A collaborative study, recently published in the prestigious journal Plos Medicine and conducted amongst scientists from UKZN/Africa Health Research Institute (AHRI), the United States and the United Kingdom has linked migration to a high rate of mortality amongst HIV positive women, up to a year after giving birth. The findings of this study are significant given that mobility within South Africa is common.
Lead authors of the study, Dr Hae-Young Kim from UKZN’s KRISP/ AHRI and Honorary Professor in the School of Nursing and Public Health, Frank Tanser indicated that the study was conducted due to the lack of information about within-country mobility patterns among peripartum women and their associated maternal health outcomes. Kim said, ‘Migration is a risk factor for poor retention in care among people living with HIV. HIV-positive women who initiate or continue life-long antiretroviral treatment (ARV) during pregnancy face unique challenges to remain in HIV care in the postpartum period, potentially leading to worse health outcomes including death.
The study was based on data from one of the largest population-based longitudinal HIV and demographic surveys managed by AHRI. Study participants were females from the age of 15 who resided within the survey area. Overall, 19,334 women had 30 291 pregnancies and 3 339 of those were HIV-positive, 10 958 were HIV-negative, and 15 994 had an unknown HIV status at delivery. The study found that the mortality rate was 5.8 per 1000 person-years (or 831 deaths per 100,000 live births) in the first year postpartum. The major causes of deaths were AIDS- or TB-related conditions both within 42 days of delivery (53%) and during the first year postpartum (62%).
Kim said, ‘In this study, we found that a substantial portion of peripartum women moved within-country around the time of delivery and experienced a significantly higher risk of mortality. Despite the scale-up of universal ART and declining trends in maternal mortality, there is an urgent need to develop a greater understanding of the mechanisms underlying this finding and the development of targeted interventions for mobile HIV-positive peripartum women.’