Zimbabwean national and PhD graduate, Dr Armstrong Dzomba.

Doctoral Study Assesses Effects of Mobility on HIV Risk

Dr Armstrong Dzomba’s PhD study investigated the effects of mobility on HIV acquisition risk in South Africa. He was supervised by Professor Frank Tanser from the College of Health Sciences and Professor Kaymarlin Govender from the College of Humanities.

‘The study identified the mechanisms behind the complex relationship between mobility, risky sexual practices and HIV acquisition, and is the first to capture the changing epidemiological profile of HIV among those who migrate in a hyper-endemic rural community in South Africa,’ explained Dzomba.

According to Dzomba, South African women are now migrating at a rate similar to men, yet remain an understudied population. The study examined whether female migrants remained at increased risk of HIV infection given the changing HIV treatment/antiretroviral therapy (ART) and prevention landscape, ie, pre-ART (before 2009) and post-ART (2010 onwards).

‘The results demonstrated that ART substantially reduced the risk of HIV acquisition among highly mobile women. During the post-ART scale-up period, the risk of HIV acquisition declined fivefold compared to the pre-ART scale-up period,’ said Dzomba.

According to Dzomba, his study is one of the first to provide conclusive evidence that scale-up of ART in South Africa reduced HIV acquisition risk among female migrants. These results are a strong justification for the use of novel models of differentiated service delivery in the public health system to simplify and adapt HIV services to the needs of mobile people.

‘For example, HIV self-testing and other mobile health solutions across the prevention and treatment cascade for this often-underserved population may help to decongest the health system,’ he said.

Dzomba believes his work has filled a major knowledge gap in the literature regarding the link between migration and HIV acquisition risk in the era of access to ART. He has submitted a joint National Institutes of Health (NIH) grant application to support new research on the use of HIV self-testing (HIVST) to improve outcomes along the HIV cascade for migrants.

‘This will examine the role of technological innovations in reducing the size of the undiagnosed population to the 5% level or below by 2030 in light of the 95-95-95 target in HIV hyper-endemic rural communities in sub-Saharan Africa,’ he said.

Dzomba is currently a postdoctoral fellow at the Medical Research Council/University of the Witwatersrand (MRC/Wits) Unit in the Rural Public Health Transitions Research Unit (Agincourt).

He is grateful to have been supervised by two great professors. ‘I was fortunate to have two supervisors, as I needed all the help I could get!’ He is also grateful to his home country, Zimbabwe, for awarding him a scholarship.

‘The incredible support UKZN offered to graduate students was a real boon. Based in the state-of-the-art lab at the Africa Health Research Institute at the Nelson R Mandela School of Medicine in the beautiful city of Durban, with its sub-tropical weather and stretch of the Indian Ocean coast for occasional Sunday runs, there was no question that UKZN was the place to be throughout my PhD,’ he said.

Words: Nombuso Dlamini

Photograph: Supplied