ministry of Health, Osogbo, Osun State, Nigeria
| | - Ayelawa Samuel Damilola
- School of Public Health, University of Port Harcourt, Port Harcourt, Nigeria
- Ibrahim Babangida Badamosi Specialist Hospital, Minna, Nigeria
| | - Silvia Ojonoka Onoja
- Dora Akunyili College of Pharmacy, Igbinedion University Okada, Okada, Edo State, Nigeria
| | | | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Global Health Focus, Bujumbura, Burundi.
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Clouse K, Noholoza S, Madwayi S, Mrubata M, Robbins NN, Camlin CS, Myer L, Phillips TK. Peripartum mobility and maternal/child separation among women living with HIV in South Africa. AIDS Care 2024; 36:946-953. [PMID: 38176056 PMCID: PMC11222306 DOI: 10.1080/09540121.2023.2299745] [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: 06/21/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
This prospective cohort study investigated the mobility patterns of 200 pregnant and postpartum women living with HIV in South Africa. Participants were enrolled during their third trimester from routine antenatal care near Cape Town, South Africa, and followed for six months postpartum. Quantitative data were collected at enrollment and follow-up. Mobility (self-reported) was common among the participants, despite the brief study period and the concurrent COVID-19 pandemic. While most reported stability in their current residence, 71% had a second main residence, primarily in the Eastern Cape (EC). Participants had a median of two lifetime moves, motivated by work, education, and family life. During the study period, 20% of participants met the study definition of travel (>7 days and >50 km), with trips predominantly to the EC, lasting a median duration of 30 days. Over one-third of participants with other living children reported that these children lived apart from them, with the mother's family being primary caregivers. These findings emphasize the need for targeted interventions to support continuity of care for mobile populations, particularly peripartum women living with HIV. The study contributes valuable insights into mobility dynamics and highlights unique barriers faced by this population, contributing to improved HIV care in resource-limited settings.
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Affiliation(s)
- Kate Clouse
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sandisiwe Noholoza
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Sindiswa Madwayi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Megan Mrubata
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Natalie N. Robbins
- Vanderbilt Institute for Spatial Research, Vanderbilt University, Nashville, TN, USA
| | - Carol S. Camlin
- University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, San Francisco, CA, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Tamsin K. Phillips
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
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Ugwu NH, Odimegwu CO. Contextual determinants of multiple sexual partnerships amongst young people in South Africa: a multilevel analysis. BMC Public Health 2024; 24:1533. [PMID: 38849818 PMCID: PMC11157945 DOI: 10.1186/s12889-024-18872-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Risky sexual behaviour (RSB), particularly multiple sexual partnerships (MSP) continues to be a major public health concern and has been linked to the increasing STIs, including HIV/AIDS in many parts of sub-Saharan Africa (SSA), suggesting that there is an association between contextual factors and multiple sexual partnering. However, in South Africa, this association is not well established in recent literature. Hence, this study examined the contextual factors contributing to multiple sexual partnerships among young people in South Africa. MATERIALS AND METHODS Data was extracted from the 2016 South Africa Demographics and Health Survey (2016 SADHS). A cross-sectional study of 3889 never-married young people. Descriptive and inferential statistics as well as multilevel logistic regression were used to analyse the data on never-married young people aged 15 to 24 years. RESULTS The results indicated that at the individual level, young males (61.7%) were significantly more likely than their female counterparts (56.1%) to engage in multiple sexual partners, although, the difference was not as significant as expected. At the community level clustering, the likelihood of exposure to multiple sexual partnerships significantly increased among females (OR = 1.47; 95% CI: 1.25-1.73) but decreased among their male counterparts (OR = 0.73; 95% CI: 0.58-0.92), in particular, family disruption, residential instability, and ethnic diversity led young people to engage in multiple sexual partnerships. CONCLUSIONS There is a need to intensify programmes aimed at considering appropriate policy options to reduce the prevalence of multiple sexual partnerships. Adopting the implications of these findings is essential for a developmental strategy towards achieving the sustainable development goal of ending STIs among young people in South Africa.
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Affiliation(s)
- Nebechukwu H Ugwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Institute for Development Studies, University of Nigeria, Enugu Campus, Enugu, Nigeria.
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Shiferaw W, Martin BM, Dean JA, Mills D, Lau C, Paterson D, Koh K, Eriksson L, Furuya-Kanamori L. A systematic review and meta-analysis of sexually transmitted infections and blood-borne viruses in travellers. J Travel Med 2024; 31:taae038. [PMID: 38438164 PMCID: PMC11149723 DOI: 10.1093/jtm/taae038] [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: 11/01/2023] [Revised: 02/18/2024] [Accepted: 02/29/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) and blood-borne viruses (BBVs) impose a global health and economic burden. International travellers facilitate the spread of infectious diseases, including STIs. Hence, this review assessed the prevalence/proportionate morbidity of travellers with STIs and sexually transmitted BBVs and factors associated with the infection in this population. METHODS PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Cochrane Library were searched from inception of the databases until November 2022. Published analytical observational studies reporting the prevalence/proportionate morbidity of travellers with STIs and factors associated with STIs by type of traveller [i.e. tourists, business travellers, students, visiting friends or relatives (VFRs), international truck drivers, backpackers, expatriates and men who have sex with men (MSM)] were included. The selection of articles, data extraction and risk of bias assessment were conducted by two independent reviewers. Meta-analyses were conducted for each STI by clinical presentation and type of traveller. RESULTS Thirty-two studies (n = 387 731 travellers) were included; 19 evaluated the proportionate morbidity of STIs among symptomatic travellers, while 13 examined the prevalence of STIs in asymptomatic travellers. The highest proportionate morbidity was found among VFRs (syphilis, 1.67%; 95% CI: 1.03-2.81%), backpackers (Chlamydia trachomatis, 6.58%; 95% CI: 5.96-7.25%) and MSM (HIV [2.50%;95% CI: 0.44-12.88%], gonorrhoea [4.17%; 95% CI: 1.1.5-13.98%], lymphogranuloma venereum [4.17%;95% CI: 1.1.5-13.98%] and HAV [20.0%; 95% CI: 14.99-26.17%]). The highest prevalence of STIs among asymptomatic were found in MSM (HIV [25.94%; 95% CI: 22.21-30.05%] and HBV [24.90%; 95% CI: 21.23-28.96%]) and backpackers (C. trachomatis, 3.92%; 95% CI: 2.72-5.32%). Short duration of the trip (<1 month), not having pre-travel consultation, travelling to Southeast Asia and being unvaccinated for HBV were identified as risk factors for STIs. CONCLUSION Strategies to prevent STIs and sexually transmitted BBVs should be discussed at pre-travel consultations, and recommendations should be prioritized in high-risk groups of travellers, such as backpackers, VFRs and MSMs. Additionally, healthcare providers should tailor recommendations for safe sex practices to individual travellers' unique needs.
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Affiliation(s)
- Wondimeneh Shiferaw
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Asrat Woldeyes Health Science Campus, Debre Berhan University, Ethiopia
| | - Beatris Mario Martin
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Judith A Dean
- UQ Poche Centre for Indigenous Health, Faculty of Health, and Behavioural Sciences, The University of Queensland, Toowong, Australia
| | - Deborah Mills
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Australia
| | - Colleen Lau
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - David Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Kenneth Koh
- Gladstone Road Medical Centre, Brisbane, Australia
| | - Lars Eriksson
- Herston Health Sciences Library, The University of Queensland, Herston, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
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Namusisi P, Yeh PT, Ssekubugu R, Chang LW, Lutalo T, Zimmerman L, Grabowski MK. The intersection between migration, HIV, and contraceptive use in Uganda: a cross-sectional population-based study. Reprod Health 2024; 21:65. [PMID: 38760855 PMCID: PMC11100193 DOI: 10.1186/s12978-024-01796-z] [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: 08/18/2023] [Accepted: 04/20/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Low use of modern methods of contraception has been linked to HIV seropositivity and to migration, but few studies have evaluated the intersection of both risk factors with contraceptive use. METHODS We analyzed cross-sectional data from sexually active female participants aged 15 to 49 years in the Rakai Community Cohort Study (RCCS) between 2011 and 2013. The RCCS is an open population-based census and individual survey in south-central Uganda. Recent in-migrants (arrival within approximately 1.5 years) into RCCS communities were identified at time of household census. The primary outcome was unsatisfied demand for a modern contraceptive method (injectable, oral pill, implant, or condom), which was defined as non-use of a modern contraceptive method among female participants who did not want to become pregnant in the next 12 months. Poisson regression models with robust variance estimators were used to identify associations and interactions between recent migration and HIV serostatus on unsatisfied contraceptive demand. RESULTS There were 3,417 sexually active participants with no intention of becoming pregnant in the next year. The mean age was 30 (± 8) years, and 17.3% (n = 591) were living with HIV. Overall, 43.9% (n = 1,500) were not using any modern contraceptive method. Recent in-migrants were somewhat more likely to have unsatisfied contraceptive demand as compared to long-term residents (adjusted prevalence risk ratio [adjPRR] = 1.14; 95% confidence interval [95%CI]: 1.02-1.27), whereas participants living with HIV were less likely to have unsatisfied contraceptive demand relative to HIV-seronegative participants (adjPRR = 0.80; 95%CI = 0.70-0.90). When stratifying on migration and HIV serostatus, we observed the highest levels of unsatisfied contraceptive demand among in-migrants living with HIV (48.7%); however, in regression analyses, interaction terms between migration and HIV serostatus were not statistically significant. CONCLUSIONS Unsatisfied contraceptive demand was high in this rural Ugandan setting. Being an in-migrant, particularly among those living with HIV, was associated with higher unsatisfied contraceptive demand.
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Affiliation(s)
- Prossy Namusisi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Kawempe National Referral Hospital, Kampala, Uganda.
| | - Ping Teresa Yeh
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Larry William Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Linnea Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary Kathryn Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Knight J, Ma H, Sithole B, Khumalo L, Wang L, Schwartz S, Muzart L, Matse S, Mnisi Z, Kaul R, Escobar M, Baral S, Mishra S. Quantifying the impact of cascade inequalities: a modelling study on the prevention impacts of antiretroviral therapy scale-up in Eswatini. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.16.24302584. [PMID: 38405846 PMCID: PMC10889039 DOI: 10.1101/2024.02.16.24302584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Inequalities in the antiretroviral therapy (ART) cascade across subpopulations remain an ongoing challenge in the global HIV response. Eswatini achieved the UNAIDS 95-95-95 targets by 2020, with differentiated programs to minimize inequalities across subpopulations, including for female sex workers (FSW) and their clients. We sought to estimate additional HIV infections expected in Eswatini if cascade scale-up had not been equal, and under which epidemic conditions these inequalities could have the largest influence. Methods Drawing on population-level and FSW-specific surveys in Eswatini, we developed a compartmental model of heterosexual HIV transmission which included eight subpopulations and four sexual partnership types. We calibrated the model to stratified HIV prevalence, incidence, and ART cascade data. Taking observed cascade scale-up in Eswatini as the base-case-reaching 95-95-95 in the overall population by 2020-we defined four counterfactual scenarios in which the population overall reached 80-80-90 by 2020, but where FSW, clients, both, or neither were disproportionately left behind, reaching only 60-40-80. We quantified relative additional cumulative HIV infections by 2030 in counterfactual vs base-case scenarios. We further estimated linear effects of viral suppression gap among FSW and clients on additional infections by 2030, plus effect modification by FSW/client population sizes, rates of turnover, and HIV prevalence ratios. Results Compared with the base-case scenario, leaving behind neither FSW nor their clients led to the fewest additional infections by 2030: median (95% credible interval) 14.9 (10.4, 18.4)% vs 26.3 (19.7, 33.0)% if both were left behind-a 73 (40, 149)% increase. The effect of lower cascade on additional infections was larger for clients vs FSW, and both effects increased with population size and relative HIV incidence. Conclusions Inequalities in the ART cascade across subpopulations can undermine the anticipated prevention impacts of cascade scale-up. As Eswatini has shown, addressing inequalities in the ART cascade, particularly those that intersect with high transmission risk, could maximize incidence reductions from cascade scale-up.
