|Title||Spatial Distribution and Characteristics of HIV Clusters in Ethiopia.|
|Publication Type||Journal Article|
|Year of Publication||2019|
|Authors||Ying R, Fekadu L, Schackman BR, Verguet S|
|Journal||Trop Med Int Health|
|Date Published||2019 Dec 06|
OBJECTIVES: Ethiopia's HIV prevalence has decreased by 75% in the past 20 years with the implementation of antiretroviral therapy, but HIV transmission continues in high-risk clusters. Identifying the spatial and temporal trends, and epidemiologic correlates, of these clusters can lead to targeted interventions.
METHODS: We used biomarker and survey data from the 2005, 2011, and 2016 Ethiopia Demographic and Health Surveys (DHS). The spatial-temporal distribution of HIV was estimated using the Kulldorff spatial scan statistic, a likelihood-based method for determining clustering. Significant clusters (p<0.05) were identified and compared based on HIV risk factors to non-cluster areas.
RESULTS: In 2005, 2011, and 2016, respectively, 219, 568, and 408 individuals tested positive for HIV. Four HIV clusters were identified, representing 17% of the total population and 43% of all HIV cases. The clusters were centered about Addis Ababa (1), Afar (2), Dire Dawa (3), and Gambella (4). Cluster 1 had higher rates of unsafe injections (4.9% vs. 2.2%, p<0.001) and transactional sex (6.0% vs. 1.6%, p<0.001) than non-cluster regions, but more male circumcision (98.5% vs. 91.3%, p<0.001). Cluster 2 had higher levels of transactional sex (4.9% vs. 1.6%, p<0.01), but lower levels of unsafe injections (0.8% vs. 2.2%, p<0.01). Cluster 3 had fewer individuals with >1 sexual partner (0% vs. 1.7%, p<0.001) and more male circumcision (100% vs. 91.3%, p<0.001). Cluster 4 had less male circumcision (59.1% vs. 91.3%, p<0.01).
CONCLUSIONS: In Ethiopia, geographic HIV clusters are driven by different risk factors. Decreasing the HIV burden requires targeted interventions.
|Alternate Journal||Trop. Med. Int. Health|