Associations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies.

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dc.contributor.affiliationCentre for Epidemic Response and Innovation, School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa.
dc.contributor.affiliationDepartment of Civil Engineering, University of Bristol, Bristol, UK.
dc.contributor.affiliationDesmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.
dc.contributor.affiliationDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
dc.contributor.affiliationKheth'Impilo AIDS Free Living, Cape Town, South Africa.
dc.contributor.affiliationNIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK.
dc.contributor.affiliationUK Meteorological Office, Exeter, UK.
dc.contributor.affiliationNewlands Clinic, Harare, Zimbabwe.
dc.contributor.affiliationInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
dc.contributor.affiliationLighthouse Trust, Mzimba, Malawi.
dc.contributor.affiliationDivision of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
dc.contributor.affiliationInstitute of Environmental Science and Geography, University of Potsdam, Potsdam, Germany.
dc.contributor.affiliationDepartment of Civil Engineering and Cabot Institute of the Environment, University of Bristol, Bristol, UK.
dc.contributor.affiliationClimate and Earth Observation Unit, Research Assessment and Monitoring Division, World Food Programme HQ, Rome, Italy.
dc.contributor.affiliationResearch Division, African Population and Health Research Center, Nairobi, Kenya.
dc.contributor.affiliationPopulation Health Sciences, University of Bristol, Bristol, UK. adam.trickey@bristol.ac.uk.
dc.contributor.affiliationHealth Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
dc.contributor.affiliationDepartment of Global Health Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
dc.contributor.affiliationCentre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
dc.contributor.affiliationAfrica Health Research Institute, KwaZulu-Natal, South Africa.
dc.contributor.affiliationICAP at Columbia University, Nakasero, Kampala, Uganda.
dc.contributor.affiliationSchool of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
dc.contributor.affiliationDepartment of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana.
dc.contributor.affiliationDepartment of Global Health and Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
dc.contributor.affiliationPopulation Health Sciences, University of Bristol, Bristol, UK.
dc.contributor.affiliationCentre for Infectious Disease Research in Zambia, Lusaka, Zambia.
dc.contributor.affiliationCIDRZ
dc.contributor.affiliationCentre for Infectious Disease Research in Zambia (CIDRZ)
dc.contributor.authorTrickey A
dc.contributor.authorJohnson LF
dc.contributor.authorFung F
dc.contributor.authorBonifacio R
dc.contributor.authorIwuji C
dc.contributor.authorBiraro S
dc.contributor.authorBosomprah S
dc.contributor.authorChirimuta L
dc.contributor.authorEuvrard J
dc.contributor.authorFatti G
dc.contributor.authorFox MP
dc.contributor.authorVon Groote P
dc.contributor.authorGumulira J
dc.contributor.authorHoward G
dc.contributor.authorJennings L
dc.contributor.authorKiragga A
dc.contributor.authorMuula G
dc.contributor.authorTanser F
dc.contributor.authorWagener T
dc.contributor.authorLow A
dc.contributor.authorVickerman P
dc.date.accessioned2025-05-23T11:40:29Z
dc.date.issued2023-Dec-19
dc.description.abstractBACKGROUND: 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/mm 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/mm 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.
dc.identifier.doi10.1186/s12879-023-08902-9
dc.identifier.urihttps://pubs.cidrz.org/handle/123456789/10193
dc.sourceBMC infectious diseases
dc.titleAssociations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies.

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