HIV incidence among non-migrating persons following a household migration event: a population-based, longitudinal study in Uganda

Background The impact of migration on HIV risk among non-migrating household members is poorly understood. We measured HIV incidence among non-migrants living in households with and without migrants in Uganda. Methods We used four survey rounds of data collected from July 2011-May 2018 from non-migrant participants aged 15-49 years in the Rakai Community Cohort Study, an open, population-based cohort. Non-migrants were individuals with no evidence of migration between surveys or at the prior survey. The primary exposure, household migration, was assessed using census data and defined as 1 or more household members migrating in or out of the house from another community between surveys (~18 months). Incident HIV cases tested positive following a negative result at the preceding visit. Incidence rate ratios (IRR) with 95% confidence intervals were estimated using Poisson regression with generalized estimating equations and robust standard errors. Analyses were stratified by gender, migration into or out of the household, and the relationship between non-migrants and migrants (i.e., any household migration, spouse, child). Findings Overall, 11,318 non-migrants (5,674 women) were followed for 37,320 person-years. 28% (6,059/21,370) of non-migrant person-visits had recent migration into or out of the household, and 240 HIV incident cases were identified in non-migrating household members. Overall, non-migrants in migrant households were not at greater risk of acquiring HIV. However, HIV incidence among men was significantly higher when the spouse had recently migrated in (adjIRR:2.12;95%CI:1.05-4.27) or out (adjIRR:4.01;95%CI:2.16-7.44) compared to men with no spousal migration. Women with in- and out-migrant spouses also had higher HIV incidence, but results were not statistically significant. Interpretation HIV incidence is higher among non-migrating persons with migrant spouses, especially men. Targeted HIV testing and prevention interventions such as pre-exposure prophylaxis could be considered for those with migrant spouses. Funding National Institutes of Health, US Centers for Disease Control and Prevention ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement We thank the cohort participants and many staff and investigators who made this study possible. This work was presented as an e-poster at AIDS 2022 and part of RY's doctoral dissertation. This work was supported by grants from the National Institute of Allergy and Infectious Diseases (grant numbers R01AI114438, R01AI110324, R01AI123002, R01AI128779, R01AI143333, R01AI155080, R01AI087409, U01AI075115, U01AI100031, K25AI114461, K01AI125086), the National Institute of Mental Health (grant number R01MH107275, R01MH105313, R01MH099733, F31MH095649), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R01HD091003, R01HD050180, R01HD070769), the National Institute on Alcohol Abuse and Alcoholism (K01AA024068), the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases, the Bill and Melinda Gates Foundation (grant number OPP1175094), and the President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention (grant number NU2GGH000817). RY was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (grant number 1F31HD102287). We thank the personnel at the Office of Cyberinfrastructure and Computational Biology at the National Institute of Allergy and Infectious Diseases for data management support. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committees and Institutional Review Boards of the Uganda National Council for Science and Technology, Uganda Virus Research Institute, Johns Hopkins School of Medicine, and Western Institutional Review Board gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes A de-identified version of the data can be provided to interested parties subject to completion of the Rakai Health Sciences Program data request form and signing of a Data Transfer Agreement. Inquiries should be directed to datarequests@rhsp.org.