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Affiliation(s)
- Jesse Knight
- MAP Centre for Urban Health Solutions, Unity Health Toronto
- Institute of Medical Science, University of Toronto
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, Unity Health Toronto
| | | | | | - Linwei Wang
- MAP Centre for Urban Health Solutions, Unity Health Toronto
| | | | | | | | | | - Rupert Kaul
- Division of Infectious Diseases, Department of Medicine, University of Toronto
| | | | - Stefan Baral
- Bloomberg School of Public Health, Johns Hopkins University
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Unity Health Toronto
- Institute of Medical Science, University of Toronto
- Division of Infectious Diseases, Department of Medicine, University of Toronto
- Dalla Lana School of Public Health, University of Toronto
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
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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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AHONKHAI AA, BIAN A, ROBBINS NN, MAURER LA, CLOUSE K, PIERCE LJ, PERKINS JM, WERNKE SA, SHEPHERD BE, BRANTLEY M. Characterizing residential mobility among people with HIV in Tennessee and its impact on HIV care outcomes. AIDS 2024; 38:397-405. [PMID: 37916463 PMCID: PMC10872643 DOI: 10.1097/qad.0000000000003778] [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] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Our objective was to assess the prevalence and patterns of mobility among people with HIV (PWH) in Tennessee and its impact on HIV care outcomes. DESIGN Retrospective cohort study. METHODS We combined residential address and HIV surveillance data from PWH in Tennessee from 2016 to 2018. Using Poisson regression, we estimated associations between in-state mobility (change in address or total miles moved) in 1 year and outcomes in the subsequent year; retention: having two CD4 + /HIV RNA values (labs) in a calendar year at least 3 months apart, loss to follow-up (LTFU): having labs at baseline but not the subsequent year, and viral suppression: HIV RNA less than 200 copies/ml. We applied a kernel density estimator to origin-destination address lines to visualize mobility patterns across demographic subgroups. RESULTS Among 17 428 PWH [median age 45 years (interquartile range; IQR 34-53)], 6564 (38%) had at least one move. Median miles moved was 8.9 (IQR 2.6-143.4)). We observed in-state movement between major cities (Chattanooga, Knoxville, Memphis and Nashville) and out-of-state movement to and from Georgia and Florida. Having at least one in-state move was associated with a decreased likelihood of retention [adjusted relative risk (aRR) = 0.91; 95% confidence interval (CI) 0.88-0.95], and an increased risk of LTFU (aRR = 1.17; 95% CI 1.04-1.31, two to three moves vs. none). Greater distance moved in-state was associated with decreased retention and increased LTFU (aRR = 0.53; 95% CI 0.49-0.58, aRR = 2.52; 95% CI 2.25-2.83, respectively for 1000 vs. 0 miles). There was no association between mobility and viral suppression. CONCLUSION Mobility is common among PWH in Tennessee and is associated with initial poor engagement in HIV care.
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Affiliation(s)
- Aima A. AHONKHAI
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Aihua BIAN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Kate CLOUSE
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt University School of Nursing, Nashville, TN
| | - Leslie J. PIERCE
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jessica M. PERKINS
- Department of Human & Organizational Development, Peabody College, Vanderbilt University, Nashville, TN
| | - Steven A. WERNKE
- Department of Anthropology, Vanderbilt University, Nashville, TN
| | - Bryan E. SHEPHERD
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
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Nardell MF, Govathson C, Mngadi-Ncube S, Ngcobo N, Letswalo D, Lurie M, Miot J, Long L, Katz IT, Pascoe S. Migrant men and HIV care engagement in Johannesburg, South Africa. BMC Public Health 2024; 24:435. [PMID: 38347453 PMCID: PMC10860300 DOI: 10.1186/s12889-024-17833-2] [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: 09/28/2023] [Accepted: 01/20/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND South Africa (SA) has one of the highest rates of migration on the continent, largely comprised of men seeking labor opportunities in urban centers. Migrant men are at risk for challenges engaging in HIV care. However, rates of HIV and patterns of healthcare engagement among migrant men in urban Johannesburg are poorly understood. METHODS We analyzed data from 150 adult men (≥ 18 years) recruited in 10/2020-11/2020 at one of five sites in Johannesburg, Gauteng Province, SA where migrants typically gather for work, shelter, transit, or leisure: a factory, building materials store, homeless shelter, taxi rank, and public park. Participants were surveyed to assess migration factors (e.g., birth location, residency status), self-reported HIV status, and use and knowledge of HIV and general health services. Proportions were calculated with descriptive statistics. Associations between migration factors and health outcomes were examined with Fisher exact tests and logistic regression models. Internal migrants, who travel within the country, were defined as South African men born outside Gauteng Province. International migrants were defined as men born outside SA. RESULTS Two fifths (60/150, 40%) of participants were internal migrants and one fifth (33/150, 22%) were international migrants. More internal migrants reported living with HIV than non-migrants (20% vs 6%, p = 0.042), though in a multi-variate analysis controlling for age, being an internal migrant was not a significant predictor of self-reported HIV positive status. Over 90% all participants had undergone an HIV test in their lifetime. Less than 20% of all participants had heard of pre-exposure prophylaxis (PrEP), with only 12% international migrants having familiarity with PrEP. Over twice as many individuals without permanent residency or citizenship reported "never visiting a health facility," as compared to citizens/permanent residents (28.6% vs. 10.6%, p = 0.073). CONCLUSIONS Our study revealed a high proportion of migrants within our community-based sample of men and demonstrated a need for HIV and other healthcare services that effectively reach migrants in Johannesburg. Future research is warranted to further disaggregate this heterogenous population by different dimensions of mobility and to understand how to design HIV programs in ways that will address migrants' challenges.
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Affiliation(s)
- Maria Francesca Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Caroline Govathson
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithabile Mngadi-Ncube
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nkosinathi Ngcobo
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Letswalo
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Lurie
- Brown University School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jacqui Miot
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Ingrid Theresa Katz
- Harvard Medical School, Boston, MA, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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10
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Mody A, Sohn AH, Iwuji C, Tan RKJ, Venter F, Geng EH. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403:471-492. [PMID: 38043552 DOI: 10.1016/s0140-6736(23)01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 12/05/2023]
Abstract
The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability. Nonetheless, innovations in prevention and treatment have often failed to reach large segments of the global population (eg, key and marginalised populations), and these major disparities in access and uptake at multiple levels have caused progress to fall short of their potential to affect public health. Moving forward, sharper epidemiologic tools based on longitudinal, person-centred data are needed to more accurately characterise remaining gaps and guide continued progress against the HIV epidemic. We should also increase prioritisation of strategies that address socio-behavioural challenges and can lead to effective and equitable implementation of existing interventions with high levels of quality that better match individual needs. We review HIV epidemiologic trends; advances in HIV prevention, treatment, and care delivery; and discuss emerging challenges for ending the HIV epidemic over the next decade that are relevant for general practitioners and others involved in HIV care.
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Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annette H Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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11
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Nanyonjo G, Kwena Z, Nakamanya S, Okello E, Oketch B, Bahemuka UM, Ssetaala A, Okech B, Price MA, Kapiga S, Fast P, Bukusi E, Seeley J. Finding women in fishing communities around Lake Victoria: "Feasibility and acceptability of using phones and tracking devices". PLoS One 2024; 19:e0290634. [PMID: 38206982 PMCID: PMC10783786 DOI: 10.1371/journal.pone.0290634] [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: 02/18/2022] [Accepted: 08/01/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Women in fishing communities have both high HIV prevalence and incidence, hence they are a priority population for HIV prevention and treatment interventions. However, their mobility is likely to compromise the effectiveness of interventions. We assessed the acceptability, feasibility and of using phones and global positioning system (GPS) devices for tracking mobility, to inform future health research innovations. METHODS A mult-site formative qualitative study was conducted in six purposively selected Fishing Communities on the shores of Lake Victoria in Kenya, Tanzania, and Uganda. Participants were selected based on duration of stay in the community and frequency of movement. Sixty-four (64) women participated in the study (16 per fishing community). Twenty-four (24) participants were given a study phone; 24 were asked to use their own phones and 16 were provided with a portable GPS device to understand what is most preferred. Women were interviewed about their experiences and recommendations on carrying GPS devices or phones. Twenty four (24) Focus Group Discussions with 8-12 participants were conducted with community members to generate data on community perceptions regarding GPS devices and phones acceptability among women. Data were analyzed thematically and compared across sites/countries. RESULTS Women reported being willing to use tracking devices (both phones and GPS) because they are easy to carry. Their own phone was preferred compared to a study phone and GPS device because they were not required to carry an additional device, worry about losing it or be questioned about the extra device by their sexual partner. Women who carried GPS devices suggested more sensitization in communities to avoid domestic conflicts and public concern. Women suggested changing the GPS colour from white to a darker colour and, design to look like a commonly used object such as a telephone Subscriber Identity Module (SIM) card, a rosary/necklace or a ring for easy and safe storage. CONCLUSION Women in the study communities were willing to have their movements tracked, embraced the use of phones and GPS devices for mobility tracking. Devices need to be redesigned to be more discrete, but they could be valuable tools to understanding movement patterns and inform design of interventions for these mobile populations.
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Affiliation(s)
| | - Zachary Kwena
- Research Care and Training Program (RCTP), Kenya Medical Research Institute, Kisumu, Kenya
| | - Sarah Nakamanya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Elialilia Okello
- National Institute for Medical Research, Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
| | - Bertha Oketch
- Research Care and Training Program (RCTP), Kenya Medical Research Institute, Kisumu, Kenya
| | - Ubaldo M. Bahemuka
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Ali Ssetaala
- UVRI-IAVI HIV Vaccine Program Limited, Entebbe, Uganda
| | - Brenda Okech
- UVRI-IAVI HIV Vaccine Program Limited, Entebbe, Uganda
| | - Matt A. Price
- IAVI, New York, NY, United States of America
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, United States of America
| | - Saidi Kapiga
- National Institute for Medical Research, Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pat Fast
- IAVI, New York, NY, United States of America
| | - Elizabeth Bukusi
- Research Care and Training Program (RCTP), Kenya Medical Research Institute, Kisumu, Kenya
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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12
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Esra R, Mmelesi M, Ketlogetswe AT, Wolock TM, Howes A, Nong T, Matlhaga MT, Ratladi S, Ramaabya D, Imai-Eaton JW. Improved Indicators for Subnational Unmet Antiretroviral Therapy Need in the Health System: Updates to the Naomi Model in 2023. J Acquir Immune Defic Syndr 2024; 95:e24-e33. [PMID: 38180736 PMCID: PMC10769176 DOI: 10.1097/qai.0000000000003324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Quantifying subnational need for antiretroviral therapy (ART) for HIV is challenging because people living with HIV (PLHIV) access health facilities in areas that may differ from their residence. We defined and demonstrated new indicators for PLHIV treatment needed to guide health system target setting and resource allocation. SETTING Botswana. METHODS We extended Naomi, a Bayesian small-area model for estimating district-level HIV indicators from national household survey and HIV service delivery data. We used model outputs for ART seeking probabilities in neighboring districts to define the "PLHIV (attending)" indicator representing the estimated number of PLHIV who would seek treatment at health facilities in a district, and "Untreated PLHIV attending" representing gaps in ART service provision. Botswana 2021 district HIV estimates were used to demonstrate new outputs and assess the sensitivity to uncertainty in district population sizes. RESULTS Across districts of Botswana, estimated adult ART coverage in December 2021 ranged 90%-96%. In the capital city Gaborone, there were 50,400 resident PLHIV and 64,200 receiving ART, of whom 24% (95% CI: 20 to 32) were estimated to reside in neighboring districts. Applying ART attendance probabilities gave a "PLHIV attending" denominator of 68,300 and unmet treatment need of 4100 adults (95% CI: 3000 to 5500) for Gaborone health facilities. The facility-based "PLHIV attending" denominator was less-sensitive to fluctuations in district population size assumptions. CONCLUSIONS New indicators provided more consistent targets for HIV service provision, but are limited by ART data quality. This challenge will increase as treatment coverage reaches high levels and treatment gaps are smaller.
