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Dzomba A, Ginsburg C, Kabudula CW, Yorlets RR, Ndagurwa P, Harawa S, Lurie MN, McGarvey ST, Tollman S, Collinson MA, White MJ, Gomez-Olive FX. Epidemiology of chronic multimorbidity and temporary migration in a rural South African community in health transition: A cross-sectional population-based analysis. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1054108. [PMID: 38455922 PMCID: PMC10910947 DOI: 10.3389/fepid.2023.1054108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/03/2023] [Indexed: 03/09/2024]
Abstract
Introduction In sub-Saharan African settings, the increasing non-communicable disease mortality is linked to migration, which disproportionately exposes sub-populations to risk factors for co-occurring HIV and NCDs. Methods We examined the prevalence, patterns, and factors associated with two or more concurrent diagnoses of chronic diseases (i.e., multimorbidity) among temporary within-country migrants. Employing a cross-sectional design, our study sample comprised 2144 residents and non-residents 18-40 years interviewed and with measured biomarkers in 2018 in Wave 1 of the Migrant Health Follow-up Study (MHFUS), drawn from the Agincourt Health and Demographic Surveillance System (AHDSS) in rural north-eastern South Africa. We used modified Poisson regression models to estimate the association between migration status and prevalent chronic multimorbidity conditional on age, sex, education, and healthcare utilisation. Results Overall, 301 participants (14%; 95% CI 12.6-15.6), median age 31 years had chronic multimorbidity. Multimorbidity was more prevalent among non-migrants (14.6%; 95% CI 12.8-16.4) compared to migrants (12.8%; 95% CI 10.3-15.7). Non-migrants also had the greatest burden of dual-overlapping chronic morbidities, such as HIV-obesity 5.7%. Multimorbidity was 2.6 times as prevalent (PR 2.65. 95% CI 2.07-3.39) among women compared to men. Among migrants, men, and individuals with secondary or tertiary education manifested lower prevalence of two or more conditions. Discussion In a rural community with colliding epidemics, we found low but significant multimorbidity driven by a trio of conditions: HIV, hypertension, and obesity. Understanding the multimorbidity burden associated with early adulthood exposures, including potential protective factors (i.e., migration coupled with education), is a critical first step towards improving secondary and tertiary prevention for chronic disease among highly mobile marginalised sub-populations.
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Affiliation(s)
- Armstrong Dzomba
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Carren Ginsburg
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Chodziwadziwa W. Kabudula
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Rachel R. Yorlets
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
- Population Studies and Training Center, Brown University, Providence, RI, United States
| | - Pedzisai Ndagurwa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sadson Harawa
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Mark N. Lurie
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
- Population Studies and Training Center, Brown University, Providence, RI, United States
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
| | - Stephen T. McGarvey
- International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
- Department of Anthropology, Brown University, Providence, RI, United States
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
| | - Mark A. Collinson
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
- Department of Science and Innovation/ Medical Research Council, South African Population Research Infrastructure Network, Durban, South Africa
| | - Michael J. White
- Population Studies and Training Center, Brown University, Providence, RI, United States
- Department of Sociology, Brown University, Providence, RI, United States
| | - Francesc X. Gomez-Olive
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa
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Zuma K, Simbayi L, Zungu N, Moyo S, Marinda E, Jooste S, North A, Nadol P, Aynalem G, Igumbor E, Dietrich C, Sigida S, Chibi B, Makola L, Kondlo L, Porter S, Ramlagan S. The HIV Epidemic in South Africa: Key Findings from 2017 National Population-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138125. [PMID: 35805784 PMCID: PMC9265818 DOI: 10.3390/ijerph19138125] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022]
Abstract
