Migration and first-year maternal mortality among HIV-positive postpartum women: A population-based longitudinal study in rural South Africa

Abstract

Background In South Africa, within-country migration is common. Mobility affects many of the factors in the pathway for entry to or retention in care among people living with HIV. We characterized the patterns of migration (i.e., change in residency) among peripartum women from rural South Africa and their association with first-year postpartum mortality. Methods and findings All pregnant women aged �15 years were followed-up during pregnancy and the first year postpartum in a population-based longitudinal demographic and HIV surveillance program in KwaZulu-Natal, South Africa, from 2000 to 2016. During the household surveys (every 4-6 months), each household head was interviewed to record demographic components of the household, including composition, migration, and mortality. External migration was defined as moving (i.e., change in residency) into or out of the study area. For women of reproductive age, detailed information on new pregnancy and birth was recorded. Maternal death was ascertained via verbal autopsy and HIV status at delivery via annual HIV surveys. We fitted mixed-effects Cox regression models adjusting for multiple pregnancies per individual. Overall, 19,334 women had 30,291 pregnancies: 3,339 were HIV-positive, 10,958 were HIV-negative, and 15,994 had unknown HIV status at delivery. The median age was 24 (interquartile range: 20-30) years. During pregnancy and the first year postpartum, 64% (n = 19,344) and 13% (n = 3,994) did not migrate and resided within and outside the surveillance area, respectively. Of the 23% who had externally migrated at least once, 39% delivered outside the surveillance area. Overall, the mortality rate was 5.8 per 1,000 personyears (or 831 deaths per 100,000 live births) in the first year postpartum. The major causes

Timing of HIV diagnosis relative to pregnancy and postpartum HIV care continuum outcomes among Latin American women, 2000 to 2017

“…Evaluations of retention in care after HIV diagnosis in lowand lower-middle-income settings also currently suggest that youth and general good health, characteristics of most women of reproductive age, are associated with worse care continuum outcomes [22][23][24][25]. Studies from several sub-Saharan African countries found higher risks of LTFU among women who were younger, had a higher CD4, and were pregnant [23,26,27].…”

Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)

“…Other characteristics of the surveillance area include low marital rates (i.e. only 20% of conjugal couples among those 20–29 years were married), late marriages, high partnership dissolution rates among older women and younger men [ 33 – 35 ], multiple sexual partnerships as well as by poor knowledge and disclosure of HIV status [ 33 ]. KwaZulu-Natal Province bears the largest HIV burden in South Africa, with adult HIV prevalence in this region being 36% in 2017 [ 36 ] and disproportionate provision of HIV services particularly in poorer settings [ 37 – 39 ].…”

Predictors of Migration in an HIV Hyper-Endemic Rural South African Community: Evidence From a Population-Based Cohort (2005-2017)

“…Other characteristics of the surveillance area include low marital rates (i.e. only 20% of conjugal couples among those 20-29 years were married), late marriages, high partnership dissolution rates among older women and younger men [35], multiple sexual partnerships as well as by poor knowledge and disclosure of HIV status [34]. KwaZulu-Natal Province bears the largest HIV burden in South Africa, with adult HIV prevalence in this region being 36% in 2017 [36] and disproportionate provision of HIV services particularly in poorer settings [37][38][39].…”