Nothing about us without us: Community-based participatory research to improve HIV care for mobile patients in Kenya and Uganda

Maeri, Irene; Eyul, Patrick; Getahun, Monica; Hatchett, Khalela; Owino, Lawrence; Akatukwasa, Cecilia; Itiakorit, Harriet; Gutin, Sarah A.; Johnson-Peretz, Jason; Ssali, Sarah; Cohen, Craig R.; Bukusi, Elizabeth A.; Kamya, Moses R.; Charlebois, Edwin D.; Camlin, Carol S.

doi:10.1016/j.socscimed.2022.115471

Cited by 1 publication

(1 citation statement)

References 28 publications

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“…SEARCH was a cluster-randomized trial conducted between 2013 and 2017 in Kenya and Uganda designed to test the effect of universal ART ("test and treat") on HIV incidence and other health outcomes [12]. In 2016, the "Mobility in SEARCH" study enrolled a cohort from 6 control and 6 intervention SEARCH communities via stratified random sampling (defined by gender, HIV status, and prior mobility) to examine the impact of mobility on sexual risk behavior, HIV and sexually transmitted infection incidence, and HIV care engagement [10,11,[13][14][15][16][17]. At enrollment, participants answered detailed questionnaires regarding demographics, lifetime migration histories, and overnight travel in the past 6 months.…”

Section: Study Design and Samplementioning

confidence: 99%

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

Ayieko,

Thorp,

Getahun

et al. 2023

TropicalMed

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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.

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