South Africa has the largest number of people living with HIV worldwide. South Africa has implemented five population-based HIV prevalence surveys since 2002 aimed at understanding the dynamics and the trends of the epidemic. This paper presents key findings from the fifth HIV prevalence, incidence, and behaviour survey conducted in 2017 following policy, programme, and epidemic change since the prior survey was conducted in 2012. A cross-sectional population-based household survey collected behavioural and biomedical data on all members of the eligible households. A total of 39,132 respondents from 11,776 households were eligible to participate, of whom 93.6% agreed to be interviewed, and 61.1% provided blood specimens. The provided blood specimens were used to determine HIV status, HIV incidence, viral load, exposure to antiretroviral treatment, and HIV drug resistance. Overall HIV incidence among persons aged 2 years and above was 0.48% which translates to an estimated 231,000 new infections in 2017. HIV prevalence was 14.0% translating to 7.9 million people living with HIV. Antiretroviral (ARV) exposure was 62.3%, with the lowest exposure among those aged 15 to 24 years (39.9%) with 10% lower ARV coverage among males compared to females. Viral suppression among those on treatment was high (87.3%), whilst HIV population viral load suppression was much lower (62.3%). In terms of risk behaviours, 13.6% of youth reported having had an early sexual debut (first sex before the age of 15 years), with more males reporting having done so (19.5%) than females (7.6%). Age-disparate relationships, defined as having a sexual partner 5+ years different from oneself,) among adolescents were more common among females (35.8%) than males (1.5%). Self-reported multiple sexual partnerships (MSPs), defined as having more than one sexual partner in the previous 12 months, were more commonly reported by males (25.5%) than females (9.0%). Condom use at last sexual encounter was highest among males than females. Three quarters (75.2%) of people reported they had ever been tested for HIV, with more females (79.3%) having had done so than males (70.9%). Two-thirds of respondents (66.8%) self-reported having tested for HIV in the past 12 months. Finally, 61.6% of males in the survey self-reported as having been circumcised, with circumcision being more common among youth aged 15–24 years (70.2%), Black Africans (68.9%), and those living in both rural informal (tribal) areas (65%) and urban areas (61.9%). Slightly more (51.2%) male circumcisions were reported to have occurred in a medical setting than in traditional settings (44.8%), with more young males aged 15–24 (62.6%) and men aged 25–49 (51.5%) reporting to have done so compared to most men aged 50 and older (57.1%) who reported that they had undergone circumcision in a traditional setting. The results of this survey show that strides have been made in controlling the HIV epidemic, especially in the reduction of HIV incidence, HIV testing, and treatment. Although condom use at last sex act remains unchanged, there continue to be some challenges with the lack of significant behaviour change as people, especially youth, continue to engage in risky behaviour and delay treatment initiation. Therefore, there is a need to develop or scale up targeted intervention programmes to increase HIV testing further and put more people living with HIV on treatment as well as prevent risky behaviours that put young people at risk of HIV infection.
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Affiliation(s)
- Khangelani Zuma
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
- School of Public Health, University of the Witwatersrand, Johannesburg 2000, South Africa
- Correspondence:
| | - Leickness Simbayi
- Human Sciences Research Council, Cape Town 8000, South Africa; (L.S.); (S.M.); (S.J.); (A.N.); (L.M.)
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town 7925, South Africa
| | - Nompumelelo Zungu
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
- The School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Sizulu Moyo
- Human Sciences Research Council, Cape Town 8000, South Africa; (L.S.); (S.M.); (S.J.); (A.N.); (L.M.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7700, South Africa
| | - Edmore Marinda
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
| | - Sean Jooste
- Human Sciences Research Council, Cape Town 8000, South Africa; (L.S.); (S.M.); (S.J.); (A.N.); (L.M.)
| | - Alicia North
- Human Sciences Research Council, Cape Town 8000, South Africa; (L.S.); (S.M.); (S.J.); (A.N.); (L.M.)
| | - Patrick Nadol
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria 0001, South Africa; (P.N.); (G.A.); (E.I.); (C.D.); (S.P.)
| | - Getahun Aynalem
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria 0001, South Africa; (P.N.); (G.A.); (E.I.); (C.D.); (S.P.)
| | - Ehimario Igumbor
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria 0001, South Africa; (P.N.); (G.A.); (E.I.); (C.D.); (S.P.)
