Mobility and HIV care engagement: a research agenda

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 highrisk 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.

Characterizing Mobility and its Association with HIV Outcomes in Refugee Settlements in Uganda

“…In our study, we found that men were more likely to spend prolonged periods of time away from the refugee settlement than women. Differences in mobility profiles by sex have also been described by others [ 17 28 29 ]. Apopulation-based study in Kenya and rural Uganda (non-refugee populations) showed that men were more likely to travel for labor reasons, while women more often traveled for other reasons such as care-giving or -seeking, visiting family or friends, and attending a funeral [ 28 ].…”

“…Improving ART access for traveling refugees is also of importance, as evidenced in our study, in which participants reported bringing insufficient ART for their travels, losing ART medication, and having ART stolen during their trip. Currently, accessing services at other facilities may be challenging for mobile populations, as others have reported that official transfer letters are sometimes required in order to do so [ 17 ]. Finally, a proportion of refugees deemed lost to follow-up (LTFU) may have transferred out to other facilities [ 35 ].…”

“…Research among non-refugee populations demonstrates that mobility is associated with lower uptake of HIV testing [ 8 ], an increased likelihood of loss to follow-up or disengagement from care [ 9 10 11 12 ], a higher probability of antiretroviral therapy (ART) non-adherence [ 13 14 ], and lower rates of HIV viral suppression [ 15 16 ]. A recent publication by Thorp et al highlighted the need to unpack the concept of mobility and gain a better understanding of the types of mobility that most impact HIV outcomes, as well as the demographic profiles associated with high-risk mobility [ 17 ]. As conflict and violence continue to rise globally and the impacts of climate change worsen, forced migration will become more prevalent.…”

Migrant men and HIV care engagement in Johannesburg, South Africa

“…This suggests that although these men are not migrants in terms of their birthplace, they are nonetheless mobile in terms of where they have lived throughout their lifetime. Mobility is associated with heightened HIV risk and poor HIV treatment outcomes due to factors such as interruptions in HIV services and challenges transferring clinics [ 64 ]. It will be important for future research to further understand the ways in which mobility and migration overlap in affecting HIV risk and HIV care engagement for men, as well as tease apart the factors that may be uniquely associated with migration or mobility alone.…”

The role of migration networks in the development of Botswana’s generalized HIV epidemic

“…We have discussed the potential impact of mobility on Botswana’s HIV epidemic, and focused on migration, that is, one directional movement in terms of a permanent relocation of residency. This type of migration, by changing an individual’s sexual network and social environment, has been shown to increase the risk of acquiring HIV for both women and men ( Anglewicz et al, 2018 ; Camlin and Charlebois, 2019 ; Dzomba et al, 2019 ; Low et al, 2021 ; Olawore et al, 2018 ; Thorp et al, 2023 ). Short-term mobility (e.g., short-term circular migration, where the trip can range in duration from overnight to an entire season) can also affect HIV transmission dynamics.…”