HIV incidence among non-migrating persons following a household migration event: a population-based, longitudinal study in Uganda

  1. R. Young
  2. J. Ssekasanvu
  3. J. Kagaayi
  4. R. Ssekubugu
  5. G. Kigozi
  6. S.J. Reynolds
  7. M.J. Wawer
  8. B.A.S. Nonyane
  9. Betty Nantume
  10. Thomas C. Quinn
  11. Aaron A.R. Tobian
  12. John Santelli
  13. L.W. Chang
  14. C.E. Kennedy
  15. L. Paina
  16. P.A. Anglewicz
  17. D. Serwadda
  18. F. Nalugoda
  19. M.K. Grabowski

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Abstract

Background

The impact of migration on HIV risk among non-migrating household members is poorly understood. We measured HIV incidence among non-migrants living in households with and without migrants in Uganda.

Methods

We used four survey rounds of data collected from July 2011–May 2018 from non-migrant participants aged 15–49 years in the Rakai Community Cohort Study, an open, population-based cohort. Non-migrants were individuals with no evidence of migration between surveys or at the prior survey. The primary exposure, household migration, was assessed using census data and defined as ≥1 household member migrating in or out of the house from another community between surveys (∼18 months). Incident HIV cases tested positive following a negative result at the preceding visit. Incidence rate ratios (IRR) with 95% confidence intervals were estimated using Poisson regression with generalized estimating equations and robust standard errors. Analyses were stratified by gender, migration into or out of the household, and the relationship between non-migrants and migrants (i.e., any household migration, spouse, child).

Findings

Overall, 11,318 non-migrants (5,674 women) were followed for 37,320 person-years. 28% (6,059/21,370) of non-migrant person-visits had recent migration into or out of the household, and 240 HIV incident cases were identified in non-migrating household members. Overall, non-migrants in migrant households were not at greater risk of acquiring HIV. However, HIV incidence among men was significantly higher when the spouse had recently migrated in (adjIRR:2·12;95%CI:1·05-4·27) or out (adjIRR:4·01;95%CI:2·16-7·44) compared to men with no spousal migration. Women with in- and out-migrant spouses also had higher HIV incidence, but results were not statistically significant.

Interpretation

HIV incidence is higher among non-migrating persons with migrant spouses, especially men. Targeted HIV testing and prevention interventions such as pre-exposure prophylaxis could be considered for those with migrant spouses.

Funding

National Institutes of Health, US Centers for Disease Control and Prevention

Research in context

We searched PubMed for studies focused on HIV acquisition, prevalence or sexual behaviors among non-migrants who lived with migrants in sub-Saharan Africa (SSA) using search terms such as “HIV”, “Emigration and Immigration”, “family”, “spouses”, “household”, “parents”, and “children”. Despite high levels of migration and an established association with HIV risk in SSA, there is limited data on the broader societal impacts of migration on HIV acquisition risk among non-migrant populations directly impacted by it.

There has been only one published study that has previously evaluated impact of migration on HIV incidence among non-migrating persons in sub-Saharan Africa. This study, which exclusively assessed spousal migration, was conducted in Tanzania more than two decades earlier prior to HIV treatment availability and found that non-migrant men with long-term mobile partners were more than four times as likely to acquire HIV compared to men who had partners that were residents. To the best of our knowledge, this is the first study to examine the effect of non-spousal migration, including any household migration and child migration, on HIV incidence among non-migrants

Added value of this study

In this study, we used data from the Rakai Community Cohort Study (RCCS), a population-based HIV surveillance cohort to measure the impact of migration on HIV incidence for non-migrant household members. The RCCS captures HIV incident events through regular, repeat HIV testing of participants and migration events through household censuses. Our study adds to the current literature by examining the general effect of migration in the household on HIV incidence in addition to child, and spousal migration. Using data from over 11,000 non-migrant individuals, we found that spousal, but not other types of household migration, substantially increased HIV risk among non-migrants, especially among men. Taken together, our results suggest that spousal migration may be associated with an increased risk of HIV acquisition in the period surrounding and immediately after spousal migration.

Implications of all the available evidence

Our findings suggest that spousal migration in or out of the household is associated with greater HIV incidence. Targeted HIV testing and prevention interventions such as pre-exposure prophylaxis could be considered for men with migrant spouses.

Article activity feed

  1. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/10065255.

    Does the introduction explain the objective of the research presented in the preprint? Yes The introduction clearly states the research question of the preprint and also provides background knowledge on the topic.
    Are the methods well-suited for this research? Highly appropriate The methods of this study are well laid out and include an appropriate sample size, length of observation, testing methods, and integration of appropriate outside data (US census).
    Are the conclusions supported by the data? Highly supported The outcome of the research demonstrating that "HIV incidence is higher among non-migrating persons with migrant spouses, especially men. Targeted HIV testing and prevention interventions such as pre-exposure prophylaxis could be considered for those with migrant spouses", is highly supported by the method's results.
    Are the data presentations, including visualizations, well-suited to represent the data? Highly appropriate and clear Yes, all results and key patterns in the data are clearly communicated.
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Very clearly Yes, the authors discuss, explain and interpret their findings multiple times, very clearly. Additionally, they pose further steps in stating "targeted HIV testing and prevention interventions such as pre-exposure prophylaxis could be considered for men with migrant spouses".
    Is the preprint likely to advance academic knowledge? Highly likely Yes, this research will help decrease HIV prevalence in households where one spouse is migrating.
    Would it benefit from language editing? No The language is clear.
    Would you recommend this preprint to others? Yes, it's of high quality The research is robust and the findings are clearly communicated.
    Is it ready for attention from an editor, publisher or broader audience? Yes, as it is

    Competing interests

    The author declares that they have no competing interests.

  2. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/10065249.

    Does the introduction explain the objective of the research presented in the preprint? Yes
    Are the methods well-suited for this research? Highly appropriate
    Are the conclusions supported by the data? Highly supported
    Are the data presentations, including visualizations, well-suited to represent the data? Somewhat appropriate and clear
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Very clearly
    Is the preprint likely to advance academic knowledge? Highly likely
    Would it benefit from language editing? No
    Would you recommend this preprint to others? Yes, it's of high quality
    Is it ready for attention from an editor, publisher or broader audience? Yes, as it is

    Competing interests

    The author declares that they have no competing interests.

  3. Version published to 10.1101/2023.09.23.23295865v1 on medRxiv