- School of Public Health, University of the Western Cape, Bellville, Cape Town 7535, South Africa
| | - Cheryl Dietrich
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria 0001, South Africa; (P.N.); (G.A.); (E.I.); (C.D.); (S.P.)
| | - Salome Sigida
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
| | - Buyisile Chibi
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
| | - Lehlogonolo Makola
- Human Sciences Research Council, Cape Town 8000, South Africa; (L.S.); (S.M.); (S.J.); (A.N.); (L.M.)
| | - Lwando Kondlo
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
| | - Sarah Porter
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria 0001, South Africa; (P.N.); (G.A.); (E.I.); (C.D.); (S.P.)
| | - Shandir Ramlagan
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
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Dzomba A, Kim HY, Tomita A, Vandormael A, Govender K, Tanser F. Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005-2017). BMC Public Health 2022; 22:1141. [PMID: 35672845 PMCID: PMC9175358 DOI: 10.1186/s12889-022-13526-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
Globally, South Africa hosts the highest number of people living with HIV (PLHIV) and the unique legacy of internal labour migration continues to be a major driver of the regional epidemic, interrupting treatment-as-prevention efforts. The study examined levels, trends, and predictors of migration in rural KwaZulu-Natal Province, South Africa, using population-based surveillance data from 2005 through 2017. We followed 69 604 adult participants aged 15-49 years and recorded their migration events (i.e., out-migration from the surveillance area) in 423 038 person-years over 525 397 observations. Multiple failure Cox-regression models were used to measure the risk of migration by socio-demographic factors: age, sex, educational status, marital status, HIV, and community antiretroviral therapy (ART) coverage. Overall, 69% of the population cohort experienced at least one migration event during the follow-up period. The average incidence rate of migration was 9.96 events and 13.23 events per 100 person-years in women and men, respectively. Migration rates declined from 2005 to 2008 then peaked in 2012 for both women and men. Adjusting for other covariates, the risk of migration was 3.4-times higher among young women aged 20-24 years compared to those aged ≥ 40 years (adjusted Hazard Ratio [aHR] = 3.37, 95% Confidence Interval [CI]: 3:19-3.57), and 2.9-times higher among young men aged 20-24 years compared to those aged ≥ 40 years (aHR = 2.86, 95% CI:2.69-3.04). There was a 9% and 27% decrease in risk of migration among both women (aHR = 0.91, 95% CI: 0.83 - 0.99) and men (aHR = 0.73, 95% CI 0.66 - 0.82) respectively per every 1% increase in community ART coverage. Young unmarried women including those living with HIV, migrated at a magnitude similar to that of their male counterparts, and lowered as ART coverage increased over time, reflecting the role of improved HIV services across space in reducing out-migration. A deeper understanding of the characteristics of a migrating population provides critical information towards identifying and addressing gaps in the HIV prevention and care continuum in an era of high mobility.
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Affiliation(s)
- Armstrong Dzomba
- Discipline of Public Health Medicine, Africa Health Research Institute(AHRI), University of KwaZulu-Natal, KwaZulu-Natal Province, K-RITH Tower Building, 719 Umbilo Road, Private Bag X7, Congella, Durban, South Africa.
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa.
- Medical Research Council (MRC)/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Acornhoek, South Africa.
