Built Environment and HIV Linkage to Care in Rural South Africa

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  • Shangase, N.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Pence, B.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Lippman, S.A.
    • Other Affiliation: University of the Witwatersrand
  • Dufour, M.-S.K.
    • Other Affiliation: University of California, San Francisco
  • Kabudula, C.W.
    • Other Affiliation: University of the Witwatersrand
  • Gómez-Olivé, F.X.
    • Other Affiliation: University of the Witwatersrand
  • Kahn, K.
    • Other Affiliation: University of the Witwatersrand
  • Pettifor, A.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Background: We assessed built environment (residential density, landuse mix and aesthetics) and HIV linkage to care (LTC) among 1,681 (18–49 years-old) residents of 15 Mpumalanga villages, South Africa. Methods: Multilevel models (linear-binomial) were used for the association between built environment, measured using NEWS for Africa, and LTC from a clinical database of 9 facilities (2015–2018). Additionally, we assessed effect-measure modification by universal test-and-treat policy (UTT). Results: We observed, a significant association in the adjusted 3-month probability of LTC for residential density (risk difference (RD)%: 5.6, 95%CI: 1.2–10.1), however, no association for land-use mix (RD%: 2.4, 95%CI: −0.4, 5.2) and aesthetics (RD%: −1.2, 95%CI: −4.5–2.2). Among those diagnosed after UTT, residents of high land-use villages were more likely to link-to-care than those of low land-use villages at 12 months (RD%: 4.6, 95%CI: 1.1–8.1, p < 0.04), however, not at 3 months (RD%: 3.0, 95%CI: −2.1–8.0, p > 0.10). Conclusion: Findings suggest, better built environment conditions (adequate infrastructure, proximity to services etc.) help facilitate LTC. Moreover, UTT appears to have a protective effect on LTC.
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  • Article
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  • In Copyright
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  • Attribution 4.0 International
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  • International Quarterly of Community Health Education
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  • English
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  • 0272-684X
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  • SAGE Publications Inc.

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