Abstract
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/mm3, 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/mm3 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.
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/mm3, 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/mm3 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.
| Original language | English |
|---|---|
| Article number | 889 |
| Journal | BMC Infectious Diseases |
| Volume | 23 |
| Issue number | 1 |
| Early online date | 19 Dec 2023 |
| DOIs | |
| Publication status | Published - 19 Dec 2023 |
Bibliographical note
Funding Information:AT acknowledges funding from Wellcome Trust (222770/Z/21/Z). PV acknowledges funding from NIAID and NIDA (R01AI147490, R01DA033679 and R21DA047902), the Wellcome Trust (WT 226619/Z/22/Z), and support from the UK National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science. TW acknowledges funding from the Alexander von Humboldt Foundation in the framework of the Alexander von Humboldt Professorship endowed by the German Federal Ministry of Education and Research.
Funding Information:
This research was funded in whole, or in part, by the Wellcome Trust (222770/Z/21/Z). For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Funding Information:
Research reported in this publication was supported by the U.S. National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Fogarty International Center (FIC) under Award Number U01AI069924. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
We would like to thank all those who contributed data or were involved in data collection. AT acknowledges funding from Wellcome Trust (222770/Z/21/Z). PV acknowledges funding from NIAID and NIDA (R01AI147490, R01DA033679 and R21DA047902), the Wellcome Trust (WT 226619/Z/22/Z), and support from the UK National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science. TW acknowledges funding from the Alexander von Humboldt Foundation in the framework of the Alexander von Humboldt Professorship endowed by the German Federal Ministry of Education and Research. Research reported in this publication was supported by the U.S. National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Fogarty International Center (FIC) under Award Number U01AI069924. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Site investigators and cohorts: Gary Maartens, Aid for AIDS, South Africa; Carolyn Bolton, Center for Infectious Disease Research in Zambia (CIDRZ), Zambia; Robin Wood, Gugulethu (Desmond Tutu HIV Centre), South Africa; Nosisa Sipambo, Harriet Shezi Children’s Clinic, South Africa; Frank Tanser, Collins Iwuji, Hlabisa (Africa Health Research Institute), South Africa; Jonathan Euvrard, Khayelitsha ART Programme, South Africa; Geoffrey Fatti, Kheth’Impilo AIDS Free Living, South Africa; Safari Mbewe, Lighthouse Trust, Malawi; Mazvita Muchengeti, National Cancer Registry (National Health Laboratory Service), South Africa; Cleophas Chimbetete, Newlands Clinic (Ruedi Luethy Foundation Zimbabwe), Zimbabwe; Karl Technau, Rahima Moosa Mother and Child Hospital, South Africa; Brian Eley, Red Cross War Memorial Children’s Hospital, South Africa; Irene Ayakaka, SolidarMed Lesotho; Idivino Rafael, SolidarMed Mozambique; Cordelia Kunzekwenyika, SolidarMed Zimbabwe, Matthew P Fox, Themba Lethu Clinic, South Africa; Hans Prozesky, Tygerberg Hospital, South Africa; Andrew Boulle, Western Cape Provincial Health Data Centre. Data centers: John Andoh, Marie Ballif, Nicolas Banholzer, Cam Ha Dao Ostinelli, Matthias Egger, Lukas Fenner, Nathalie Fernandez, Andreas Haas, Eliane Rohner, Julien Riou, Tiana Schwab, Veronika W Skrivankova, Lilian Smith, Katayoun Taghavi, Per von Groote, Gilles Wandeler, Elizabeth Zaniewski, Institute of Social and Preventive Medicine, University of Bern, Switzerland; Nanina Anderegg, Kim Anderson, Andrew Boulle, Chido Chinogurei, Morna Cornell, Mary-Ann Davies, Leigh Johnson, Reshma Kassanjee, Amohelang Lehloa Nicola Maxwell, Haroon Moolla, Carl Morrow, Patience Nyakato, Gem Patten, Mpho Tlali, Renee de Waal, Wendy Wiemers, Center for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, South Africa.
Funding Information:
PV reports research grants from Gilead unrelated to this work. CI reports research grants and conference attendance support from Gilead Sciences unrelated to this work. All other authors report no conflicts of interest.
Publisher Copyright:
© 2023, The Author(s).
Research Groups and Themes
- Water and Environmental Engineering
