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Kitaw TA, Abate BB, Tilahun BD, Haile RN. Geospatial pattern of HIV seropositivity and its predictors among women in Ethiopia. A spatial and multiscale geographically weighted regression analysis. PLoS One 2024; 19:e0306645. [PMID: 38990932 PMCID: PMC11239007 DOI: 10.1371/journal.pone.0306645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 06/20/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Although promising efforts have been made so far, HIV remains a public health concern. Women in Ethiopia are disproportionately affected by HIV, accounting for a majority of new infections and AIDS-related deaths. However, the geospatial distribution of HIV among women in Ethiopia is not well understood, making it challenging to develop geographically targeted measures. Besides, to accelerate the pathway of decreasing HIV prevalence and plan geographically specific interventions, understanding the geospatial distribution of HIV seropositivity and its predictors among women plays a significant role. METHODS A spatial and multiscale geographically weighted regression analysis was conducted using the 2016 EDHS dataset, comprising 14,778 weighted samples of women in the reproductive age group. The EDHS sample underwent two-stage stratification and selection. The data were extracted between October 18 and 30, 2023. Non-spatial analysis was carried out using STATA version 17. Additionally, ArcGIS Pro and Sat Scan version 9.6 were used to visually map HIV seropositivity. Global Moran's I was computed to evaluate the distribution of HIV seropositivity. The Getis-Ord Gi* spatial statistic was utilized to identify significant spatial clusters of cold and hot spot areas. Geographically weighted regression analysis was subsequently performed to identify significant predictors of HIV seropositivity. Significance was established at a P-value <0.05 throughout all statistical analyses. RESULTS HIV seropositivity among women in Ethiopia is distributed non-randomly (Global Moran's I = 0.16, p-value <0.001 and Z-score = 7.12). Significant hotspot clustering of HIV seropositivity was found in the Addis Ababa, Harari, Dire Dawa, and Gambela region. Poor wealth index, being divorced and widowed, having more than one sexual partner, and early first sexual experience (<15 years) were found to be predictors of geographical variation of HIV seropositivity among women. CONCLUSION HIV seropositivity among women in Ethiopia varies geographically. Thus, deploying additional resources in high hotspot regions is recommended. Programs should focus on improving the economic empowerment of women to prevent the from engaging in risky sexual behaviors. Furthermore, comprehensive sex education programs in schools and community settings regarding the consequences of early first sexual debut might play a role in reducing HIV seropositivity among women in Ethiopia.
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Affiliation(s)
- Tegene Atamenta Kitaw
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Befkad Derese Tilahun
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Ribka Nigatu Haile
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
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Birri Makota R, Musenge E. Spatial heterogeneity in relationship between district patterns of HIV incidence and covariates in Zimbabwe: a multi-scale geographically weighted regression analysis. GEOSPATIAL HEALTH 2023; 18. [PMID: 38010422 DOI: 10.4081/gh.2023.1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/28/2023] [Indexed: 11/29/2023]
Abstract
A study was conducted to investigate the district-level patterns of incidence of the human immunodeficiency virus (HIV) in Zimbabwe in the period 2005-2015 and explore variations in the relationship between covariates and HIV incidence across different districts. Demographic health survey data were analysed using hotspot analysis, spatial autocorrelation, and multi-scale geographically weighted regression (MGWR) techniques. The analysis revealed hotspots of the HIV epidemic in the southern and western regions of Zimbabwe in contrast to the eastern and northern regions. Specific districts in Matabeleland South and Matabeleland North provinces showed clusters of HIV incidence in 2005-2006, 2010-2011 and 2015. Variables studied were multiple sex partners and sexually transmitted infections (STI) condom use and being married. Recommendations include implementing targeted HIV prevention programmes in identified hotspots, prioritising interventions addressing the factors mentioned above as well as enhancing access to HIV testing and treatment services in high-risk areas, strengthening surveillance systems, and conducting further research to tailor interventions based on contextual factors. The study also emphasizes the need for regular monitoring and evaluation at the district level to inform effective responses to the HIV epidemic over time. By addressing the unique challenges and risk factors in different districts, significant progress can be made in reducing HIV transmission and improving health outcomes in Zimbabwe. These findings should be valuable for policymakers in resource allocation and designing evidence-based interventions.