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Affiliation(s)
- Rachel Esra
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | - Timothy M. Wolock
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Adam Howes
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Tlotlo Nong
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | | | - Siphiwe Ratladi
- National AIDS and Health Promotion Agency, Gaborone, Botswana; and
| | - Dinah Ramaabya
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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13
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Hassani M, De Haro C, Flores L, Emish M, Kim S, Kelani Z, Ugarte DA, Hightow-Weidman L, Castel A, Li X, Theall KP, Young S. Exploring mobility data for enhancing HIV care engagement in Black/African American and Hispanic/Latinx individuals: a longitudinal observational study protocol. BMJ Open 2023; 13:e079900. [PMID: 38101845 PMCID: PMC10729277 DOI: 10.1136/bmjopen-2023-079900] [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: 09/14/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Increasing engagement in HIV care among people living with HIV, especially those from Black/African American and Hispanic/Latinx communities, is an urgent need. Mobility data that measure individuals' movements over time in combination with sociostructural data (eg, crime, census) can potentially identify barriers and facilitators to HIV care engagement and can enhance public health surveillance and inform interventions. METHODS AND ANALYSIS The proposed work is a longitudinal observational cohort study aiming to enrol 400 Black/African American and Hispanic/Latinx individuals living with HIV in areas of the USA with high prevalence rates of HIV. Each participant will be asked to share at least 14 consecutive days of mobility data per month through the study app for 1 year and complete surveys at five time points (baseline, 3, 6, 9 and 12 months). The study app will collect Global Positioning System (GPS) data. These GPS data will be merged with other data sets containing information related to HIV care facilities, other healthcare, business and service locations, and sociostructural data. Machine learning and deep learning models will be used for data analysis to identify contextual predictors of HIV care engagement. The study includes interviews with stakeholders to evaluate the implementation and ethical concerns of using mobility data to increase engagement in HIV care. We seek to study the relationship between mobility patterns and HIV care engagement. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Institutional Review Board of the University of California, Irvine (#20205923). Collected data will be deidentified and securely stored. Dissemination of findings will be done through presentations, posters and research papers while collaborating with other research teams.
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Affiliation(s)
- Maryam Hassani
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
| | - Cristina De Haro
- University of California Irvine, Paul Merage School of Business, Irvine, California, USA
| | - Lidia Flores
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
| | - Mohamed Emish
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
| | - Seungjun Kim
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
| | - Zeyad Kelani
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
| | - Dominic Arjuna Ugarte
- Department of Emergency Medicine, University of California Irvine, Orange, California, USA
| | | | - Amanda Castel
- Department of Epidemiology, The George Washington University, Washington, District of Columbia, USA
- The George Washington University, Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Xiaoming Li
- University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Sean Young
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
- Department of Emergency Medicine, University of California Irvine, Orange, California, USA
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14
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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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15
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Odayar J, Phillips TK, Kabanda S, Malaba TR, Mukonda E, Hsiao NY, Lesosky M, Myer L. Mobility during the post-partum period and viraemia in women living with HIV in South Africa. Int Health 2023; 15:692-701. [PMID: 36715066 PMCID: PMC10629960 DOI: 10.1093/inthealth/ihad001] [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: 07/28/2022] [Revised: 12/15/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We investigated the association between travel and viraemia in post-partum women with human immunodeficiency virus on antiretroviral therapy (ART). METHODS Data are from a trial of post-partum ART delivery strategies. Women who initiated ART during pregnancy, were clinically stable with a viral load (VL) <400 copies/ml and were <10 weeks post-partum were enrolled at a primary care antenatal clinic in Cape Town, South Africa. Study visits at 3, 6, 12, 18 and 24 months post-partum included questions about travel, defined as ≥1 night spent outside of the city, and VL testing. Generalised mixed effects models assessed the association between travel and subsequent VL ≥400 copies/ml. RESULTS Among 402 women (mean age 29 y, 35% born in the Western Cape), 69% reported one or more travel events over 24 months. Being born beyond the Western Cape (adjusted odds ratio [aOR] 2.03 [95% confidence interval {CI} 1.49 to 2.77]), duration post-partum in months (aOR 1.03 [95% CI 1.02 to 1.05]) and living with the child (aOR 0.60 [95% CI 0.38 to 0.93]) were associated with travel. In multivariable analyses, a travel event was associated with a 92% increase in the odds of a VL ≥400 copies/ml (aOR 1.92 [95% CI 1.19 to 3.10]). CONCLUSIONS Interventions to support women on ART who travel are urgently required.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Siti Kabanda
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Thokozile R Malaba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Elton Mukonda
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nei-yuan Hsiao
- Division of Medical Virology, National Health Laboratory Service, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
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16
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Robsky KO, Tram KH, Dowdy DW, Zelner J. Methods for measuring short-term geographical mobility used in infectious disease research: a scoping review protocol. BMJ Open 2023; 13:e072439. [PMID: 37793932 PMCID: PMC10551932 DOI: 10.1136/bmjopen-2023-072439] [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: 02/03/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Geographical mobility, the movement of individuals or populations, may increase an individual's risk of acquiring or transmitting infectious diseases, including HIV, tuberculosis, malaria and COVID-19. Many studies have collected information on short-term mobility through self-reported travel histories or using GPS trackers, but there has been no consistent conceptualisation and operationalisation of such geographical mobility in global health research. This protocol aims to describe and synthesise different approaches to measuring short-term mobility. METHODS AND ANALYSIS We will search three databases (PubMed, Embase and Global Health) for peer-reviewed articles. After removing duplicates, two reviewers will first screen the titles and abstracts and then proceed to full-text screening. We will include studies that measure mobility at the individual level in the context of infectious diseases, including clinical trials, epidemiological studies and analyses of register data. Additional articles for inclusion may be identified through review of references in selected papers. We will summarise the method of data collection (GPS trackers, cellphones, retrospective self-report, travel journal, etc) and the specific measures used (overnight travel, having a secondary residence, travel outside of district, etc). ETHICS AND DISSEMINATION This study consists of reviewing and abstracting existing data from publicly available materials, and therefore does not require ethical approval. The results of this study will be submitted for peer reviewed publication and may be presented at a relevant global health conference.
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Affiliation(s)
- Katherine O Robsky
- Center for Global Health Practice and Impact, Georgetown University, Washington, District of Columbia, USA
| | - Khai Hoan Tram
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jon Zelner
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
- Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, Michigan, USA
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Hendrickson ZM, Tomko C, Galai N, Sisson LN, Glick JL, Sherman SG. A Longitudinal Analysis of Residential Mobility and Experience of Client Violence Among Women Who Exchange Sex in Baltimore. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11017-11045. [PMID: 37395208 DOI: 10.1177/08862605231178492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Residential mobility remains an underexplored yet critical construct that may influence the risk of violence among women who exchange sex. This study examined the longitudinal relationship between residential mobility and experience of client-perpetrated physical or sexual violence among women who exchange sex in Baltimore, Maryland. Participants were at least at 18 years of age, were cisgender women, reported having engaged in transactional sex three or more times within the last 3 months, and were willing to be contacted for 6-, 12-, and 18-month follow-up visits. Analyses of responses from 370 women who exchange sex participating in at least one study visit were conducted. Unadjusted and adjusted Poisson regression models of the association over time between residential mobility and recent experience of physical or sexual violence were fit. Generalized estimating equations with an exchangeable correlation structure and robust variance estimation were used to account for clustering of participants' responses over time. Findings demonstrated that those who had lived in at least four places in the past 6 months had a 39% increased risk of client-perpetrated physical violence (aRR: 1.39; 95% CI: 1.07-1.80; p < .05) and a 63% increased risk of sexual violence (aRR: 1.63; 95% CI: 1.14-2.32; p < .01) compared to their less-mobile counterparts. These findings provide necessary evidence of correlations over time between residential mobility and experience of client-perpetrated violence among women who exchange sex. Strengthening our understanding of how residential mobility intersects with violence is critical for the development of public health interventions that are relevant to women's lives and needs. Future interventions should explore including residential mobility, a critical pillar of housing instability, with efforts to address client-perpetrated violence.
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Affiliation(s)
| | - Catherine Tomko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of Haifa, Mt Carmel, Haifa, Israel
| | | | - Jennifer L Glick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Song J, Okano JT, Ponce J, Busang L, Seipone K, Valdano E, Blower S. The role of migration networks in the development of Botswana's generalized HIV epidemic. eLife 2023; 12:e85435. [PMID: 37665629 PMCID: PMC10476964 DOI: 10.7554/elife.85435] [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: 12/08/2022] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
The majority of people with HIV live in sub-Saharan Africa, where epidemics are generalized. For these epidemics to develop, populations need to be mobile. However, the role of population-level mobility in the development of generalized HIV epidemics has not been studied. Here we do so by studying historical migration data from Botswana, which has one of the most severe generalized HIV epidemics worldwide; HIV prevalence was 21% in 2021. The country reported its first AIDS case in 1985 when it began to rapidly urbanize. We hypothesize that, during the development of Botswana's epidemic, the population was extremely mobile and the country was highly connected by substantial migratory flows. We test this mobility hypothesis by conducting a network analysis using a historical time series (1981-2011) of micro-census data from Botswana. Our results support our hypothesis. We found complex migration networks with very high rates of rural-to-urban, and urban-to-rural, migration: 10% of the population moved annually. Mining towns (where AIDS cases were first reported, and risk behavior was high) were important in-flow and out-flow migration hubs, suggesting that they functioned as 'core groups' for HIV transmission and dissemination. Migration networks could have dispersed HIV throughout Botswana and generated the current hyperendemic epidemic.
