Geographic Mobility and HIV Care Engagement among People Living with HIV in Rural Kenya and Uganda.

Autor:	Ayieko J; Kenya Medical Research Institute, Center for Microbiology Research, Nairobi 00200, Kenya., Thorp M; Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA., Getahun M; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA., Gandhi M; Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA., Maeri I; Kenya Medical Research Institute, Center for Microbiology Research, Nairobi 00200, Kenya., Gutin SA; Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA 94143, USA., Okiring J; Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda., Kamya MR; School of Medicine, Makerere University, Kampala P.O. Box 7072, Uganda., Bukusi EA; Kenya Medical Research Institute, Center for Microbiology Research, Nairobi 00200, Kenya., Charlebois ED; Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA., Petersen M; Division of Biostatistics, University of California, Berkeley, CA 94720, USA., Havlir DV; Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA., Camlin CS; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143, USA., Murnane PM; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA.; Institute for Global Health Sciences, University of California, San Francisco, CA 94143, USA.
Jazyk:	angličtina
Zdroj:	Tropical medicine and infectious disease [Trop Med Infect Dis] 2023 Nov 10; Vol. 8 (11). Date of Electronic Publication: 2023 Nov 10.
DOI:	10.3390/tropicalmed8110496
Abstrakt:	Introduction: Human mobility is a critical aspect of existence and survival, but may compromise care engagement among people living with HIV (PLHIV). We examined the association between various forms of human mobility with retention in HIV care and antiretroviral treatment (ART) interruptions. Methods: In a cohort of adult PLHIV in Kenya and Uganda, we collected surveys in 2016 about past 6-month travel and lifetime migration histories, including reasons and locations, and engagement in HIV care defined as (1) discontinuation of care, and (2) history of a treatment interruption among those who remained in care. We estimated associations between mobility and these care engagement outcomes via logistic regression, adjusted for sex, prior mobility, age, region, marital status, household wealth, and education. Results: Among 1081 participants, 56 (5%) reported having discontinued care; among those in care, 104 (10%) reported treatment interruption. Past-year migration was associated with a higher risk of discontinuation of care (adjusted odds ratio [aOR] 1.98, 95% CI 1.08-3.63). In sex-stratified models, the association was somewhat attenuated in women, but remained robust among men. Past-year migration was associated with reduced odds of having a treatment interruption among men (aOR 0.51, 95% CI 0.34-0.77) but not among women (aOR 2.67, 95% CI 0.78, 9.16). Travel in the past 6 months was not associated with discontinuation of care or treatment interruptions. Conclusions: We observed both negative and protective effects of recent migration on care engagement and ART use that were most pronounced among men in this cohort. Migration can break ties to ongoing care, but for men, who have more agency in the decision to migrate, may foster new care and treatment strategies. Strategies that enable health facilities to support individuals throughout the process of transferring care could alleviate the risk of care disengagement.
Databáze:	MEDLINE
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