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Affiliation(s)
- Rutendo Birri Makota
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Spatial Co-Clustering of Tuberculosis and HIV in Ethiopia. Diseases 2022; 10:diseases10040106. [PMID: 36412600 PMCID: PMC9680430 DOI: 10.3390/diseases10040106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Tuberculosis (TB) and HIV are epidemiologically associated, and their co-dynamics suggest that the two diseases are directly related at the population level and within the host. However, there is no or little information on the joint spatial patterns of the two diseases in Ethiopia. The main objective of the current study was to assess the spatial co-clustering of TB and HIV cases simultaneously in Ethiopia at the district level. Methods: District-level aggregated data collected from the national Health Management Information System (HMIS) for the years 2015 to 2018 on the number of TB cases enrolled in directly observed therapy, short course (DOTS) who were tested for HIV and the number of HIV patients enrolled in HIV care who were screened for TB during their last visit to health care facilities were used in this study. The univariate and bivariate global and local Moran’s I indices were applied to assess the spatial clustering of TB and HIV separately and jointly. Results: The results of this study show that the two diseases were significantly (p-value <0.001) spatially autocorrelated at the district level with minimum and maximum global Moran’s I values of 0.407 and 0.432 for TB, 0.102 and 0.247 for HIV, and 0.152 and 0.251 for joint TB/HIV. The district-level TB/HIV spatial co-clustering patterns in Ethiopia in most cases overlapped with the hot spots of TB and HIV. The TB/HIV hot-spot clusters may appear due to the observed high TB and HIV prevalence rates in the hot-spot districts. Our results also show that there were low-low TB/HIV co-clusters or cold spots in most of the Afar and Somali regions, which consistently appeared for the period 2015−2018. This may be due to very low notifications of both diseases in the regions. Conclusions: This study expanded knowledge about TB and HIV co-clustering in Ethiopia at the district level. The findings provide information to health policymakers in the country to plan geographically targeted and integrated interventions to jointly control TB and HIV.
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Chimoyi L, Matsena-Zingoni Z, Charalambous S, Marinda E, Manda S, Musenge E. Assessing spatial patterns of HIV prevalence and interventions in semi-urban settings in South Africa. Implications for spatially targeted interventions. GEOSPATIAL HEALTH 2022; 17:10.4081/gh.2022.1084. [PMID: 36047343 PMCID: PMC9892013 DOI: 10.4081/gh.2022.1084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/19/2022] [Indexed: 05/09/2023]
Abstract
Equitable allocation of resources targeting the human immunodeficiency virus (HIV) at the local level requires focusing interventions in areas of the greatest need. Understanding the geographical variation in the HIV epidemic and uptake of selected HIV prevention and treatment programmes are necessary to identify such areas. Individual-level HIV data were obtained from a 2012 national HIV survey in South Africa. Spatial regression models on each outcome measure (HIV infection, sub-optimal condom use or non-anti-retroviral treatment (ART) adjusted for spatial random effects at the ward level were fitted using WINBUGS software. In addition, ward-level data was utilized to estimate condom use coverage and ART initiation rates which were obtained from routinely collected data in 2012. Ordinary Kriging was used to produce smoothed maps of HIV infection, condom use coverage and ART initiation rates. HIV infection was associated with individuals undertaking tertiary education [posterior odds ratio (POR): 19.53; 95% credible intervals (CrI): 3.22- 84.93]. Sub-optimal condom use increased with age (POR: 1.09; 95%CrI: 1.06-1.11) and was associated with being married (POR: 4.14; 95%CrI: 1.23-4.28). Non-ART use was associated with being married (POR: 6.79; 95%CrI: 1.43-22.43). There were clusters with high HIV infection, sub-optimal condom use, and non- ART use in Ekurhuleni, an urban and semi-urban district in Gauteng province, South Africa. Findings show the need for expanding condom programmes and/or strengthening other HIV prevention programmes such as pre-exposure prophylaxis and encouraging sustained engagement in HIV care and treatment in the identified areas with the greatest need in Ekurhuleni Metropolitan Municipality.
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Affiliation(s)
- Lucy Chimoyi
- Implementation Research Division, The Aurum Institute, Johannesburg; School of Public Health, University of the Witwatersrand, Johannesburg.
| | | | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg; School of Public Health, University of the Witwatersrand, Johannesburg.
| | - Edmore Marinda
- School of Public Health, University of the Witwatersrand, Johannesburg; Human Sciences Research Council, Pretoria.
| | - Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria; Department of Statistics, University of Pretoria, Pretoria.