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Affiliation(s)
- Janet Song
- Center for Biomedical Modeling, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los AngelesLos AngelesUnited States
| | - Justin T Okano
- Center for Biomedical Modeling, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los AngelesLos AngelesUnited States
| | - Joan Ponce
- Center for Biomedical Modeling, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los AngelesLos AngelesUnited States
| | - Lesego Busang
- The African Comprehensive HIV/AIDS Partnerships (ACHAP)GaboroneBotswana
| | - Khumo Seipone
- The African Comprehensive HIV/AIDS Partnerships (ACHAP)GaboroneBotswana
| | - Eugenio Valdano
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé PubliqueParisFrance
| | - Sally Blower
- Center for Biomedical Modeling, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los AngelesLos AngelesUnited States
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Namusisi P, Yeh PT, Ssekubugu R, Chang LW, Lutalo T, Zimmerman LA, Grabowski MK. The intersection between migration, HIV, and family planning in Uganda: a cross-sectional population-based study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.05.23293691. [PMID: 37609347 PMCID: PMC10441507 DOI: 10.1101/2023.08.05.23293691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Low use of modern methods of contraception has been linked to HIV seropositivity and to migration, but few studies have evaluated the intersection of both risk factors with contraceptive use. Methods We analyzed cross-sectional data from sexually active female participants aged 15 to 49 years in the Rakai Community Cohort Study (RCCS) between 2011 and 2013. The RCCS is an open population-based census and individual survey in south-central Uganda. Recent in-migrants (arrival within approximately 1.5 years) into RCCS communities were identified at time of household census. The primary outcome was unsatisfied demand for a modern contraceptive method (injectable, oral pill, implant, or condom), which was defined as non-use of a modern contraceptive method among female participants who did not want to become pregnant in the next 12 months. Poisson regression models with robust variance estimators were used to identify associations and interactions between recent migration and HIV serostatus on unsatisfied contraceptive demand. Results There were 3,417 sexually active participants with no intention of becoming pregnant in the next year. The mean age was 30 (±8) years, and 17.3% (n=591) were living with HIV. Overall, 43.9% (n=1,500) were not using any modern contraceptive method. Recent in-migrants were somewhat more likely to have unsatisfied contraceptive demand as compared to long-term residents (adjusted prevalence risk ratio [adjPRR]=1.14; 95% confidence interval [95%CI]: 1.02-1.27), whereas participants living with HIV were less likely to have unsatisfied contraceptive demand relative to HIV-seronegative participants (adjPRR=0.80; 95%CI=0.70-0.90). When stratifying on migration and HIV serostatus, we observed the highest levels of unsatisfied contraceptive demand among in-migrants living with HIV (48.7%); however, in regression analyses, interaction terms between migration and HIV serostatus were not statistically significant. Conclusions Unsatisfied contraceptive demand was high in this rural Ugandan setting. Being an in-migrant, particularly among those living with HIV, was associated with higher unsatisfied contraceptive demand.
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Kiyingi J, Witte SS, Nabunya P, Nsubuga E, Bahar OS, Mayo-Wilson LJ, Kizito S, Nattabi J, Nabayinda J, Ssewamala FM. Predictors of mobility among women engaged in commercial sex work in Uganda using generalized estimating equations model. Int J STD AIDS 2023; 34:633-640. [PMID: 37018458 PMCID: PMC10523898 DOI: 10.1177/09564624231167910] [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] [Indexed: 04/07/2023]
Abstract
BACKGROUND Women engaged in commercial sex work (WESW) are at a higher risk of acquiring and transmitting HIV. WESW are highly mobile, and their mobility may increase their economic status, and increased access to healthcare and other social services. However, it may also facilitate the spread of HIV infection from higher to lower prevalence regions. This study examined the predictors of mobility among WESW in Uganda using a generalized estimating equations model. METHODS We defined and measured mobility as the change in residence by WESW between baseline, 6 months, and 12 months follow-up. Participants who changed places were considered mobile, and those who never changed were non-mobile. We used data from a longitudinal study, which recruited 542 WESW from Southern Uganda aged 18-55 years and constructed a Generalized Estimating Equations Model. RESULTS Findings show that 19.6% of WESW changed residence between baseline and 6 months of follow-up and 26.2% (cumulative) between baseline and 12 months of follow-up. Older women (OR = 0.966, 95% CI = 0.935, 0.997) were associated with decreased odds of mobility, whereas WESW who were HIV positive (OR = 1.475, 95% CI = 1.078, 2.018) and those from large households (OR = 1.066, 95% CI = 1.001, 1.134) were associated with increased odds of mobility. WESW residing in rural areas (OR = 0.535, 95% CI = 0.351, 0.817) were associated with decreased odds of mobility compared to those from fishing sites. CONCLUSION The results indicate risk factors for mobility, further research is needed to determine the directionality of these factors in order to design interventions addressing mobility among WESW.
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Affiliation(s)
- Joshua Kiyingi
- Washington University in St Louis Brown School, International Center for Child Health and Development (ICHAD), St Louis, MO, USA
| | - Susan S Witte
- Columbia University, School of Social Work, New York, NY, USA
| | - Proscovia Nabunya
- Washington University in St Louis Brown School, International Center for Child Health and Development (ICHAD), St Louis, MO, USA
| | - Edward Nsubuga
- Washington University in St Louis Brown School, International Center for Child Health and Development (ICHAD), St Louis, MO, USA
| | - Ozge Sensoy Bahar
- Washington University in St Louis Brown School, International Center for Child Health and Development (ICHAD), St Louis, MO, USA
| | | | - Samuel Kizito
- Washington University in St Louis Brown School, International Center for Child Health and Development (ICHAD), St Louis, MO, USA
| | - Jennifer Nattabi
- Washington University in St Louis Brown School, International Center for Child Health and Development (ICHAD), St Louis, MO, USA
| | - Josephine Nabayinda
- Washington University in St Louis Brown School, International Center for Child Health and Development (ICHAD), St Louis, MO, USA
| | - Fred M Ssewamala
- Washington University in St Louis Brown School, International Center for Child Health and Development (ICHAD), St Louis, MO, USA
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Khalifa A, Ssekubugu R, Lessler J, Wawer M, Santelli JS, Hoffman S, Nalugoda F, Lutalo T, Ndyanabo A, Ssekasanvu J, Kigozi G, Kagaayi J, Chang LW, Grabowski MK. Implications of rapid population growth on survey design and HIV estimates in the Rakai Community Cohort Study (RCCS), Uganda. BMJ Open 2023; 13:e071108. [PMID: 37495389 PMCID: PMC10373715 DOI: 10.1136/bmjopen-2022-071108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Since rapid population growth challenges longitudinal population-based HIV cohorts in Africa to maintain coverage of their target populations, this study evaluated whether the exclusion of some residents due to growing population size biases key HIV metrics like prevalence and population-level viremia. DESIGN, SETTING AND PARTICIPANTS Data were obtained from the Rakai Community Cohort Study (RCCS) in south central Uganda, an open population-based cohort which began excluding some residents of newly constructed household structures within its surveillance boundaries in 2008. The study includes adults aged 15-49 years who were censused from 2019 to 2020. MEASURES We fit ensemble machine learning models to RCCS census and survey data to predict HIV seroprevalence and viremia (prevalence of those with viral load >1000 copies/mL) in the excluded population and evaluated whether their inclusion would change overall estimates. RESULTS Of the 24 729 census-eligible residents, 2920 (12%) residents were excluded from the RCCS because they were living in new households. The predicted seroprevalence for these excluded residents was 10.8% (95% CI: 9.6% to 11.8%)-somewhat lower than 11.7% (95% CI: 11.2% to 12.3%) in the observed sample. Predicted seroprevalence for younger excluded residents aged 15-24 years was 4.9% (95% CI: 3.6% to 6.1%)-significantly higher than that in the observed sample for the same age group (2.6% (95% CI: 2.2% to 3.1%)), while predicted seroprevalence for older excluded residents aged 25-49 years was 15.0% (95% CI: 13.3% to 16.4%)-significantly lower than their counterparts in the observed sample (17.2% (95% CI: 16.4% to 18.1%)). Over all ages, the predicted prevalence of viremia in excluded residents (3.7% (95% CI: 3.0% to 4.5%)) was significantly higher than that in the observed sample (1.7% (95% CI: 1.5% to 1.9%)), resulting in a higher overall population-level viremia estimate of 2.1% (95% CI: 1.8% to 2.4%). CONCLUSIONS Exclusion of residents in new households may modestly bias HIV viremia estimates and some age-specific seroprevalence estimates in the RCCS. Overall, HIV seroprevalence estimates were not significantly affected.
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Affiliation(s)
- Aleya Khalifa
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
- ICAP, Columbia University, New York, New York, USA
| | - Robert Ssekubugu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Global and Sexual Health, Karolinska Institutet, Stockholm, Sweden
| | - Justin Lessler
- Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Maria Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John S Santelli
- Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Susie Hoffman
- Department of Epidemiology, Columbia University, New York, New York, USA
- HIV Centre for Clinical and Behavioural Studies, Columbia University Irving Medical Centre, New York, New York, USA
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Kathryn Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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22
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Gutin SA, Neilands TB, Charlebois ED, Getahun M, Okiring J, Akullian A, Maeri I, Eyul P, Ssali S, Cohen CR, Kamya MR, Bukusi EA, Camlin CS. Mobility is Associated with Higher-risk Sexual Partnerships Among Both Men and Women in Co-resident Couples in Rural Kenya and Uganda: A Longitudinal Cohort Study. AIDS Behav 2023; 27:1418-1429. [PMID: 36318427 PMCID: PMC10129962 DOI: 10.1007/s10461-022-03878-0] [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] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
Population mobility is associated with higher-risk sexual behaviors in sub-Saharan Africa and is a key driver of the HIV epidemic. We conducted a longitudinal cohort study to estimate associations between recent mobility (overnight travel away from home in past six months) or migration (changes of residence over defined geopolitical boundaries) and higher-risk sexual behavior among co-resident couples (240 couples aged ≥ 16) from 12 rural communities in Kenya and Uganda. Data on concurrent mobility and sexual risk behaviors were collected every 6-months between 2015 and 2020. We used sex-pooled and sex-stratified multilevel models to estimate associations between couple mobility configurations (neither partner mobile, male mobile/female not mobile, female mobile/male not mobile, both mobile) and the odds of higher-risk (casual, commercial sex worker/client, one night stand, inherited partner, stranger) and concurrent sexual partnerships based on who was mobile. On average across all time points and subjects, mobile women were more likely than non-mobile women to have a higher-risk partner; similarly, mobile men were more likely than non-mobile men to report a higher-risk partnership. Men with work-related mobility versus not had higher odds of higher-risk partnerships. Women with work-related mobility versus not had higher odds of higher-risk partnerships. Couples where both members were mobile versus neither had greater odds of higher-risk partnerships. In analyses using 6-month lagged versions of key predictors, migration events of men, but not women, preceded higher-risk partnerships. Findings demonstrate HIV risks for men and women associated with mobility and the need for prevention approaches attentive to the risk-enhancing contexts of mobility.
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Affiliation(s)
- Sarah A Gutin
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco (UCSF), 550 16th Street, 3rd Floor, 94143, San Francisco, CA, USA.
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco (UCSF), 550 16th Street, 3rd Floor, 94143, San Francisco, CA, USA
| | - Edwin D Charlebois
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco (UCSF), 550 16th Street, 3rd Floor, 94143, San Francisco, CA, USA
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), Oakland, CA, USA
| | - Jaffer Okiring
- The Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Adam Akullian
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Irene Maeri
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patrick Eyul
- The Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Sarah Ssali
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), Oakland, CA, USA
| | - Moses R Kamya
- The Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Carol S Camlin
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco (UCSF), 550 16th Street, 3rd Floor, 94143, San Francisco, CA, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (UCSF), Oakland, CA, USA
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23
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Bahemuka UM, Okimat P, Webb EL, Seeley J, Ssetaala A, Okech B, Oketch B, Kibengo FM, Okello E, Kwena Z, Kuteesa MO, Price MA, Kaleebu P, Grosskurth H, Fast P. Factors Associated with Short and Long Term Mobility and HIV Risk of Women Living in Fishing Communities Around Lake Victoria in Kenya, Tanzania, and Uganda: A Cross Sectional Survey. AIDS Behav 2023; 27:880-890. [PMID: 36088399 PMCID: PMC9944640 DOI: 10.1007/s10461-022-03824-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 11/01/2022]
Abstract
Mobility is linked to negative HIV care continuum outcomes. We sought to understand factors associated with short and long term mobility among women in fishing communities in Kenya, Tanzania, and Uganda. From 2018 through 2019 we conducted a cross-sectional survey of women aged 15 years and above, randomly selected from a census of six fishing villages, around Lake Victoria. Data collected included: demographics, risky sexual behaviour on the most recent trip, and travel behaviour in the previous 4 months. Mobility was recorded as any overnight trip outside the participant's village. A two-level multinomial logistic regression model was used to determine the associated factors. A total of 901 participants were enrolled, of whom 645 (71.6%) reported travelling (53.4%; short and 18.2% long term trips). Five factors were associated with long term travel: age, travel purpose, frequency of travel, sexual behaviour while travelling, and destination. Trips made by women aged 46-75 years were less likely to be long term. Long term trips were more common if the trip was to visit, rather than to trade, and more common for women who reported one or two trips rather than three or more trips. Women who made long term trips were more likely to engage in unprotected sex while on a trip. Women who travelled to a regional town/district or another town/district were more likely to take long term trips. The factors associated with travel duration among women living in fishing communities could inform planning of future health care interventions in these communities.