| | - Hae-Young Kim
- Discipline of Public Health Medicine, Africa Health Research Institute(AHRI), University of KwaZulu-Natal, KwaZulu-Natal Province, K-RITH Tower Building, 719 Umbilo Road, Private Bag X7, Congella, Durban, South Africa
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, USA
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alain Vandormael
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
- Department of Medicine, Stanford University, Stanford, USA
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Discipline of Public Health Medicine, Africa Health Research Institute(AHRI), University of KwaZulu-Natal, KwaZulu-Natal Province, K-RITH Tower Building, 719 Umbilo Road, Private Bag X7, Congella, Durban, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- Lincoln Institute for Health, University of Lincoln, Lincoln, LN6 7TS, UK
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Etoori D, Kabudula CW, Wringe A, Rice B, Renju J, Gomez-Olive FX, Reniers G. Investigating clinic transfers among HIV patients considered lost to follow-up to improve understanding of the HIV care cascade: Findings from a cohort study in rural north-eastern South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000296. [PMID: 36962304 PMCID: PMC10022370 DOI: 10.1371/journal.pgph.0000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/02/2022] [Indexed: 11/18/2022]
Abstract
Investigating clinical transfers of HIV patients is important for accurate estimates of retention and informing interventions to support patients. We investigate transfers for adults reported as lost to follow-up (LTFU) from eight HIV care facilities in the Agincourt health and demographic surveillance system (HDSS), South Africa. Using linked clinic and HDSS records, outcomes of adults more than 90 days late for their last scheduled clinic visit were determined through clinic and routine tracing record reviews, HDSS data, and supplementary tracing. Factors associated with transferring to another clinic were determined through Cox regression models. Transfers were graphically and geospatially visualised. Transfers were more common for women, patients living further from the clinic, and patients with higher baseline CD4 cell counts. Transfers to clinics within the HDSS were more likely to be undocumented and were significantly more likely for women pregnant at ART initiation. Transfers outside the HDSS clustered around economic hubs. Patients transferring to health facilities within the HDSS may be shopping for better care, whereas those who transfer out of the HDSS may be migrating for work. Treatment programmes should facilitate transfer processes for patients, ensure continuity of care among those migrating, and improve tracking of undocumented transfers.
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Affiliation(s)
- David Etoori
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chodziwadziwa Whiteson Kabudula
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Alison Wringe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Brian Rice
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jenny Renju
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Francesc Xavier Gomez-Olive
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Georges Reniers
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC/WITS Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Simmons SS. A longitudinal multilevel analysis of the evermigrated population subjective HIV infection expectation in Malawi. Psychol Health 2021; 37:890-902. [PMID: 33879011 DOI: 10.1080/08870446.2021.1910697] [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
OBJECTIVE The primary purpose of this study is to assess the variance in the effects of factors influencing ever migrated Malawian population's subjective HIV infection expectation. DESIGN Using data from the Malawi Longitudinal Study of Families and Health (MLSFH) survey (1998-2010), 7805 ever migrated Malawian adults were selected for the study. Summary statistics, logistic regression and longitudinal multi-level models were fitted for the study. A binary logistic regression was used to estimate the direction and magnitude of the associations between the variables selected for the study Five multilevel models with random intercepts and coefficients nominal response were fitted. RESULTS The study revealed that sexual behaviours had the most significant effect on ever migrated Malawian's subjective HIV infection expectation. All metrics showed that the conditional growth model had the most signficant outcome. The addition of time and other variables as predictors had a significant effect on the conditional growth model. CONCLUSION Interventions designed to decrease the spread of HIV should target sexual behaviours and widespread testing among the ever migrated population to reduce subjective HIV infection thoughts.
