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.
ART scale-up
Female migrants
Migration intensity
New HIV infections
Risk of HIV acquisition
South Africa
Universal test and treat
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
14 Feb 2019
14 Feb 2019
Historique:
received:
15
08
2018
accepted:
29
01
2019
entrez:
16
2
2019
pubmed:
16
2
2019
medline:
10
4
2019
Statut:
epublish
Résumé
Despite increased antiretroviral therapy (ART) coverage, the incidence of HIV infection among women in rural South Africa remains high. While many socio-demographic and behavioral factors have been identified, the effect of female migration intensity on the risk of HIV acquisition before and after ART scale-up has not been evaluated in the country. We followed 13,315 female participants aged 15-49 who were HIV-uninfected at baseline and recorded their migration events between 2004 and 2015. Using a Cox proportional hazard model, we estimated the time to HIV acquisition among the women, adjusting for annual migration intensity (high: ≥2 events/year, moderate = 1 event/year, and low = 0 event/year) before and after ART scale-up in 2010. 1998 (15%) new HIV-infection events were recorded during the observation period. Overall, high migration intensity was associated with an increased HIV acquisition risk among women when compared with low migration intensity (HR = 2.88, 95% CI: 1.56-5.53). Among those with high migration intensity, the risk of HIV acquisition was significantly lower in the post-ART period compared to the pre-ART period, after controlling for key socio-demographic and behavioural covariates (aHR = 0.18, 95% CI 0.04-0.83). Women who migrated frequently after ART scale-up had a significantly reduced HIV acquisition risk compared to those before its implementation. While this reduction is encouraging, women who migrate frequently remain at high risk of HIV acquisition. In the era of ART, there remains a critical need for public health interventions to reduce the risk of HIV acquisition in this highly vulnerable population.
Sections du résumé
BACKGROUND
BACKGROUND
Despite increased antiretroviral therapy (ART) coverage, the incidence of HIV infection among women in rural South Africa remains high. While many socio-demographic and behavioral factors have been identified, the effect of female migration intensity on the risk of HIV acquisition before and after ART scale-up has not been evaluated in the country.
METHODS
METHODS
We followed 13,315 female participants aged 15-49 who were HIV-uninfected at baseline and recorded their migration events between 2004 and 2015. Using a Cox proportional hazard model, we estimated the time to HIV acquisition among the women, adjusting for annual migration intensity (high: ≥2 events/year, moderate = 1 event/year, and low = 0 event/year) before and after ART scale-up in 2010.
RESULTS
RESULTS
1998 (15%) new HIV-infection events were recorded during the observation period. Overall, high migration intensity was associated with an increased HIV acquisition risk among women when compared with low migration intensity (HR = 2.88, 95% CI: 1.56-5.53). Among those with high migration intensity, the risk of HIV acquisition was significantly lower in the post-ART period compared to the pre-ART period, after controlling for key socio-demographic and behavioural covariates (aHR = 0.18, 95% CI 0.04-0.83).
CONCLUSIONS
CONCLUSIONS
Women who migrated frequently after ART scale-up had a significantly reduced HIV acquisition risk compared to those before its implementation. While this reduction is encouraging, women who migrate frequently remain at high risk of HIV acquisition. In the era of ART, there remains a critical need for public health interventions to reduce the risk of HIV acquisition in this highly vulnerable population.
Identifiants
pubmed: 30764786
doi: 10.1186/s12889-019-6494-x
pii: 10.1186/s12889-019-6494-x
pmc: PMC6376673
doi:
Substances chimiques
Anti-Retroviral Agents
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
196Subventions
Organisme : National Institutes of Health
ID : R01HD084233
Organisme : NICHD NIH HHS
ID : R01 HD084233
Pays : United States
Organisme : Academy of Medical Sciences
ID : NA150161
Organisme : South African Medical Research Council
ID : MRC-RFA-UFSP-01-2013/UKZN HIVEPI
Organisme : NIAID NIH HHS
ID : R01 AI124389
Pays : United States
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : National Institutes of Health
ID : R01AI124389
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