DROught, Poverty and HIV drug RESISTance: threat to resilience in vulnerable rural settings


The project explored the relationship between the vulnerability created by drought and the increased risk of HIV drug resistance in the UMkhanyakude district of South Africa where HIV and diarrhoeal diseases are the two leading causes of death.

The hypothesis is that the added stress from drought contributes to HIV-positive individuals prioritising their means of livelihood over their health resulting in poor engagement with care and HIV drug resistance (HIVDR) in the district.

By investigating the increased vulnerability created by drought and poor socioeconomic status this project sought to understand the difficult trade-offs HIV-positive individuals face on a daily basis between health care utilisation and the pursuit of economic sustenance.

Project description

DROP-RESIST was a multi-stakeholder collaboration between the University of Sussex, Institute for Development Studies, Africa Health Research Institute, London School of Hygiene and Tropical Medicine and the University of Lincoln. The project team worked under a network referred to as the HIV Drug Resistance Elimination and Management (H-DREAM) network which was responsible for developing interventions to tackle HIVDR and drought mitigation.
The project investigators include clinical epidemiologists, spatial epidemiologists, public health experts, climate scientist, geographers and social scientists. The study was divided up into the following research steps:


  • Literature analysis: We undertook a secondary analysis of the current body of literature to understand factors that promote HIVDR through a system approach.



  • Quantitative secondary data analysis: We analysed existing data collected as part of AHRI's population intervention platform. Data sources include HIV-positive individuals on antiretroviral therapy (ART) in the government programme, and a recently concluded trial investigating the impact of population ART on HIV incidence in the Hlabisa sub-district in UMkhanyakude.

    i) We explored the impact of drought and seasonality on health care utilisation, using existing health records from AHRI's databases.

    ii)We used spatial epidemiological techniques to map the distribution of diarrhoeal diseases in HIV-positive children and socio-economic status and link these data to the severity of drought in the sub-district and HIV clinical outcomes.


  • Primary data analysis: The team undertook primary investigation of how data relevant to HIVDR collected at the largest clinic in the same community are used to inform policy.

    i) Stakeholders responsible for drought management were interviewed to understand if there were prior drought early warning indicators and disaster preparedness and if the data collected informed policy.

    ii) We also interviewed households affected by drought to assess its economic, social and demographic impact.

This first field study was followed up by an empirical investigation using Q-methodology to explore the perceptions, attitudes and feelings of people who are currently on ART and people who have fallen out of care for different reasons.

The aim of DROP-RESIST was to develop interventions that reduce disengagement from care and the need for trade-offs between economic sustenance and health care utilisation.

Timeline and funding


April 2018-March 2020



Useful links

The team

  • Principle Investigator (PI) and Co-Investigators

    Principal Investigator

    • Dr Collins Iwuji, Brighton and Sussex Medical School

    • Professor Deenan Pillay, University College London


    • Dr Anne Roemer-Mahler, School of Global Studies
    • Professor Dominic Kniveton, School of Global Studies
    • Dr Sonja Ayeb-Karlsson, Brighton and Sussex Medical School
    • Professor Bobbie Farsides, Brighton and Sussex Medical School
    • Dr Hayley MacGregor, Institute of Development Studies
    • Professor Janet Seeley, London School of Hygiene and Tropical Medicine & Head of Social Science Research at AHRI, KwaZulu-Natal, South Africa
    • Professor Frank Tanser, University of KwaZulu-Natal, South Africa
    • Kathy Baisley, Senior Statistician, Africa Health Research Institute, KwaZulu-Natal, South Africa
    • Kobus Herbst, Public Health Specialist and Chief Information Officer at Africa Health Research Institute, KwaZulu-Natal, South Africa
  • Collaborators

    AHRI Research Team

    • Dr Kingsley Orievulu (Post-Doctoral Research Fellow)
    • Ms Ursula Ngema (Research Assistant)

Where we worked

Hlabisa, UMkhanyakude district of South Africa.