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Affiliation(s)
- Sally Sonia Simmons
- Department of Social Policy, London School of Economics and Political Science, London, UK.,Institute of Demography, National Research University-Higher School of Economics, Moscow, Russia
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Kwena Z, Nakamanya S, Nanyonjo G, Okello E, Fast P, Ssetaala A, Oketch B, Price M, Kapiga S, Bukusi E, Seeley J. Understanding mobility and sexual risk behaviour among women in fishing communities of Lake Victoria in East Africa: a qualitative study. BMC Public Health 2020; 20:944. [PMID: 32539818 PMCID: PMC7296721 DOI: 10.1186/s12889-020-09085-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND HIV-prevalence and incidence is high in many fishing communities around Lake Victoria in East Africa. In these settings, mobility among women is high and may contribute to increased risk of HIV infection and poor access to effective prevention and treatment services. Understanding the nature and patterns of this mobility is important for the design of interventions. We conducted an exploratory study to understand the nature and patterns of women's mobility to inform the design of HIV intervention trials in fishing communities of Lake Victoria. METHODS This was a cross-sectional formative qualitative study conducted in six purposively selected fishing communities in Kenya, Tanzania and Uganda. Potential participants were screened for eligibility on age (18+ years) and having stayed in the fishing community for more than 6 months. We collected data using introductory and focus group discussions, and in-depth interviews with key informants. Data focused on: history and patterns of mobility, migration in and out of fishing communities and the relationship between mobility and HIV infection. Since the interviews and discussions were not audio-recorded, detailed notes were taken and written up into full scripts for analysis. We conducted a thematic analysis using constant comparison analysis. RESULTS Participants reported that women in fishing communities were highly mobile for work-related activities. Overall, we categorized mobility as travels over long and short distances or periods depending on the kind of livelihood activity women were involved in. Participants reported that women often travelled to new places, away from familiar contacts and far from healthcare access. Some women were reported to engage in high risk sexual behaviour and disengaging from HIV care. However, participants reported that women often returned to the fishing communities they considered home, or followed a seasonal pattern of work, which would facilitate contact with service providers. CONCLUSION Women exhibited circular and seasonal mobility patterns over varying distances and duration away from their home communities. These mobility patterns may limit women's access to trial/health services and put them at risk of HIV-infection. Interventions should be tailored to take into account mobility patterns of seasonal work observed in this study.
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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 MRC/UVRI and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Gertrude Nanyonjo
- Uganda Virus Research Institute-International AIDS Vaccine Initiative (UVRI-IAVI) Project, Uganda Virus Research Institute, Entebbe, Uganda
| | - Elialilia Okello
- Mwanza Intervention Trials Unit (MITU), National Institute for Medical Research, Mwanza, Tanzania
| | - Pat Fast
- International AIDS Vaccine Initiative (IAVI), New York, USA
| | - Ali Ssetaala
- Uganda Virus Research Institute-International AIDS Vaccine Initiative (UVRI-IAVI) Project, Uganda Virus Research Institute, Entebbe, Uganda
| | - Bertha Oketch
- Research Care and Training Program (RCTP), Kenya Medical Research Institute, Kisumu, Kenya
| | - Matt Price
- International AIDS Vaccine Initiative (IAVI), New York, USA
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit (MITU), National Institute for Medical Research, Mwanza, Tanzania
- London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Bukusi
- Research Care and Training Program (RCTP), Kenya Medical Research Institute, Kisumu, Kenya
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute MRC/UVRI and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
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Dobra A, Bärnighausen T, Vandormael A, Tanser F. A method for statistical analysis of repeated residential movements to link human mobility and HIV acquisition. PLoS One 2019; 14:e0217284. [PMID: 31166973 PMCID: PMC6550382 DOI: 10.1371/journal.pone.0217284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 05/08/2019] [Indexed: 12/05/2022] Open
Abstract
We propose a method for analyzing repeated residential movements based on graphical loglinear models. This method allows an explicit representation of residential presence and absence patterns from several areas without defining mobility measures. We make use of our method to analyze data from one of the most comprehensive demographic surveillance sites in Africa that is characterized by high adult HIV prevalence, high levels of poverty and unemployment and frequent residential changes. Between 2004 and 2016, residential changes were recorded for 8,857 men over 35,500.01 person-years, and for 12,158 women over 57,945.35 person-years. These individuals were HIV negative at baseline. Over the study duration, there were a total of 806 HIV seroconversions in men, and 2,458 HIV seroconversions in women. Our method indicates that establishing a residence outside the rural study area is a strong predictor of HIV seroconversion in men (OR = 2.003, 95% CI = [1.718,2.332]), but not in women. Residing inside the rural study area in a single or in multiple locations is a less significant risk factor for HIV acquisition in both men and women compared to moving outside the rural study area.
