ArticleJournal of global health2014
Evidence for localised HIV related micro-epidemics associated with the decentralised provision of antiretroviral treatment in rural South Africa: a spatio-temporal analysis of changing mortality patterns (2007-2010).
Article in Journal of global health, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed.
- Spatial distribution and determinants of HIV high burden in the Southern African sub-region.PloS one · 2024Article
- 'Sometimes it is not about men': Gendered and generational discourses of caregiving HIV transmission in a rural South African setting.Global public health · 2022Article
- Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019.BMC public health · 2022Article
- From "Secret" to "Sensitive Issue": Shifting Ideas About HIV Disclosure Among Middle-Aged and Older Rural South Africans in the Era of Antiretroviral Treatment.Journal of aging and health · 2022Article
- "A NOWADAYS DISEASE": HIV/AIDS AND SOCIAL CHANGE IN A RURAL SOUTH AFRICAN COMMUNITY.AJS; American journal of sociology · 2021Article
- Clusters of HIV Risk and Protective Sexual Behaviors in Agincourt, Rural South Africa: Findings from the Ha Nakekela Population-Based Study of Ages 15 and Older.Archives of sexual behavior · 2020Article
- How to "Live a Good Life": Aging and HIV Testing in Rural South Africa.Journal of aging and health · 2019Article
- Geographic Information Systems, spatial analysis, and HIV in Africa: A scoping review.PloS one · 2019Article
- Sexual behavior and HIV risk across the life course in rural South Africa: trends and comparisons.AIDS care · 2018Article
- Finding Hidden HIV Clusters to Support Geographic-Oriented HIV Interventions in Kenya.Journal of acquired immune deficiency syndromes (1999) · 2018Article
- Identifying 'corridors of HIV transmission' in a severely affected rural South African population: a case for a shift toward targeted prevention strategies.International journal of epidemiology · 2018Article
- Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001-13: a population surveillance analysis.The Lancet. Global health · 2017Article
- Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993-2013.BMC public health · 2017Article
- Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study.The lancet. HIV · 2016Observational
- The development of a localised HIV epidemic and the associated excess mortality burden in a rural area of South Africa.Global health, epidemiology and genomics · 2016Article
- Genotypic Variability of HIV-1 Reverse Transcriptase Gene from Long-Term Antiretroviral-Experienced Patients in Kenya.AIDS research and human retroviruses · 2015Article
- Targeting HIV services to male migrant workers in southern Africa would not reverse generalized HIV epidemics in their home communities: a mathematical modeling analysis.International health · 2015Article
- Determinants of the risk of dying of HIV/AIDS in a rural South African community over the period of the decentralised roll-out of antiretroviral therapy: a longitudinal study.Global health action · 2014Article
- Two decades of mortality change in rural northeast South Africa.Global health action · 2014Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundIn this study we analysed the spatial and temporal changes in patterns of mortality over a period when antiretroviral therapy (ART) was rolled out in a rural region of north-eastern South Africa. Previous studies have identified localised concentrated HIV related sub-epidemics and recommended that micro-level analyses be carried out in order to direct focused interventions.
methodsData from an ongoing health and socio-demographic surveillance study was used in the analysis. The follow-up was divided into two periods, 2007-2008 and 2009-2010, representing the times immediately before and after the effects on mortality of the decentralised ART provision from a newly established local health centre would be expected to be evident. The study population at the start of the analysis was approximately 73 000 individuals. Data were aggregated by village and also using a 2 × 2 km grid. We identified villages, grid squares and regions in the site where mortality rates within each time period or rate ratios between the periods differed significantly from the overall trends. We used clustering techniques to identify cause-specific mortality hotspots.
findingsComparing the two periods, there was a 30% decrease in age and gender standardised adult HIV-related and TB (HIV/TB) mortality with no change in mortality due to other causes. There was considerable spatial heterogeneity in the mortality patterns. Areas separated by 2 to 4 km with very different epidemic trajectories were identified. There was evidence that the impact of ART in reducing HIV/TB mortality was greatest in communities with higher mortality rates in the earlier period.
conclusionsThis study shows the value of conducting high resolution spatial analyses in order to understand how local micro-epidemics contribute to changes seen over a wider area. Such analyses can support targeted interventions.
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