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Affiliation(s)
- Ubaldo M. Bahemuka
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute Uganda Research Unit & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Paul Okimat
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute Uganda Research Unit & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Emily L. Webb
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute Uganda Research Unit & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Ali Ssetaala
- grid.415861.f0000 0004 1790 6116UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
| | - Brenda Okech
- grid.415861.f0000 0004 1790 6116UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
| | - Bertha Oketch
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, KEMRI, Kisumu, Kenya
| | - Freddie M. Kibengo
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute Uganda Research Unit & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Elialilia Okello
- grid.452630.60000 0004 8021 6070Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Zachary Kwena
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, KEMRI, Kisumu, Kenya
| | - Monica O. Kuteesa
- grid.420368.b0000 0000 9939 9066International AIDS Vaccine Initiative, New York, USA
| | - Matt A. Price
- grid.420368.b0000 0000 9939 9066International AIDS Vaccine Initiative, New York, USA
- grid.266102.10000 0001 2297 6811University of California, San Francisco, San Francisco, USA
| | - Pontiano Kaleebu
- grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute Uganda Research Unit & London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Heiner Grosskurth
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
- grid.452630.60000 0004 8021 6070Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Pat Fast
- grid.420368.b0000 0000 9939 9066International AIDS Vaccine Initiative, New York, USA
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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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Thorp M, Bellos M, Temelkovska T, Mphande M, Cornell M, Hubbard J, Choko A, Coates TJ, Hoffman R, Dovel K. Mobility and ART retention among men in Malawi: a mixed-methods study. J Int AIDS Soc 2023; 26:e26066. [PMID: 36943753 PMCID: PMC10029992 DOI: 10.1002/jia2.26066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/30/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Mobility is associated with worse outcomes across the HIV treatment cascade, especially among men. However, little is known about the mechanisms that link mobility and poor HIV outcomes and what types of mobility most increase the risk of treatment interruption among men in southern Africa. METHODS From August 2021 to January 2022, we conducted a mixed-methods study with men living with HIV (MLHIV) but not currently receiving antiretroviral therapy (ART) in Malawi. Data collection was embedded within two larger trials (ENGAGE and IDEaL trials). We analysed baseline survey data of 223 men enrolled in the trials who reported being mobile (defined as spending ≥14 nights away from home in the past 12 months) using descriptive statistics and negative binomial regressions. We then recruited 32 men for in-depth interviews regarding their travel experiences and ART utilization. We analysed qualitative data using constant comparative methods. RESULTS Survey data showed that 34% of men with treatment interruptions were mobile, with a median of 60 nights away from home in the past 12 months; 69% of trips were for income generation. More nights away from home in the past 12 months and having fewer household assets were associated with longer periods out of care. In interviews, men reported that travel was often unplanned, and men were highly vulnerable to exploitive employer demands, which led to missed appointments and ART interruption. Men made major efforts to stay in care but were often unable to access care on short notice, were denied ART refills at non-home facilities and/or were treated poorly by providers, creating substantial barriers to remaining in and returning to care. Men desired additional multi-month dispensing (MMD), the ability to refill treatment at any facility in Malawi, and streamlined pre-travel refills at home facilities. CONCLUSIONS Men prioritize ART and struggle with the trade-offs between their own health and providing for their families. Mobility is an essential livelihood strategy for MLHIV in Malawi, but it creates conflict with ART retention, largely due to inflexible health systems. Targeted counselling and peer support, access to ART services anywhere in the country, and MMD may improve outcomes for mobile men.
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Affiliation(s)
- Marguerite Thorp
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Tijana Temelkovska
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julie Hubbard
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Partners in Hope, Lilongwe, Malawi
| | | | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Risa Hoffman
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kathryn Dovel
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Partners in Hope, Lilongwe, Malawi
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Song J, Okano JT, Ponce J, Busang L, Seipone K, Valdano E, Blower S. Population mobility and the development of Botswana's generalized HIV epidemic: a network analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.01.23285339. [PMID: 36778345 PMCID: PMC9915826 DOI: 10.1101/2023.02.01.23285339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The majority of people with HIV live in sub-Saharan Africa, where HIV epidemics are generalized. For these epidemics to develop, populations need to be mobile. However, population-level mobility has not yet been studied in the context of the development of generalized HIV epidemics. Here we do so by studying historical migration data from Botswana which has one of the most severe generalized HIV epidemics worldwide; in 2021, HIV prevalence was 21%. The country reported its first AIDS case in 1985 when it began to rapidly urbanize. We hypothesize that, during the development of Botswana's epidemic, the population was highly mobile and there were substantial urban-to-rural and rural-to-urban migratory flows. We test this hypothesis by conducting a network analysis using a historical time series (1981 to 2011) of micro-census data from Botswana. We found 10% of the population moved their residency annually, complex migration networks connected urban with rural areas, and there were very high rates of rural-to-urban migration. Notably, we also found mining towns were both important in-flow and out-flow migration hubs; consequently, there was a very high turnover of residents in towns. Our results support our hypothesis, and together, provide one explanation for the development of Botswana's generalized epidemic.
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Affiliation(s)
- Janet Song
- Center for Biomedical Modeling, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
| | - Justin T. Okano
- Center for Biomedical Modeling, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
| | - Joan Ponce
- Center for Biomedical Modeling, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
| | - Lesego Busang
- The African Comprehensive HIV/AIDS Partnerships (ACHAP), Gaborone, Botswana
| | - Khumo Seipone
- The African Comprehensive HIV/AIDS Partnerships (ACHAP), Gaborone, Botswana
| | - Eugenio Valdano
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, F75012, Paris, France
| | - Sally Blower
- Center for Biomedical Modeling, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
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27
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Nakamanya S, Okello ES, Kwena ZA, Nanyonjo G, Bahemuka UM, Kibengo FM, Ssetaala A, Bukusi EA, Kapiga S, Fast PE, Seeley J. Social networks, mobility, and HIV risk among women in the fishing communities of Lake Victoria. BMC Womens Health 2022; 22:555. [PMID: 36578062 PMCID: PMC9798550 DOI: 10.1186/s12905-022-02144-8] [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: 06/08/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Population mobility is a demonstrated barrier to reducing HIV incidence. A clear understanding of social networks and their influence on mobility among women in the fishing communities of Lake Victoria may contribute to tailoring effective interventions that suit the needs of these mobile women. METHODS A cross-sectional qualitative methods study was conducted to understand mobility patterns among women resident and or working in fishing communities of Lake Victoria in Kenya, Tanzania, and Uganda. The study was conducted in six fishing communities from March 2018 to June 2019. The communities were purposively selected, based on population size (1000 people or more) and HIV prevalence of > 15% among women aged 18 years or older who had lived in the fishing community for at least six months. In-depth interviews were conducted with 24 key informants and 72 women from the sites in the three countries. Questions focused on women's social networks and other factors that fuelled or facilitated women's mobility as well as challenges they faced due to mobility. Data analysis followed a thematic framework approach. RESULTS Different social groupings/networks existed among women in the fishing communities of Lake Victoria. These included female sex workers, women fish processors/traders, women bar workers/owners, restaurant workers, and family networks. Networks encouraged mobility, supporting finding work opportunities, but also increased sexual risks through partner changes. The benefits of networks included information sharing, financial support, and group protection, especially against violence. CONCLUSION Social networks and groupings among women in the fishing communities of Lake Victoria could be useful in tailoring HIV prevention and HIV care interventions to suit the needs of these highly mobile populations.
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Affiliation(s)
- Sarah Nakamanya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM), Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.
| | - Elialilia S Okello
- Mwanza Intervention Trials Unit (MITU), National Institute for Medical Research, Mwanza, Tanzania
| | - Zachary A Kwena
- Research Care and Training Program (RCTP), Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Ubaldo M Bahemuka
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM), Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Freddie M Kibengo
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM), Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | | | - Elizabeth A Bukusi
- Research Care and Training Program (RCTP), Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit (MITU), National Institute for Medical Research, Mwanza, Tanzania
| | - Patricia E Fast
- International AIDS Vaccine Initiative (IAVI), New York, USA
- Pediatric Infectious Diseases, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM), Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Clouse K, Noholoza S, Ngcobo N, Madwayi S, Mrubata M, Camlin CS, Myer L, Phillips TK. Cohort profile: CareConekta: a pilot study of a smartphone application to improve engagement in postpartum HIV care in South Africa. BMJ Open 2022; 12:e064946. [PMID: 36414286 PMCID: PMC9685000 DOI: 10.1136/bmjopen-2022-064946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Pregnant and postpartum women living with HIV in South Africa are at high risk of dropping out of care, particularly after delivery. Population mobility may contribute to disruptions in HIV care, and postpartum women are known to be especially mobile. To improve engagement in HIV care during the peripartum period, we developed CareConekta, a smartphone application (app) that uses GPS coordinates to characterise mobility and allow for real-time intervention. We conducted a randomised controlled pilot study to assess feasibility, acceptability and initial efficacy of the app intervention to improve engagement in HIV care. This cohort profile describes participant enrolment and follow-up, describes the data collected and provides participant characteristics. PARTICIPANTS We enrolled 200 pregnant women living with HIV attending routine antenatal care at the Gugulethu Midwife Obstetric Unit in Cape Town, South Africa. Eligible women must have owned smartphones that met the app's technical requirements. Seven participants were withdrawn near enrolment, leaving 193 in the cohort. FINDINGS TO DATE Data were collected from detailed participant questionnaires at enrolment and follow-up (6 months after delivery), as well as GPS data from the app, and medical records. Follow-up is complete; initial analyses have explored smartphone ownership, preferences and patterns of use among women screened for eligibility and those enrolled in the study. FUTURE PLANS Additional planned analyses will characterise mobility in the population using the phone GPS data and participant self-reported data. We will assess the impact of mobility on engagement in care for the mother and infant. We also will describe the acceptability and feasibility of the study, including operational lessons learnt. By linking this cohort to the National Health Laboratory Service National HIV Cohort in South Africa, we will continue to assess engagement in care and mobility outcomes for years to come. Collaborations are welcome. TRIAL REGISTRATION NUMBER NCT03836625.
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Affiliation(s)
- Kate Clouse
- Vanderbilt University School of Nursing, Nashville, TN, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sandisiwe Noholoza
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nkosinathi Ngcobo
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sindiswa Madwayi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Megan Mrubata
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
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Sanchez T, Mavragani A, Materu J, Drake M, Majani E, Casalini C, Mjungu D, Mbita G, Kalage E, Komba A, Nyato D, Nnko S, Shao A, Changalucha J, Wambura M. Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial. JMIR Public Health Surveill 2022; 8:e30372. [PMID: 36121686 PMCID: PMC9531008 DOI: 10.2196/30372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/19/2022] [Accepted: 08/02/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk. OBJECTIVE This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior. METHODS A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit. RESULTS Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders. CONCLUSIONS Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer. TRIAL REGISTRATION ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243.
