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Built Environment and HIV Linkage to Care in Rural South Africa


Shangase, Nosipho; Pence, Brian W.; Lippman, Sheri A.; Dufour, Mi-Suk Kang; Kabudula, Chodziwadziwa Whiteson; Gómez-Olivé, F. Xavier; Kahn, Kathleen; & Pettifor, Audrey E. (Online ahead of print). Built Environment and HIV Linkage to Care in Rural South Africa. International Quarterly of Community Health Education.


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.


Reference Type

Journal Article

Article Type


Year Published

Online ahead of print

Journal Title

International Quarterly of Community Health Education


Shangase, Nosipho
Pence, Brian W.
Lippman, Sheri A.
Dufour, Mi-Suk Kang
Kabudula, Chodziwadziwa Whiteson
Gómez-Olivé, F. Xavier
Kahn, Kathleen
Pettifor, Audrey E.

Data Set/Study

Tsima Cluster Randomized Trial


South Africa