Discipline of Public Health Medicine, Africa Health Research Institute(AHRI), University of KwaZulu-Natal, KwaZulu-Natal Province, K-RITH Tower Building, 719 Umbilo Road, Private Bag X7, Congella, Durban, South Africa.
KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa.
BMC Public Health. 2022 Jun 7;22(1):1141. doi: 10.1186/s12889-022-13526-w.
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.
全球范围内，南非拥有最多的艾滋病毒感染者（PLHIV），其独特的内部劳动力迁移遗产继续成为该地区疫情的主要驱动因素，中断了治疗即预防的努力。本研究利用 2005 年至 2017 年期间基于人群的监测数据，考察了南非夸祖鲁-纳塔尔省农村地区的迁移水平、趋势和预测因素。我们对 69604 名 15-49 岁的成年参与者进行了随访，并在 525397 次观察中记录了他们在 423038 人年中的迁移事件（即从监测地区迁出）。我们使用多失效 Cox 回归模型来衡量社会人口因素（年龄、性别、教育程度、婚姻状况、艾滋病毒和社区抗逆转录病毒治疗（ART）覆盖率）对迁移的风险。总体而言，在随访期间，69%的人群队列经历了至少一次迁移事件。女性和男性的平均迁移发生率分别为每 100 人年 9.96 次和 13.23 次。女性和男性的迁移率均从 2005 年至 2008 年下降，然后在 2012 年达到峰值。在调整其他协变量后，20-24 岁的年轻女性比 40 岁及以上的女性（调整后的危险比[aHR]为 3.37，95%置信区间[CI]为 3.19-3.57）和 20-24 岁的年轻男性比 40 岁及以上的男性（aHR 为 2.86，95%CI 为 2.69-3.04）的迁移风险高 3.4 倍和 2.9 倍。社区 ART 覆盖率每增加 1%，女性（aHR 为 0.91，95%CI 为 0.83-0.99）和男性（aHR 为 0.73，95%CI 为 0.66-0.82）的迁移风险分别降低 9%和 27%。包括艾滋病毒感染者在内的年轻未婚女性的迁移幅度与男性相似，随着时间的推移，随着 ART 覆盖率的提高，这种情况有所减少，这反映了在高流动性时代，改善空间内的艾滋病毒服务在减少外迁方面发挥了作用。深入了解迁移人口的特征，为确定和解决艾滋病毒预防和护理连续体中的差距提供了关键信息。
