Coming Home for Faster Treatment: Antiretroviral Treatment and In-Migration Patterns in Rural South Africa

Analia Olgiati, Harvard University

While the South African government is committed to universal antiretroviral treatment (ART) coverage, only 42% of all HIV-positive individuals in need of treatment at the end of 2008 were receiving it. One of the reasons for this is the long waiting lists that many eligible patients face. This study examines to what extent individuals reallocate in their search for easier-to-access ART care. We use a novel data set that links ART and CD4 count records of patients on ART with migration history. Employing Cox proportional hazard models we estimate hazard of enrollment and first contact by migration status. We find that the risk of getting pre-ART or ART care is on average 60% larger for immigrants than for long-time residents. This excess intention to enroll increases three-fold if the immigrant co-resides with someone with previous experience with the programme. The government should consider these additional flows when budgeting additional expansions.