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Affiliation(s)
| | | | - Jacqueline Materu
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Mary Drake
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Esther Majani
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Caterina Casalini
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Deusdedit Mjungu
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Gaspar Mbita
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Esther Kalage
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Albert Komba
- Sauti Project, Jhpiego (an affiliate of John Hopkins University), Dar-es-Salaam, United Republic of Tanzania
| | - Daniel Nyato
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Soori Nnko
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Amani Shao
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - John Changalucha
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Mwita Wambura
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, United Republic of Tanzania
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Khalifa A, Findley S, Gummerson E, Mantell JE, Hakim AJ, Philip NM, Ginindza C, Hassani AS, Hong SY, Jalloh MF, Kirungi WL, Maile L, Mgomella GS, Miller LA, Minchella P, Mutenda N, Njau P, Schwitters A, Ward J, Low A. Associations Between Mobility, Food Insecurity, and Transactional Sex Among Women in Cohabitating Partnerships: An Analysis From 6 African Countries 2016-2017. J Acquir Immune Defic Syndr 2022; 90:388-398. [PMID: 35389376 PMCID: PMC9909688 DOI: 10.1097/qai.0000000000002995] [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: 12/14/2021] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mobile women are at risk of HIV infection in sub-Saharan Africa, although we lack evidence for HIV risk among women in mobile partnerships, especially in the context of household food insecurity, a growing concern in the region. SETTING Women aged 15-59 years with a cohabitating male partner who participated in population-based HIV impact assessment surveys in Eswatini, Lesotho, Namibia, Tanzania, Uganda, and Zambia. METHODS We evaluated the association between women's and their partner's mobility (being away from home for more than 1 month or staying elsewhere) and transactional sex (selling sex or receiving money or goods in exchange for sex). We examined associations for effect measure modification by food insecurity level in the household in the past month. We used survey-weighted logistic regression, pooled and by country, adjusting for individual, partner, and household-level variables. RESULTS Among women with a cohabitating male partner, 8.0% reported transactional sex, ranging from 2.7% in Lesotho to 13.4% in Uganda. Women's mobility [aOR 1.35 (95% CI: 1.08 to 1.68)], but not their partner's mobility [aOR 0.91 (0.74-1.12)], was associated with transactional sex. Food insecurity was associated with transactional sex independent of mobility [aOR 1.29 (1.10-1.52)]. Among those who were food insecure, mobility was not associated with increased odds of transactional sex. CONCLUSION Food insecurity and women's mobility each increased the odds of transactional sex. Because transactional sex is associated with HIV risk, prevention programs can address the needs of mobile and food-insecure women, including those in cohabitating relationships.
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Affiliation(s)
- Aleya Khalifa
- ICAP at Columbia University, New York USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York USA
| | - Sally Findley
- Population & Family Health Department, Mailman School of Public Health, Columbia University, New York USA
| | | | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center
| | - Avi J. Hakim
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - Ahmed Saadani Hassani
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Steven Y. Hong
- Division of Global HIV and TB, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | | | | | | | | | | | - Prosper Njau
- National AIDS Control Programme, Dar es Salaam, Tanzania
| | | | - Jennifer Ward
- Centers for Disease Control and Prevention, Kampala, Uganda
| | - Andrea Low
- ICAP at Columbia University, New York USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York USA
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Okiring J, Getahun M, Gutin SA, Lebu S, Lee J, Maeri I, Eyul P, Bukusi EA, Cohen CR, Neilands TB, Ssali S, Charlebois ED, Camlin CS. Sexual partnership concurrency and age disparities associated with sexually transmitted infection and risk behavior in rural communities in Kenya and Uganda. Int J Infect Dis 2022; 120:158-167. [PMID: 35472527 PMCID: PMC9984205 DOI: 10.1016/j.ijid.2022.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/02/2022] [Accepted: 04/20/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES We examined sex-specific associations of partner age disparity and relationship concurrency with Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT) infection, higher-risk relationships, and condom use as proxies for HIV risk. METHODS Data were collected in 2016 from 2179 adults in 12 communities in Uganda and Kenya. Logistic regression models examined associations of age disparity and relationship concurrency with NG/CT infection, condom use, and higher-risk (commercial sex and other higher-risk) relationships in the past 6 months, controlling for covariates. RESULTS Partner age and relationship concurrency were associated with NG/CT infection in women but not men. Relative to women in age-disparate relationships, women in both age-disparate and age-homogeneous relationships had higher odds of NG/CT infection (adjusted odds ratio [aOR]=3.82, 95% confidence interval [CI]: 1.46-9.98). Among men and women, partnership concurrency was associated with higher-risk partnerships. In addition, relative to those with a single age-homogeneous partner, those with concurrent age-homogeneous partners had higher odds of condom use (men: aOR=2.85, 95% CI: 1.89-4.31; women: aOR=2.99, 95% CI: 1.52-5.89). Concurrent age-disparate partnerships were associated with condom use among men only (aOR=4.02, 95% CI: 2.54-6.37). CONCLUSION Findings underscore the importance of targeted HIV prevention efforts for couples in age-disparate and concurrent relationships.
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Affiliation(s)
- Jaffer Okiring
- Infectious Diseases Research Collaboration, Plot 2C Nakasero Hill Road, P.O. Box 7475, Kampala, Uganda
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA
| | - Sarah A Gutin
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Sarah Lebu
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA
| | - Joi Lee
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA
| | - Irene Maeri
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200, Nairobi, Kenya
| | - Patrick Eyul
- Infectious Diseases Research Collaboration, Plot 2C Nakasero Hill Road, P.O. Box 7475, Kampala, Uganda
| | - Elizabeth A Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA; Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200, Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Sarah Ssali
- School of Women and Gender Studies, Makerere University, Pool Road, Kampala, Uganda
| | - Edwin D Charlebois
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, 1330 Broadway, Ste. 1100, Oakland CA 94612, USA; Center for AIDS Prevention Studies (CAPS), Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA.
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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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Nardell MF, Adeoti O, Peters C, Kakuhikire B, Govathson-Mandimika C, Long L, Pascoe S, Tsai AC, Katz IT. Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis. J Int AIDS Soc 2022; 25:e25889. [PMID: 35324089 PMCID: PMC8944222 DOI: 10.1002/jia2.25889] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Men are missing along the HIV care continuum. However, the estimated proportions of men in sub-Saharan Africa meeting the UNAIDS 95-95-95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95-95-95 goals across studies in sub-Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. METHODS We systematically searched PubMed and Embase for peer-reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95-95-95 goal in sub-Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion-Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta-synthesis. RESULTS AND DISCUSSION We screened 14,896 studies and included 129 studies in the meta-analysis, compiling data over the data collection period. Forty-seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41-0.58; range, 0.09-0.97]) or not being on treatment (0.58 [95% CI, 0.51-0.65; range, 0.07-0.97]), while over three-quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77-0.81; range, 0.39-0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta-synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. CONCLUSIONS Psychosocial and systems-level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.
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Affiliation(s)
- Maria F Nardell
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Oluwatomi Adeoti
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Carson Peters
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Bernard Kakuhikire
- Faculty of Business and Management Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caroline Govathson-Mandimika
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander C Tsai
- Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Global Health Institute, Cambridge, Massachusetts, USA
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Mweemba C, Hangoma P, Fwemba I, Mutale W, Masiye F. Estimating district HIV prevalence in Zambia using small-area estimation methods (SAE). Popul Health Metr 2022; 20:8. [PMID: 35183216 PMCID: PMC8858531 DOI: 10.1186/s12963-022-00286-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The HIV/AIDS pandemic has had a very devastating impact at a global level, with the Eastern and Southern African region being the hardest hit. The considerable geographical variation in the pandemic means varying impact of the disease in different settings, requiring differentiated interventions. While information on the prevalence of HIV at regional and national levels is readily available, the burden of the disease at smaller area levels, where health services are organized and delivered, is not well documented. This affects the targeting of HIV resources. There is need, therefore, for studies to estimate HIV prevalence at appropriate levels to improve HIV-related planning and resource allocation.
Methods
We estimated the district-level prevalence of HIV using Small-Area Estimation (SAE) technique by utilizing the 2016 Zambia Population-Based HIV Impact Assessment Survey (ZAMPHIA) data and auxiliary data from the 2010 Zambian Census of Population and Housing and the HIV sentinel surveillance data from selected antenatal care clinics (ANC). SAE models were fitted in R Programming to ascertain the best HIV predicting model. We then used the Fay–Herriot (FH) model to obtain weighted, more precise and reliable HIV prevalence for all the districts.
Results
The results revealed variations in the district HIV prevalence in Zambia, with the prevalence ranging from as low as 4.2% to as high as 23.5%. Approximately 32% of the districts (n = 24) had HIV prevalence above the national average, with one district having almost twice as much prevalence as the national level. Some rural districts have very high HIV prevalence rates.
Conclusions
HIV prevalence in Zambian is highest in districts located near international borders, along the main transit routes and adjacent to other districts with very high prevalence. The variations in the burden of HIV across districts in Zambia point to the need for a differentiated approach in HIV programming within the country. HIV resources need to be prioritized toward districts with high population mobility.
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Nhampossa T, Fernández-Luis S, Fuente-Soro L, Bernardo E, Nhacolo A, Augusto O, Nhacolo A, Sacoor C, Saura-Lázaro A, Lopez-Varela E, Naniche D. The impact of the caregiver mobility on child HIV care in the Manhiça District, Southern Mozambique: A clinical based study. PLoS One 2021; 16:e0261356. [PMID: 34914769 PMCID: PMC8675651 DOI: 10.1371/journal.pone.0261356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Manhiça District, in Southern Mozambique harbors high HIV prevalence and a long history of migration. To optimize HIV care, we sought to assess how caregiver’s mobility impacts children living with HIV (CLHIV)´s continuation in HIV care and to explore the strategies used by caregivers to maintain their CLHIV on antiretroviral treatment (ART). Methods A clinic-based cross-sectional survey conducted at the Manhiça District Hospital between December-2017 and February-2018. We enrolled CLHIV with a self-identified migrant caregiver (moved outside of Manhiça District ≤12 months prior to survey) and non-migrant caregiver, matched by the child age and sex. Survey data were linked to CLHIV clinical records from the HIV care and treatment program. Results Among the 975 CLHIV screened, 285 (29.2%) were excluded due to absence of an adult at the appointment. A total of 232 CLHIV-caregiver pairs were included. Of the 41 (35%) CLHIV migrating with their caregivers, 38 (92.6%) had access to ART at the destination because either the caregivers travelled with it 24 (63%) or it was sent by a family member 14 (36%). Among the 76 (65%) CLHIV who did not migrate with their caregivers, for the purpose of pharmacy visits, 39% were cared by their grandfather/grandmother, 28% by an aunt/uncle and 16% by an adult brother/sister. CLHIV of migrant caregivers had a non-statistically significant increase in the number of previous reported sickness episodes (OR = 1.38, 95%CI: 0.79–2.42; p = 0.257), ART interruptions (OR = 1.73; 95%CI: 0.82–3.63; p = 0.142) and lost-to-follow-up episodes (OR = 1.53; 95%CI: 0.80–2.94; p = 0.193). Conclusions Nearly one third of the children attend their HIV care appointments unaccompanied by an adult. The caregiver mobility was not found to significantly affect child’s retention on ART. Migrant caregivers adopted strategies such as the transportation of ART to the mobility destination to avoid impact of mobility on the child’s HIV care. However this may have implications on ART stability and effectiveness that should be investigated in rural areas.
