Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda.
Lancet HIV. 2018 Apr;5(4):e181-e189. doi: 10.1016/S2352-3018(18)30009-2. Epub 2018 Feb 25.
BACKGROUND: In sub-Saharan Africa, migrants typically have higher HIV prevalence than non-migrants; however, whether HIV acquisition typically precedes or follows migration is unknown. We aimed to investigate the risk of HIV after migration in Rakai District, Uganda. METHODS: In a prospective population-based cohort of HIV-negative participants aged 15-49 years in Rakai, Uganda, between April 6, 1999, and Jan 30, 2015, we assessed the association between migration and HIV acquisition. Individuals were classified as recent in-migrants (≤2 years in community), non-recent in-migrants (>2 years in community), or permanent residents with no migration history. The primary outcome was incident HIV infection. We used Poisson regression to estimate incidence rate ratios (IRRs) of HIV associated with residence status with adjustment for demographics, sexual behaviours, and time. Data were also stratified and analysed within three periods (1999-2004, 2005-11, and 2011-15) in relation to the introduction of combination HIV prevention (CHP; pre-CHP, early CHP, and late CHP). FINDINGS: Among 26 995 HIV-negative people who participated in the Rakai Community Cohort Study survey, 15 187 (56%) contributed one or more follow-up visits (89 292 person-years of follow-up) and were included in our final analysis. 4451 (29%) were ever in-migrants and 10 736 (71%) were permanent residents. 841 incident HIV events occurred, including 243 (29%) among in-migrants. HIV incidence per 100 person-years was significantly increased among recent in-migrants compared with permanent residents, for both women (1·92, 95% CI 1·52-2·43 vs 0·93, 0·84-1·04; IRR adjusted for demographics 1·75, 95% CI 1·33-2·33) and men (1·52, 0·99-2·33 vs 0·84, 0·74-0·94; 1·74, 1·12-2·71), but not among non-recent in-migrants (IRR adjusted for demographics 0·94, 95% CI 0·74-1·19 for women and 1·28, 0·94-1·74 for men). Between the pre-CHP and late-CHP periods, HIV incidence declined among permanent resident men (p<0·0001) and women (p=0·002) and non-recent in-migrant men (p=0·031), but was unchanged among non-recent in-migrant women (p=0·13) and recent in-migrants (men p=0·76; women p=0·84) INTERPRETATION: The first 2 years after migration are associated with increased risk of HIV acquisition. Prevention programmes focused on migrants are needed to reduce HIV incidence in sub-Saharan Africa. FUNDING: National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Development, the National Institute for Allergy and Infectious Diseases Division of Intramural Research, National Institutes of Health; the Centers for Disease Control and Prevention; the Bill & Melinda Gates Foundation; and the Johns Hopkins University Center for AIDS Research.
背景:在撒哈拉以南非洲,移民的 HIV 感染率通常高于非移民;然而,HIV 感染是在移民之前还是之后发生尚不清楚。我们旨在调查乌干达拉凯区移民后的 HIV 感染风险。
方法:在乌干达拉凯区一项针对年龄在 15-49 岁之间的 HIV 阴性参与者的前瞻性基于人群的队列研究中,我们评估了移民与 HIV 感染之间的关联。个体被分类为近期移民(≤2 年在社区)、非近期移民(>2 年在社区)或无移民史的常住居民。主要结局是新发 HIV 感染。我们使用泊松回归来估计与居住状况相关的 HIV 感染发生率比(IRR),并调整了人口统计学、性行为和时间因素。数据还按三个时期(1999-2004 年、2005-11 年和 2011-15 年)分层和分析,以了解组合 HIV 预防(CHP;CHP 前、早期 CHP 和晚期 CHP)的引入情况。
结果:在参与拉凯社区队列研究调查的 26995 名 HIV 阴性人群中,有 15187 人(56%)参加了一次或多次随访(89292 人年随访),并纳入了我们的最终分析。4451 人(29%)曾为移民,10736 人(71%)为常住居民。发生了 841 例 HIV 事件,其中包括 243 例(29%)移民。与常住居民相比,近期移民的 HIV 发病率(每 100 人年)明显增加,女性为 1.92(95%CI 1.52-2.43)比 0.93(0.84-1.04);调整人口统计学因素后的 IRR 为 1.75(95%CI 1.33-2.33),男性为 1.52(0.99-2.33)比 0.84(0.74-0.94);1.74(1.12-2.71),而非近期移民的 IRR 调整人口统计学因素后为 0.94(95%CI 0.74-1.19),女性为 0.94(95%CI 0.74-1.19),男性为 1.28(0.94-1.74)。在 CHP 前和晚期 CHP 期间,常住居民男性(p<0.0001)和女性(p=0.002)以及非近期移民男性(p=0.031)的 HIV 发病率下降,但非近期移民女性(p=0.13)和近期移民(男性 p=0.76;女性 p=0.84)的 HIV 发病率没有变化。
结论:移民后的头 2 年与 HIV 感染风险增加相关。需要针对移民制定预防计划,以降低撒哈拉以南非洲的 HIV 发病率。
资助:美国国立卫生研究院精神健康研究所、过敏和传染病研究所、儿童健康和发展研究所、过敏和传染病研究所内部研究分部、美国国立卫生研究院;疾病控制和预防中心;比尔和梅琳达盖茨基金会;约翰霍普金斯大学艾滋病研究中心。
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