Associations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies.

Autor: Trickey A; Population Health Sciences, University of Bristol, Bristol, UK. adam.trickey@bristol.ac.uk., Johnson LF; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Fung F; Department of Civil Engineering, University of Bristol, Bristol, UK.; UK Meteorological Office, Exeter, UK., Bonifacio R; Climate and Earth Observation Unit, Research Assessment and Monitoring Division, World Food Programme HQ, Rome, Italy., Iwuji C; Africa Health Research Institute, KwaZulu-Natal, South Africa.; Department of Global Health Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK., Biraro S; ICAP at Columbia University, Nakasero, Kampala, Uganda., Bosomprah S; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana., Chirimuta L; Newlands Clinic, Harare, Zimbabwe., Euvrard J; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Fatti G; Kheth'Impilo AIDS Free Living, Cape Town, South Africa.; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa., Fox MP; Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Department of Global Health and Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA., Von Groote P; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Gumulira J; Lighthouse Trust, Mzimba, Malawi., Howard G; Department of Civil Engineering and Cabot Institute of the Environment, University of Bristol, Bristol, UK., Jennings L; Desmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa., Kiragga A; Research Division, African Population and Health Research Center, Nairobi, Kenya., Muula G; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Tanser F; Centre for Epidemic Response and Innovation, School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa.; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa., Wagener T; Institute of Environmental Science and Geography, University of Potsdam, Potsdam, Germany., Low A; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA., Vickerman P; Population Health Sciences, University of Bristol, Bristol, UK.; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2023 Dec 19; Vol. 23 (1), pp. 889. Date of Electronic Publication: 2023 Dec 19.
DOI: 10.1186/s12879-023-08902-9
Abstrakt: Background: Periods of droughts can lead to decreased food security, and altered behaviours, potentially affecting outcomes on antiretroviral therapy (ART) among persons with HIV (PWH). We investigated whether decreased rainfall is associated with adverse outcomes among PWH on ART in Southern Africa.
Methods: Data were combined from 11 clinical cohorts of PWH in Lesotho, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe, participating in the International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration. Adult PWH who had started ART prior to 01/06/2016 and were in follow-up in the year prior to 01/06/2016 were included. Two-year rainfall from June 2014 to May 2016 at the location of each HIV centre was summed and ranked against historical 2-year rainfall amounts (1981-2016) to give an empirical relative percentile rainfall estimate. The IeDEA-SA and rainfall data were combined using each HIV centre's latitude/longitude. In individual-level analyses, multivariable Cox or generalized estimating equation regression models (GEEs) assessed associations between decreased rainfall versus historical levels and four separate outcomes (mortality, CD4 counts < 200 cells/mm 3 , viral loads > 400 copies/mL, and > 12-month gaps in follow-up) in the two years following the rainfall period. GEEs were used to investigate the association between relative rainfall and monthly numbers of unique visitors per HIV centre.
Results: Among 270,708 PWH across 386 HIV centres (67% female, median age 39 [IQR: 32-46]), lower rainfall than usual was associated with higher mortality (adjusted Hazard Ratio: 1.18 [95%CI: 1.07-1.32] per 10 percentile rainfall rank decrease) and unsuppressed viral loads (adjusted Odds Ratio: 1.05 [1.01-1.09]). Levels of rainfall were not strongly associated with CD4 counts < 200 cell/mm 3 or > 12-month gaps in care. HIV centres in areas with less rainfall than usual had lower numbers of PWH visiting them (adjusted Rate Ratio: 0.80 [0.66-0.98] per 10 percentile rainfall rank decrease).
Conclusions: Decreased rainfall could negatively impact on HIV treatment behaviours and outcomes. Further research is needed to explore the reasons for these effects. Interventions to mitigate the health impact of severe weather events are required.
(© 2023. The Author(s).)
Databáze: MEDLINE
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