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Affiliation(s)
- Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde (INS), Maputo, Mozambique
- * E-mail:
| | - Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Edson Bernardo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Serviço Distrital de Saúde, Mulher e Acção Social de Manhiça, Maputo, Mozambique
| | - Arsenio Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anna Saura-Lázaro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
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Okano JT, Busang L, Seipone K, Valdano E, Blower S. The potential impact of country-level migration networks on HIV epidemics in sub-Saharan Africa: the case of Botswana. Lancet HIV 2021; 8:e787-e792. [PMID: 34774183 DOI: 10.1016/s2352-3018(21)00267-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 12/11/2022]
Abstract
Generalised HIV epidemics in sub-Saharan Africa show substantial geographical variation in prevalence, which is considered when designing epidemic control strategies. We hypothesise that the migratory behaviour of the general population of countries in sub-Saharan Africa could have a substantial effect on HIV epidemics and challenge the elimination effort. To test this hypothesis, we used census data from 2017 to identify, construct, and visualise the migration network of the population of Botswana, which has one of the most severe HIV epidemics worldwide. We found that, over 12 months, approximately 14% of the population moved their residency from one district to another. Four types of migration occurred: urban-to-urban, rural-to-urban, urban-to-rural, and rural-to-rural. Migration is leading to a marked geographical redistribution of the population, causing high rates of population turnover in some areas, and further concentrating the population in urban areas. The migration network could potentially be having a substantial effect on the HIV epidemic of Botswana: changing the location of high-transmission areas, generating cross-country transmission corridors, creating source-sink dynamics, and undermining control strategies. Large-scale migration networks could present a considerable challenge to eliminating HIV in Botswana and in other countries in sub-Saharan Africa, and should be considered when designing epidemic control strategies.
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Affiliation(s)
- Justin T Okano
- Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lesego Busang
- The African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana
| | - Khumo Seipone
- The African Comprehensive HIV/AIDS Partnerships, Gaborone, Botswana
| | - Eugenio Valdano
- Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sally Blower
- Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
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Hickey MD, Ouma GB, Mattah B, Pederson B, DesLauriers NR, Mohamed P, Obanda J, Odhiambo A, Njoroge B, Otieno L, Zoughbie DE, Ding EL, Fiorella KJ, Bukusi EA, Cohen CR, Geng EH, Salmen CR. The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya. PLoS One 2021; 16:e0255945. [PMID: 34516557 PMCID: PMC8437299 DOI: 10.1371/journal.pone.0255945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Existing social relationships are a potential source of "social capital" that can enhance support for sustained retention in HIV care. A previous pilot study of a social network-based 'microclinic' intervention, including group health education and facilitated HIV status disclosure, reduced disengagement from HIV care. We conducted a pragmatic randomized trial to evaluate microclinic effectiveness. METHODS In nine rural health facilities in western Kenya, we randomized HIV-positive adults with a recent missed clinic visit to either participation in a microclinic or usual care (NCT02474992). We collected visit data at all clinics where participants accessed care and evaluated intervention effect on disengagement from care (≥90-day absence from care after a missed visit) and the proportion of time patients were adherent to clinic visits ('time-in-care'). We also evaluated changes in social support, HIV status disclosure, and HIV-associated stigma. RESULTS Of 350 eligible patients, 304 (87%) enrolled, with 154 randomized to intervention and 150 to control. Over one year of follow-up, disengagement from care was similar in intervention and control (18% vs 17%, hazard ratio 1.03, 95% CI 0.61-1.75), as was time-in-care (risk difference -2.8%, 95% CI -10.0% to +4.5%). The intervention improved social support for attending clinic appointments (+0.4 units on 5-point scale, 95% CI 0.08-0.63), HIV status disclosure to close social supports (+0.3 persons, 95% CI 0.2-0.5), and reduced stigma (-0.3 units on 5-point scale, 95% CI -0.40 to -0.17). CONCLUSIONS The data from our pragmatic randomized trial in rural western Kenya are compatible with the null hypothesis of no difference in HIV care engagement between those who participated in a microclinic intervention and those who did not, despite improvements in proposed intervention mechanisms of action. However, some benefit or harm cannot be ruled out because the confidence intervals were wide. Results differ from a prior quasi-experimental pilot study, highlighting important implementation considerations when evaluating complex social interventions for HIV care. TRIAL REGISTRATION Clinical trial number: NCT02474992.
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Affiliation(s)
- Matthew D. Hickey
- Division of HIV, Infectious Diseases & Global Medicine, University of California San Francisco, San Francisco, California, United States of America
- Organic Health Response Research Group, Mfangano Island, Kenya
- * E-mail:
| | - Gor B. Ouma
- Organic Health Response Research Group, Mfangano Island, Kenya
- Ekialo Kiona Centre, Mfangano Island, Kenya
| | - Brian Mattah
- Organic Health Response Research Group, Mfangano Island, Kenya
- Ekialo Kiona Centre, Mfangano Island, Kenya
| | - Ben Pederson
- Organic Health Response Research Group, Mfangano Island, Kenya
- Providence Oregon Family Medicine Residency, Portland, Oregon, United States of America
| | - Nicholas R. DesLauriers
- Organic Health Response Research Group, Mfangano Island, Kenya
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Pamela Mohamed
- Organic Health Response Research Group, Mfangano Island, Kenya
- Ekialo Kiona Centre, Mfangano Island, Kenya
| | - Joyce Obanda
- Organic Health Response Research Group, Mfangano Island, Kenya
- Ekialo Kiona Centre, Mfangano Island, Kenya
| | - Abdi Odhiambo
- Organic Health Response Research Group, Mfangano Island, Kenya
- Ekialo Kiona Centre, Mfangano Island, Kenya
| | - Betty Njoroge
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Linda Otieno
- Family AIDS Care and Education Services (FACES), Kisumu, Kenya
| | - Daniel E. Zoughbie
- Microclinic International, San Francisco, California, United States of America
| | - Eric L. Ding
- Microclinic International, San Francisco, California, United States of America
| | - Kathryn J. Fiorella
- Organic Health Response Research Group, Mfangano Island, Kenya
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, United States of America
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology, & Reproductive Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University, St Louis, St Louis, Missouri, United States of America
| | - Charles R. Salmen
- Organic Health Response Research Group, Mfangano Island, Kenya
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
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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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Erdinc FS, Dokuzoguz B, Unal S, Komur S, Inkaya AC, Inan D, Karaoglan I, Deveci A, Celen MK, Kose S, Erben N, Senturk GC, Heper Y, Kutlu SS, Hatipoglu CA, Sumer S, Kandemir B, Sirmatel F, Bayindir Y, Yilmaz E, Ersoy Y, Kazak E, Yildirmak MT, Kayaaslan B, Ozden K, Sener A, Kara A, Gunal O, Birengel S, Akbulut A, Yetkin F, Cuvalci NO, Sargin F, Pullukcu H, Gokengin D, Multicentric Hiv Study Group. Temporal Trends in the Epidemiology of HIV in Turkey. Curr HIV Res 2021; 18:258-266. [PMID: 32342820 DOI: 10.2174/1570162x18666200427223823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016. METHODS Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes. RESULTS A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy. CONCLUSION The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.
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Affiliation(s)
- F S Erdinc
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - B Dokuzoguz
- Ankara Numune Training and Researh Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Unal
- Hacettepe Universitesi Hastaneleri, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Komur
- Cukurova University, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey
| | - A C Inkaya
- Ankara Numune Training and Researh Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - D Inan
- Akdeniz University, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - I Karaoglan
- Gaziantep University, Department of Infectious Diseases and Clinical Microbiology, Gaziantep, Turkey
| | - A Deveci
- Ondokuz Mayis University, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - M K Celen
- Dicle University, Department of Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey
| | - S Kose
- Izmir Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, İzmir, Turkey
| | - N Erben
- Eskisehir Osmangazi University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
| | - G C Senturk
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Y Heper
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - S S Kutlu
- Pamukkale University, Department of Infectious Diseases and Clinical Microbiology, Denizli, Turkey
| | - C A Hatipoglu
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - S Sumer
- Selcuk University, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey
| | - B Kandemir
- Necmettin Erbakan University, Meram Medical Faculty Hospital, Department of Infectious Diseases and Clinical Microbiology, Konya, Turkey
| | - F Sirmatel
- Abant Izzet Baysal University, Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey
| | - Y Bayindir
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - E Yilmaz
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - Y Ersoy
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - E Kazak
- Uludag University, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - M T Yildirmak
- Okmeydani Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - B Kayaaslan
- Yildirim Beyazit University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - K Ozden
- Ataturk University, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey
| | - A Sener
- Canakkale Onsekiz Mart University, Department of Infectious Diseases and Clinical Microbiology, Canakkale, Turkey
| | - A Kara
- Hacettepe University Ihsan Dogramaci Children's Hospital, Department of Infectious Diseases, Ankara, Turkey
| | - O Gunal
- Samsun Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
| | - S Birengel
- Ankara University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - A Akbulut
- Firat University, Department of Infectious Diseases and Clinical Microbiology, Elazig, Turkey
| | - F Yetkin
- Inonu University, Department of Infectious Diseases and Clinical Microbiology, Malatya, Turkey
| | - N O Cuvalci
- Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
| | - F Sargin
- Medeniyet University Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Pullukcu
- Ege University, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - D Gokengin
- Ege University, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
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Zhao M, Liu H, Chen X, Feldman MW. Sexual network and condom use among male migrants in the context of China's gender imbalance. AIDS Care 2021; 34:1048-1052. [PMID: 34115571 DOI: 10.1080/09540121.2021.1938965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the context of China's gender imbalance, this study addresses the characteristics of sexual networks and their association with condom use in a sample of 713 male migrants (aged 28-64) who have rural hukou (household registration) in China. Descriptive statistics, univariate analyses, and multilevel random intercept models were used to investigate the characteristics of sexual networks and their associations with condom use. We found that age, marital status, type of sex partners, support (the main help given to each sex partner by the participant), type of sexual intercourse, and stability of sexual relationships were associated with condom use. The sexual networks were mainly composed of sex partners of similar age (58.46%), unmarried people (50.53%), and regular partners (49.38%). Married male migrants were more likely to use condoms with casual partners; unmarried male migrants were less likely to use condoms in emotional and stable relationships. Variation in individual factors, sex partners, and sexual relationship characteristics contribute to participation in condomless sex by male migrants. HIV prevention strategies should target unmarried male migrants and their casual sex partners by increasing their awareness of the risk of HIV transmission and the availability of free condoms.
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Affiliation(s)
- Min Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Huijun Liu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Xiangjun Chen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, People's Republic of China
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Valdano E, Okano JT, Colizza V, Mitonga HK, Blower S. Using mobile phone data to reveal risk flow networks underlying the HIV epidemic in Namibia. Nat Commun 2021; 12:2837. [PMID: 33990578 PMCID: PMC8121904 DOI: 10.1038/s41467-021-23051-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
Twenty-six million people are living with HIV in sub-Saharan Africa; epidemics are widely dispersed, due to high levels of mobility. However, global elimination strategies do not consider mobility. We use Call Detail Records from 9 billion calls/texts to model mobility in Namibia; we quantify the epidemic-level impact by using a mathematical framework based on spatial networks. We find complex networks of risk flows dispersed risk countrywide: increasing the risk of acquiring HIV in some areas, decreasing it in others. Overall, 40% of risk was mobility-driven. Networks contained multiple risk hubs. All constituencies (administrative units) imported and exported risk, to varying degrees. A few exported very high levels of risk: their residents infected many residents of other constituencies. Notably, prevalence in the constituency exporting the most risk was below average. Large-scale networks of mobility-driven risk flows underlie generalized HIV epidemics in sub-Saharan Africa. In order to eliminate HIV, it is likely to become increasingly important to implement innovative control strategies that focus on disrupting risk flows.
