Camlin Carol S, Gutin Sarah A, Charlebois Edwin D, Neilands Torsten B, Balzer Laura B, Petersen Maya L, Chamie Gabriel, Cohen Craig R, Bukusi Elizabeth A, Kamya Moses R, Havlir Diane V, Ayieko James
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Division of Prevention Science, Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
AIDS Behav. 2025 May 6. doi: 10.1007/s10461-025-04743-6.
The complex and dynamic nature of human mobility requires use of multiple measures and sex-stratified analyses to fully understand its influence on HIV acquisition risk in specific populations and settings. Longitudinal population-based studies designed to measure the influence of mobility (which includes both short and long-term, temporary and permanent changes of residence across defined geopolitical boundaries) on HIV acquisition risk are rare, but needed to understand the ongoing challenges that mobility poses to progress in ending HIV. Incidence of HIV acquisition over 3 years was measured in mobile and non-mobile adults in 32 rural communities in three regions of Uganda and Kenya participating in the Sustainable East Africa Research in Community Health (SEARCH) trial (NCT01864603) from 2013-2017. Poisson regression models were used to estimate incidence rate ratios (IRRs) for HIV acquisition among categories of mobile relative to non-mobile adults, with sex-stratified multivariable models adjusted for community clustering using robust estimators. At baseline, 11,337 adult residents (9.7%) reported living at least 1 month outside their community in the past 12 months (8% women, 11.8% men, p < 0.001). By year three, 8502 HIV incidence cohort members (7.3%) had out-migrated (7.7% women, 7.1% men, p = 0.046), and 5747 adults remaining in the cohort (4.9%) reported living at least 1 month outside of their community in past 12 months (4.1% women, 5.9% men, p < 0.001). Over 3 years, the risk of HIV acquisition was 1.9 times higher in those living ≥ 1 month outside their community in the past 12 months compared to those who had not (Adj IRR = 1.88, 95% CI 1.48-2.38). HIV acquisition risk was 42% higher among men who spent some nights away in the past month at baseline (Adj IRR = 1.42, 95% CI 1.11-1.81), but not for women (Adj IRR = 1.06, 95% CI 0.85-1.32). Mobility was significantly associated with a risk of HIV acquisition among adults in rural communities in Kenya and Uganda in 2013-2017. The effect of mobility on HIV incidence varied by both sex and pattern (frequency, duration) of mobility (SEARCH ClinicalTrials.gov number, NCT01864603).
人类流动的复杂性和动态性要求使用多种测量方法和按性别分层的分析，以全面了解其对特定人群和环境中艾滋病毒感染风险的影响。旨在测量流动（包括跨越特定地缘政治边界的短期和长期、临时和永久居住变化）对艾滋病毒感染风险影响的基于人群的纵向研究很少见，但对于了解流动给终结艾滋病毒进程带来的持续挑战是必要的。2013年至2017年，在乌干达和肯尼亚三个地区参与东非社区健康可持续研究（SEARCH）试验（NCT01864603）的32个农村社区中，对流动和非流动成年人进行了为期3年的艾滋病毒感染发生率测量。使用泊松回归模型估计流动成年人类别相对于非流动成年人的艾滋病毒感染发生率比（IRR），采用按性别分层的多变量模型，并使用稳健估计量对社区聚类进行调整。在基线时，11337名成年居民（9.7%）报告在过去12个月中至少有1个月住在其社区之外（女性为8%，男性为11.8%，p<0.001）。到第三年，8502名艾滋病毒感染队列成员（7.3%）已经迁出（女性为7.7%，男性为7.1%，p = 0.046），队列中剩余的5747名成年人（4.9%）报告在过去12个月中至少有1个月住在其社区之外（女性为4.1%，男性为5.9%，p<0.001）。在3年期间，过去12个月中在社区外居住≥1个月的人感染艾滋病毒的风险是未在社区外居住者的1.9倍（调整后的IRR = 1.88，95%置信区间为1.48 - 2.38）。在基线时过去一个月有过在外过夜情况的男性中，艾滋病毒感染风险高42%（调整后的IRR = 1.42，95%置信区间为1.11 - 1.81），但女性没有（调整后的IRR = 1.06，95%置信区间为0.85 - 1.32）。2013年至2017年，在肯尼亚和乌干达的农村社区中，流动与成年人感染艾滋病毒的风险显著相关。流动对艾滋病毒感染发生率的影响因性别和流动模式（频率、持续时间）而异（SEARCH临床试验.gov编号，NCT01864603）。