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg.
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Gelibo T, Lulseged S, Eshetu F, Abdella S, Melaku Z, Ajiboye S, Demissie M, Solmo C, Ahmed J, Getaneh Y, Kaydos-Daniels SC, Abate E. Spatial distribution and determinants of HIV prevalence among adults in urban Ethiopia: Findings from the Ethiopia Population-based HIV Impact Assessment Survey (2017–2018). PLoS One 2022; 17:e0271221. [PMID: 35819961 PMCID: PMC9491827 DOI: 10.1371/journal.pone.0271221] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
The design and evaluation of national HIV programs often rely on aggregated
national data, which may obscure localized HIV epidemics. In Ethiopia, even
though the national adult HIV prevalence has decreased, little information is
available about local areas and subpopulations. To inform HIV prevention efforts
for specific populations, we identified geographic locations and drivers of HIV
transmission. We used data from adults aged 15–64 years who participated in the
Ethiopian Population-based HIV Impact Assessment survey (October 2017–April
2018). Location-related information for the survey clusters was obtained from
the 2007 Ethiopia population census. Spatial autocorrelation of HIV prevalence
data were analyzed via a Global Moran’s I test. Geographically weighted
regression analysis was used to show the relationship of covariates. The finding
indicated that uncircumcised men in certain hotspot towns and divorced or
widowed individuals in hotspot woredas/towns might have contributed to the
average increase in HIV prevalence in the hotspot areas. Hotspot analysis
findings indicated that, localized, context-specific intervention efforts
tailored to at-risk populations, such as divorced or widowed women or
uncircumcised men, could decrease HIV transmission and prevalence in urban
Ethiopia.
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Affiliation(s)
- Terefe Gelibo
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
- * E-mail:
| | - Sileshi Lulseged
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
| | - Frehywot Eshetu
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Saro Abdella
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Zenebe Melaku
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
| | - Solape Ajiboye
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Atlanta, GA, United States of
America
| | - Minilik Demissie
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Chelsea Solmo
- ICAP at Columbia University, New York, New York, United States of
America
| | - Jelaludin Ahmed
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Yimam Getaneh
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Susan C. Kaydos-Daniels
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Ebba Abate
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
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Mweemba C, Hangoma P, Fwemba I, Mutale W, Masiye F. Estimating district HIV prevalence in Zambia using small-area estimation methods (SAE). Popul Health Metr 2022; 20:8. [PMID: 35183216 PMCID: PMC8858531 DOI: 10.1186/s12963-022-00286-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The HIV/AIDS pandemic has had a very devastating impact at a global level, with the Eastern and Southern African region being the hardest hit. The considerable geographical variation in the pandemic means varying impact of the disease in different settings, requiring differentiated interventions. While information on the prevalence of HIV at regional and national levels is readily available, the burden of the disease at smaller area levels, where health services are organized and delivered, is not well documented. This affects the targeting of HIV resources. There is need, therefore, for studies to estimate HIV prevalence at appropriate levels to improve HIV-related planning and resource allocation.
Methods
We estimated the district-level prevalence of HIV using Small-Area Estimation (SAE) technique by utilizing the 2016 Zambia Population-Based HIV Impact Assessment Survey (ZAMPHIA) data and auxiliary data from the 2010 Zambian Census of Population and Housing and the HIV sentinel surveillance data from selected antenatal care clinics (ANC). SAE models were fitted in R Programming to ascertain the best HIV predicting model. We then used the Fay–Herriot (FH) model to obtain weighted, more precise and reliable HIV prevalence for all the districts.
Results
The results revealed variations in the district HIV prevalence in Zambia, with the prevalence ranging from as low as 4.2% to as high as 23.5%. Approximately 32% of the districts (n = 24) had HIV prevalence above the national average, with one district having almost twice as much prevalence as the national level. Some rural districts have very high HIV prevalence rates.
Conclusions
HIV prevalence in Zambian is highest in districts located near international borders, along the main transit routes and adjacent to other districts with very high prevalence. The variations in the burden of HIV across districts in Zambia point to the need for a differentiated approach in HIV programming within the country. HIV resources need to be prioritized toward districts with high population mobility.