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Affiliation(s)
- Adrian Dobra
- Department of Statistics, University of Washington, Seattle, WA, United States of America
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States of America
- Africa Health Research Institute,KwaZulu-Natal, South Africa
| | - Alain Vandormael
- Africa Health Research Institute,KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Africa Health Research Institute,KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- Research Department of Infection & Population Health, University College London, London, United Kingdom
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Hoddinott G, Myburgh H, de Villiers L, Ndubani R, Mantantana J, Thomas A, Mbewe M, Ayles H, Bock P, Seeley J, Shanaube K, Hargreaves J, Bond V, Reynolds L. Households, fluidity, and HIV service delivery in Zambia and South Africa - an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial. J Int AIDS Soc 2018; 21 Suppl 4:e25135. [PMID: 30027687 PMCID: PMC6053477 DOI: 10.1002/jia2.25135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/22/2018] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Population distributions, family and household compositions, and people's sense of belonging and social stability in southern Africa have been shaped by tumultuous, continuing large-scale historical disruptions. As a result, many people experience high levels of geographic and social fluidity, which intersect with individual and population-level migration patterns. We describe the complexities of household fluidity and HIV service access in South Africa and Zambia to explore implications for health systems and service delivery in contexts of high household fluidity. METHODS HPTN 071 (PopART) is a three-arm cluster randomized controlled trial implemented in 21 peri-urban study communities in Zambia and South Africa between 2013 and 2018. A qualitative cohort nested in the trial included 148 purposively sampled households. Data collection was informed by ethnographic and participatory research principles. The analysis process was reflexive and findings are descriptive narrative summaries of emergent ideas. RESULTS Households in southern Africa are extremely fluid, with people having a tenuous sense of security in their social networks. This fluidity intersects with high individual and population mobility. To characterize fluidity, we describe thematic patterns of household membership and residence. We also identify reasons people give for moving around and shifting social ties, including economic survival, fostering interpersonal relationships, participating in cultural, traditional, religious, or familial gatherings, being institutionalized, and maintaining patterns of substance use. High fluidity disrupted HIV service access for some participants. Despite these challenges, many participants were able to regularly access HIV testing services and participants living with HIV were especially resourceful in maintaining continuity of antiretroviral therapy (ART). We identify three key features of health service interactions that facilitated care continuity: disclosure to family members, understanding attitudes among health services staff including flexibility to accommodate clients' transient pressures, and participants' agency in ART-related decisions. CONCLUSIONS Choices made to manage one's experiential sense of household fluidity are intentional responses to livelihood and social support constraints. To enhance retention in care for people living with HIV, policy makers and service providers should focus on creating responsive, flexible health service delivery systems designed to accommodate many shifts in client circumstances.
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Affiliation(s)
- Graeme Hoddinott
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Hanlie Myburgh
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Laing de Villiers
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | | | - Jabulile Mantantana
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Angelique Thomas
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | | | - Helen Ayles
- Zambart, School of MedicineLusakaZambia
- Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
| | - Peter Bock
- Department of Paediatrics and Child HealthFaculty of MedicineDesmond Tutu TB CentreStellenbosch UniversityStellenboschSouth Africa
| | - Janet Seeley
- Department of Global Health and DevelopmentFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - James Hargreaves
- Department of Social and Environmental Health ResearchCentre for EvaluationLondon School of Hygiene and Tropical MedicineLondonUK
| | - Virginia Bond
- Zambart, School of MedicineLusakaZambia
- Department of Global Health and DevelopmentFaculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Lindsey Reynolds
- Department of Sociology and Social AnthropologyFaculty of Arts and Social SciencesStellenbosch UniversityStellenboschSouth Africa
- Population Studies and Training CenterBrown UniversityProvidenceRIUSA
