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

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 i...

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Autores principales: Dzomba, Armstrong, Kim, Hae-Young, Tomita, Andrew, Vandormael, Alain, Govender, Kaymarlin, Tanser, Frank
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9175358/
https://www.ncbi.nlm.nih.gov/pubmed/35672845
http://dx.doi.org/10.1186/s12889-022-13526-w
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author Dzomba, Armstrong
Kim, Hae-Young
Tomita, Andrew
Vandormael, Alain
Govender, Kaymarlin
Tanser, Frank
author_facet Dzomba, Armstrong
Kim, Hae-Young
Tomita, Andrew
Vandormael, Alain
Govender, Kaymarlin
Tanser, Frank
author_sort Dzomba, Armstrong
collection PubMed
description 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.  SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-13526-w.
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spelling pubmed-91753582022-06-09 Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017) Dzomba, Armstrong Kim, Hae-Young Tomita, Andrew Vandormael, Alain Govender, Kaymarlin Tanser, Frank BMC Public Health Research 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.  SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-13526-w. BioMed Central 2022-06-07 /pmc/articles/PMC9175358/ /pubmed/35672845 http://dx.doi.org/10.1186/s12889-022-13526-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Dzomba, Armstrong
Kim, Hae-Young
Tomita, Andrew
Vandormael, Alain
Govender, Kaymarlin
Tanser, Frank
Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)
title Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)
title_full Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)
title_fullStr Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)
title_full_unstemmed Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)
title_short Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)
title_sort predictors of migration in an hiv hyper-endemic rural south african community: evidence from a population-based cohort (2005–2017)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9175358/
https://www.ncbi.nlm.nih.gov/pubmed/35672845
http://dx.doi.org/10.1186/s12889-022-13526-w
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