Built Environment and HIV Linkage to Care in Rural South Africa. Issue 2 (January 2023)

• Record Type: Journal Article
• Authors: Shangase, Nosipho; Pence, Brian; Lippman, Sheri A.; Dufour, Mi-Suk Kang; Kabudula, Chodziwadziwa Whiteson; Gómez-Olivé, F. Xavier; Kahn, Kathleen; Pettifor, Audrey
• Is Part Of: Community health equity research & policy. Volume 43:Issue 2(2023)
• Page Start: 133
• Page End: 141
• Publication Date: 2023-01
• Subjects: HIV linkage to care -- Agincourt Health and Demographic Surveillance System -- built environment -- universal test and treat -- South Africa; Public health -- Periodicals; Health education -- Periodicals; Community health services -- Periodicals; 362.1
• DOI: 10.1177/0272684X211006590
• Languages: English
• ISSNs: 2752-535X

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.