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Dzomba A, Govender K, Mashamba-Thompson TP, Tanser F. Mobility and increased risk of HIV acquisition in South Africa: a mixed-method systematic review protocol. Syst Rev 2018; 7:37. [PMID: 29486798 PMCID: PMC6389209 DOI: 10.1186/s13643-018-0703-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 02/19/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In South Africa (home of the largest HIV epidemic globally), there are high levels of mobility. While studies produced in the recent past provide useful perspectives to the mobility-HIV risk linkage, systematic analyses are needed for in-depth understanding of the complex dynamics between mobility and HIV risk. We plan to undertake an evidence-based review of existing literature connecting mobility and increased risky sexual behavior as well as risk of HIV acquisition in South Africa. METHODS/DESIGN We will conduct a mixed-method systematic review of peer-reviewed studies published between 2000 and 2015. In particular, we will search for relevant South African studies from the following databases: MEDLINE, EMBASE, Web of Science, and J-STOR databases. Studies explicitly examining HIV and labor migration will be eligible for inclusion, while non-empirical work and other studies on key vulnerable populations such as commercial sex workers (CSW) and men who have sex with men (MSM) will be excluded. DISCUSSION The proposed mixed-method systematic review will employ a three-phase sequential approach [i.e., (i) identifying relevant studies through data extraction (validated by use of Distiller-SR data management software), (ii) qualitative synthesis, and (iii) quantitative synthesis including meta-analysis data]. Recurrent ideas and conclusions from syntheses will be compiled into key themes and further processed into categories and sub-themes constituting the primary and secondary outcomes of this study. Synthesis of main findings from different studies examining the subject issue here may uncover important research gaps in this literature, laying a strong foundation for research and development of sustainable localized migrant-specific HIV prevention strategies in South Africa. SYSTEMATIC REVIEW REGISTRATION Our protocol was registered with PROSPERO under registration number: CRD 42017055580. ( https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017055580 ).
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Affiliation(s)
- Armstrong Dzomba
- Africa Health Research Institute (AHRI), K-RITH Tower Building, 719 Umbilo Road, Durban Private Bag X7, Congella, Durban, South Africa
- Discipline of Public Health Medicine, Africa Health Research Institute (AHRI) and University of KwaZulu-Natal, K-RITH Tower Building, 719 Umbilo Road, Durban Private Bag X7, Congella, Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV/AIDS Research Division, Durban, South Africa
- Howard College, University of KwaZulu-Natal, King George V Avenue, Durban, 4001 South Africa
| | - Tivani P. Mashamba-Thompson
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Africa Health Research Institute, (AHRI), School of Nursing and Public Health, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa—CAPRISA, Congella, Durban, South Africa
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Point of care HIV testing with oral fluid among returnee migrants in a rural area of Bangladesh. Curr Opin HIV AIDS 2016; 11 Suppl 1:S52-8. [PMID: 26945144 PMCID: PMC4787103 DOI: 10.1097/coh.0000000000000267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives To determine HIV prevalence and assess the acceptability of HIV testing using oral fluid as a point of care (PoC) test method among returnee migrants in a rural area of Bangladesh. Design A cross-sectional study. Methods Matlab is a rural area southeast of Dhaka where icddr,b hosts a health and demographic surveillance system covering 225 826 people of whom 934 are returnee migrants. The sample size of 304 was proportionately distributed among randomly selected households. HIV antibodies in oral fluid were tested using OraQuick Rapid HIV 1/2 antibody test. To understand reasons of acceptability a short questionnaire was applied and 32 in-depth interviews were conducted. Results Of 304 returnee migrants approached, 97.4% accepted the test. The prevalence of HIV was 0.3% without a confirmatory blood test. Reasons for acceptance included easy accessibility of the test at the door-step which saved resources (i.e., time and money), comfortable test-procedure without any pain and fear, and receiving quick results with confidentiality. Some described knowing HIV status as a way to ‘get certified’ (of sexual fidelity) and to confront a prevailing silent stigma against migrants. Acceptability was moreover found to be grounded in icddr,b's institutional reputation and its close relationship with the local community. Conclusions The PoC oral fluid test for HIV has shown for the first time that assessment of HIV prevalence in rural-based returnee migrants is possible. Findings also suggest that PoC oral fluid test has the potential of increasing accessibility to HIV testing as it was found to be highly acceptable.
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