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Affiliation(s)
- Eugenio Valdano
- Center for Biomedical Modeling, The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Justin T Okano
- Center for Biomedical Modeling, The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Vittoria Colizza
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Honore K Mitonga
- Department of Epidemiology and Biostatistics, School of Public Health, University of Namibia, Windhoek, Namibia
| | - Sally Blower
- Center for Biomedical Modeling, The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Fuente-Soro L, Fernández-Luis S, López-Varela E, Augusto O, Nhampossa T, Nhacolo A, Bernardo E, Burgueño B, Ngeno B, Couto A, Guambe H, Tibana K, Urso M, Naniche D. Community-based progress indicators for prevention of mother-to-child transmission and mortality rates in HIV-exposed children in rural Mozambique. BMC Public Health 2021; 21:520. [PMID: 33731061 PMCID: PMC7970736 DOI: 10.1186/s12889-021-10568-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Background Eliminating mother-to-child HIV-transmission (EMTCT) implies a case rate target of new pediatric HIV-infections< 50/100,000 live-births and a transmission rate < 5%. We assessed these indicators at community-level in Mozambique, where MTCT is the second highest globally.. Methods A cross-sectional household survey was conducted within the Manhiça Health Demographic Surveillance System in Mozambique (October 2017–April 2018). Live births in the previous 4 years were randomly selected, and mother/child HIV-status was ascertained through documentation or age-appropriate testing. Estimates on prevalence and transmission were adjusted by multiple imputation chained equation (MICE) for participants with missing HIV-status. Retrospective cumulative mortality rate and risk factors were estimate by Fine-Gray model. Results Among 5000 selected mother-child pairs, 3486 consented participate. Community HIV-prevalence estimate in mothers after MICE adjustment was 37.6% (95%CI:35.8–39.4%). Estimates doubled in adolescents aged < 19 years (from 8.0 to 19.1%) and increased 1.5-times in mothers aged < 25 years. Overall adjusted vertical HIV-transmission at the time of the study were 4.4% (95% CI:3.1–5.7%) in HIV-exposed children (HEC). Pediatric case rate-infection was estimated at 1654/100,000 live-births. Testing coverage in HEC was close to 96.0%; however, only 69.1% of them were tested early(< 2 months of age). Cumulative child mortality rate was 41.6/1000 live-births. HIV-positive status and later birth order were significantly associated with death. Neonatal complications, HIV and pneumonia were main pediatric causes of death. Conclusions In Mozambique, SPECTRUM modeling estimated 15% MTCT, higher than our district-level community-based estimates of MTCT among HIV-exposed children. Community-based subnational assessments of progress towards EMTCT are needed to complement clinic-based and modeling estimates. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10568-4.
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Affiliation(s)
- Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique. .,Barcelona Institute for Global Health, Barcelona, Spain. .,ISGlobal, Barcelona Institute for Global Health, Rossello, 132, 08036, Barcelona, Spain.
| | - Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
| | - Elisa López-Varela
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Instituto Nacional de Saúde, Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Edson Bernardo
- Manhiça District Health Services, Maputo, Mozambique.,Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
| | | | - Bernadette Ngeno
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Aleny Couto
- Ministério da Saúde de Moçambique, Maputo, Mozambique
| | - Helga Guambe
- Ministério da Saúde de Moçambique, Maputo, Mozambique
| | | | - Marilena Urso
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Barcelona Institute for Global Health, Barcelona, Spain
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Cassels S, Mwenda KM, Biney AAE, Jenness SM. Is It the Timing? Short-Term Mobility and Coital Frequency in Agbogbloshie, Ghana. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:589-600. [PMID: 32989638 PMCID: PMC7889649 DOI: 10.1007/s10508-020-01815-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
Short-term mobility is often associated with increased sexual risk behavior. Mobile individuals often have higher rates of sexual risk behavior compared to non-mobile individuals, but the reasons why are not clear. Using monthly retrospective panel data from 202 men and 282 women in Agbogbloshie, Ghana, we tested whether short-term mobility was associated with changes in coital frequency, and whether the association was due to the act of travel in the given month (e.g., enabling higher risk behavior), the reason for travel, or an individual's travel propensity at other times in the year. Overnight travel specifically to visit family or friends, or for education, health, or other reasons, was associated with increased coital frequency for men. However, men with higher travel propensities had lower overall coital frequency and the act of traveling enabled more sex only for the most frequent male travelers. Men who seldom traveled had much higher coital frequency, but the act of traveling was not associated with additional sex acts. For women, travel for education, health, or other reasons increased coital frequency. Occasional female travelers had slightly more sex acts compared to non-mobile women, and the act of traveling for these women was associated with slight increases in coital frequency, supporting the enabling hypothesis. Highly mobile women had fewer sex acts per month on average. Our findings suggest that mobility characteristics measured on a broad temporal scale, as well as the reason for mobility, are important to understand the relationship between short-term mobility and sexual behavior.
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Affiliation(s)
- Susan Cassels
- Department of Geography, University of California, Santa Barbara, CA, 93106-4060, USA.
| | - Kevin M Mwenda
- Spatial Structures in the Social Sciences, Brown University, Providence, RI, USA
| | - Adriana A E Biney
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Saleem HT, Likindikoki S, Silberg C, Mbwambo J, Latkin C. Time-space constraints to HIV treatment engagement among women who use heroin in Dar es Salaam, Tanzania: A time geography perspective. Soc Sci Med 2021; 268:113379. [PMID: 32979773 PMCID: PMC7755686 DOI: 10.1016/j.socscimed.2020.113379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/08/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
Timely initiation and sustained adherence to antiretroviral therapy (ART) are essential to improving the health outcomes of people living with HIV and preventing onward HIV transmission. However, women who use heroin often face challenges to initiating and adhering to ART. In this paper we identify spatial, temporal, and social factors that affect HIV treatment engagement among women who use heroin, drawing from a time geography framework. We conducted in-depth interviews with 30 heroin-using women living with HIV in Dar es Salaam, Tanzania between January and March 2019. We found that unstable housing, high mobility, HIV-related stigma, and unpredictable daily paths due to heroin use and involvement in sex work spatially and temporally constrained women who use heroin from incorporating HIV treatment behaviors into daily routines. Some women, however, were able to overcome these time-space constraints to HIV treatment engagement through social support and social role performance. Time geography, including concepts of time-space constraints and daily paths, is a useful framework for identifying barriers to ART engagement. Structural, relational, and individual interventions aimed at eliminating time-space constraints hold the potential to improve HIV treatment engagement among particularly vulnerable and mobile populations.
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Affiliation(s)
- Haneefa T Saleem
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E5033, Baltimore, MD, USA, 21205.
| | - Samuel Likindikoki
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
| | - Claire Silberg
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, USA, 21205.
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, School of Medicine, Muhmbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - Carl Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway Avenue, Hampton House Room 737, Baltimore, MD, USA, 21205.
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Plymoth M, Sanders EJ, Van Der Elst EM, Medstrand P, Tesfaye F, Winqvist N, Balcha T, Björkman P. Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia. PLoS One 2020; 15:e0244066. [PMID: 33320900 PMCID: PMC7737988 DOI: 10.1371/journal.pone.0244066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction The potential impact of socio-economic condition on virological suppression during antiretroviral treatment (ART) in sub-Saharan Africa is largely unknown. In this case-control study, we compared socio-economic factors among Ethiopian ART recipients with lack of virological suppression to those with undetectable viral load (VL). Methods Cases (VL>1000 copies/ml) and controls (VL<150 copies/ml) aged ≥15years, with ART for >6 months and with available VL results within the last 3 months, were identified from registries at public ART clinics in Central Ethiopia. Questionnaire-based interviews on socio-economic characteristics, health condition and transmission risk behavior were conducted. Univariate variables associated with VL>1000 copies/ml (p<0.25) were added to a multivariable logistic regression model. Results Among 307 participants (155 cases, 152 controls), 61.2% were female, and the median age was 38 years (IQR 32–46). Median HIV-RNA load among cases was 6,904 copies/ml (IQR 2,843–26,789). Compared to controls, cases were younger (median 36 vs. 39 years; p = 0.004), more likely to be male (46.5% vs. 30.9%; p = 0.005) and had lower pre-ART CD4 cell counts (170 vs. 220 cells/μl; p = 0.009). In multivariable analysis of urban residents (94.8%), VL>1000 copies/ml was associated with lower relative wealth (adjusted odds ratio [aOR] 2.98; 95% CI 1.49–5.94; p = 0.016), geographic work mobility (aOR 6.27, 95% CI 1.82–21.6; p = 0.016), younger age (aOR 0.94 [year], 95% CI 0.91–0.98; p = 0.011), longer duration of ART (aOR 1.19 [year], 95% CI 1.07–1.33; p = 0.020), and suboptimal (aOR 3.83, 95% CI 1.33–10.2; p = 0.048) or poor self-perceived wellbeing (aOR 9.75, 95% CI 2.85–33.4; p = 0.012), after correction for multiple comparisons. High-risk sexual behavior and substance use was not associated with lack of virological suppression. Conclusion Geographic work mobility and lower relative wealth were associated with lack of virological suppression among Ethiopian ART recipients in this predominantly urban population. These characteristics indicate increased risk of treatment failure and the need for targeted interventions for persons with these risk factors.
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Affiliation(s)
- Martin Plymoth
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- * E-mail: ,
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Headington, United Kingdom
| | - Elise M. Van Der Elst
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Patrik Medstrand
- Clinical Virology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fregenet Tesfaye
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Niclas Winqvist
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Taye Balcha
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
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46
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Agustí C, Font-Casaseca N, Belvis F, Julià M, Vives N, Montoliu A, Pericàs JM, Casabona J, Benach J. The role of socio-demographic determinants in the geo-spatial distribution of newly diagnosed HIV infections in small areas of Catalonia (Spain). BMC Public Health 2020; 20:1533. [PMID: 33036599 PMCID: PMC7547437 DOI: 10.1186/s12889-020-09603-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates. METHODS Surveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012-2016) and associated risk factors at the small area level (ABS, acronym for "basic health area" in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, GBMSM activity indicators, and other variables at the aggregated level. RESULTS New HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be significantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520; P < 0.001), a higher proportion of men aged 15-44 years (IRR, 1.193; P = 0.003), a higher proportion of GBMSM (IRR, 1.230; P = 0.030), a higher proportion of men from Western Europe (IRR, 1.281; P = 0.003), a higher proportion of men from Latin America (IRR, 1.260; P = 0.003), and a higher number of gay locations (IRR, 2.665; P < 0.001). No association was observed between the HIV diagnosis rate and economic deprivation. CONCLUSIONS Ring maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.
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Affiliation(s)
- Cristina Agustí
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Edifici Muntanya, Ctra Can Ruti, Cami de les Escoles s/n, 08916 Badalona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain. .,Fundació Institut d'Investigació Germans Trias i Pujol IGTP, Badalona, Barcelona, Spain.
| | | | - Francesc Belvis
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Unit of Infections and Cancer - Information and Interventions (UNIC - I&I), Cancer Epidemiology Research Program (CERP), Hospitalet de Llobregat, Barcelona, Spain
| | - Mireia Julià
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Vives
- Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Montoliu
- Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Unit of Infections and Cancer - Information and Interventions (UNIC - I&I), Cancer Epidemiology Research Program (CERP), Hospitalet de Llobregat, Barcelona, Spain
| | - Juan M Pericàs
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain.,Infectious Disease Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Edifici Muntanya, Ctra Can Ruti, Cami de les Escoles s/n, 08916 Badalona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Fundació Institut d'Investigació Germans Trias i Pujol IGTP, Badalona, Barcelona, Spain.,Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Universidad Autónoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Joan Benach
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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