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

Dzomba, Armstrong; Tomita, Andrew; Vandormael, Alain; Govender, Kaymarlin; Tanser, Frank

doi:10.1186/s12889-019-6494-x

Cited by 19 publications

(20 citation statements)

References 35 publications

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“…We report that more cumulative time spent outside the study area increased both the male and female risk of HIV acquisition, a result that is supported by previous research [ 12 , 16 , 19 , 20 , 29 ]. For example, one of these studies showed that the HIV acquisition risk increased by 50% when men spent 44% and women 90% of their time away from their household residence [ 12 ].…”

Section: Discussionsupporting

confidence: 91%

HIV incidence declines in a rural South African population: a G-imputation approach for inference

et al. 2020

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Background Ad hoc assumptions about the unobserved infection event, which is known only to occur between the latest-negative and earliest-positive test dates, can lead to biased HIV incidence rate estimates. Using a G-imputation approach, we infer the infection dates from covariate data to estimate the HIV incidence rate in a hyper-endemic South African setting. Methods A large demographic surveillance system has annually tested a cohort of HIV-uninfected participants living in the KwaZulu-Natal province. Using this data, we estimated a cumulative baseline hazard function and the effects of time-dependent covariates on the interval censored infection dates. For each HIV-positive participant in the cohort, we derived a cumulative distribution function and sampled multiple infection dates conditional on the unique covariate values. We right censored the data at the imputed dates, calculated the annual HIV incidence rate per 100 person-years, and used Rubin’s rules to obtain the 95% confidence intervals. Results A total of 20,011 uninfected individuals with a repeat HIV test participated in the incidence cohort between 2005 and 2018. We observed 2,603 infections per 58,769 person-years of follow-up among women and 845 infections per 41,178 person-years of follow-up among men. Conditional on age and circumcision status (men only), the female HIV incidence rate declined by 25%, from 5.0 to 3.7 infections per 100 person-years between 2014 and 2018. During this period, the HIV incidence rate among men declined from 2.1 to 1.1 infections per 100 person-years—a reduction of 49%. We observed similar reductions in male and female HIV incidence conditional on condom-use, marital status, urban residential status, migration history, and the HIV prevalence in the surrounding community. Conclusion We have followed participants in one of the world’s largest and longest running HIV cohorts to estimate long-term trends in the population-wide incidence of infection. Using a G-imputation approach, we present further evidence for HIV incidence rate declines in this hyper-endemic South African setting.

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Section: Discussionsupporting

confidence: 91%

HIV incidence declines in a rural South African population: a G-imputation approach for inference

et al. 2020

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“…To address potential sources of confounding, we obtained adjusted IRRs using Poisson regression models. Based on previous research undertaken in the AHRI study area, we included age 33 , condom use 38 , marital status 39 , male circumcision status 39 , household socio-economic status (in tertiles) 40 , cumulative time spent outside the study area 37,41 , and the HIV prevalence of the participant’s surrounding community 29 . We ran the analyses separately for men and women, with opposite-sex ART coverage and opposite-sex HIV prevalence covariates, and excluded male circumcision status from the female-only models.…”

Section: Methodsmentioning

confidence: 99%

Declines in HIV incidence among men and women in a South African population-based cohort

et al. 2019

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Over the past decade, there has been a massive scale-up of primary and secondary prevention services to reduce the population-wide incidence of HIV. However, the impact of these services on HIV incidence has not been demonstrated using a prospectively followed, population-based cohort from South Africa—the country with the world’s highest rate of new infections. To quantify HIV incidence trends in a hyperendemic population, we tested a cohort of 22,239 uninfected participants over 92,877 person-years of observation. We report a 43% decline in the overall incidence rate between 2012 and 2017, from 4.0 to 2.3 seroconversion events per 100 person-years. Men experienced an earlier and larger incidence decline than women (59% vs. 37% reduction), which is consistent with male circumcision scale-up and higher levels of female antiretroviral therapy coverage. Additional efforts are needed to get more men onto consistent, suppressive treatment so that new HIV infections can be reduced among women.

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“…A systematic review by Weine, et al showed that prolonged or frequent absences were among the most frequently cited determinants of HIV risk in studies involving labor migrants [ 30 ]. Indeed, length of time spent away from home has been shown to be a strong predictor of HIV positive status in several international settings [ 31 – 33 ]. A previous study based on large surveys of male migrants in the Russian Federation has found that difficulty in accessing healthcare services and limited health education contributed to Tajik migrants’ HIV vulnerability [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Association between time spent in the Russian Federation and late presentation for HIV among Tajikistani migrants

et al. 2020

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Background Between 700 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV among Tajikistani migrants upon their return to Tajikistan. Method This study uses data from the Tajikistan Ministry of Health surveillance system (2006 – 2019). At time of diagnosis, patients are interviewed by staff of AIDS centers, and doctors complete routine intake forms and complete medical exams. Descriptive characteristics of migrants with HIV who had lived in the Russian Federation (n=503) were calculated and compared with those of non-migrants with HIV (n=9519). Missing data were imputed using multiple imputation (predictive means matching, logistic regression imputation, and polytomous regression imputation). Two logistic models were created to model the probability of late presentation for HIV. The first model shows unadjusted associations between predictor variables and late presentation for HIV. The second model shows multivariable associations between significant study variables identified in the univariate model, and late presentation. Results Compared to non-migrants, migrants with HIV are more likely to be from Gorno-Badakhshan region, are less likely to use illicit drugs, and are more likely to have purchased the services of sex workers. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for a Tajikistani migrant with HIV increases by 4.0% (95% CI: 0.3-7.7). The multivariate model showed that when age, sex, and region of origin are held constant, the risk of late presentation for a Tajikistani migrant with HIV increases by 4.0% (95% CI: 0.1-7.8) for each year spent in the Russian Federation. Conclusion The results of this paper suggest that if the Russian Federation were to loosen its restrictions on HIV care for foreign nationals, it might improve the treatment outcomes of migrant laborers. As this analysis is only correlational in nature, further research is needed to explicate the causal pathways of the associations found in the present analysis.

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

Cited by 19 publications

References 35 publications

HIV incidence declines in a rural South African population: a G-imputation approach for inference

HIV incidence declines in a rural South African population: a G-imputation approach for inference

Declines in HIV incidence among men and women in a South African population-based cohort

Association between time spent in the Russian Federation and late presentation for HIV among Tajikistani migrants

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