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Chimoyi L, Chikovore J, Musenge E, Mabuto T, Chetty-Makkan CM, Munyai R, Nchachi T, Charalambous S, Setswe G. Understanding factors influencing utilization of HIV prevention and treatment services among patients and providers in a heterogeneous setting: A qualitative study from South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000132. [PMID: 36962320 PMCID: PMC10021737 DOI: 10.1371/journal.pgph.0000132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
Despite advances made in HIV prevention and treatment interventions in South Africa, barriers to their utilization continue to exist. Understanding perspectives from patients and providers of healthcare can shed light on the necessary strategies to enhance uptake of HIV services. A cross-sectional qualitative study was conducted in July 2020 in Ekurhuleni District. Based on HIV prevalence estimates from a national survey, male condom use coverage and antiretroviral treatment (ART) initiation rates from routinely collected clinical data for 2012, we selected facilities from geographical areas with varying HIV prevalence and uptake of HIV services. In-depth interviews were conducted with adult (≥18 years) patients and healthcare workers in selected primary healthcare facilities. Thematic analysis was performed following a framework built around the social cognitive theory to describe behavioural, personal, and social/environmental factors influencing utilization of HIV services. Behavioural factors facilitating uptake of HIV services included awareness of the protective value of condoms, and the benefits of ART in suppressing viral load and preventing mother-to-child HIV transmission which was evident across geographical areas. Barriers in high prevalence areas included suboptimal condom use, fears of a positive HIV result, and anticipated HIV-related stigma while seeking healthcare services. Across the geographical areas, personal factors included ability to correctly use available services enhanced by knowledge acquired during counselling sessions and community-based health promotion activities. Further, social support from family reinforced engagement in care. Compared to low uptake areas, clinics in high uptake areas used care-facilitators, outreach teams and decanting programs to address the environmental barriers including staff shortages and long queues. Barriers at multiple levels prevent optimal utilization of HIV services, calling for strategies that target and address the different levels and tailored to needs of specific settings. Overall, improved delivery of HIV prevention or treatment interventions can be achieved through strengthening training of healthcare providers in facilities and communities and addressing negative sequelae from utilising services in low uptake areas.
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Affiliation(s)
- Lucy Chimoyi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremiah Chikovore
- Human and Social Capabilities Research Division, Human Sciences Research Council, Durban, South Africa
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tonderai Mabuto
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Candice M Chetty-Makkan
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Reuben Munyai
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Tshegang Nchachi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Geoffrey Setswe
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Nhampossa T, Fernández-Luis S, Fuente-Soro L, Bernardo E, Nhacolo A, Augusto O, Nhacolo A, Sacoor C, Saura-Lázaro A, Lopez-Varela E, Naniche D. The impact of the caregiver mobility on child HIV care in the Manhiça District, Southern Mozambique: A clinical based study. PLoS One 2021; 16:e0261356. [PMID: 34914769 PMCID: PMC8675651 DOI: 10.1371/journal.pone.0261356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Manhiça District, in Southern Mozambique harbors high HIV prevalence and a long history of migration. To optimize HIV care, we sought to assess how caregiver’s mobility impacts children living with HIV (CLHIV)´s continuation in HIV care and to explore the strategies used by caregivers to maintain their CLHIV on antiretroviral treatment (ART). Methods A clinic-based cross-sectional survey conducted at the Manhiça District Hospital between December-2017 and February-2018. We enrolled CLHIV with a self-identified migrant caregiver (moved outside of Manhiça District ≤12 months prior to survey) and non-migrant caregiver, matched by the child age and sex. Survey data were linked to CLHIV clinical records from the HIV care and treatment program. Results Among the 975 CLHIV screened, 285 (29.2%) were excluded due to absence of an adult at the appointment. A total of 232 CLHIV-caregiver pairs were included. Of the 41 (35%) CLHIV migrating with their caregivers, 38 (92.6%) had access to ART at the destination because either the caregivers travelled with it 24 (63%) or it was sent by a family member 14 (36%). Among the 76 (65%) CLHIV who did not migrate with their caregivers, for the purpose of pharmacy visits, 39% were cared by their grandfather/grandmother, 28% by an aunt/uncle and 16% by an adult brother/sister. CLHIV of migrant caregivers had a non-statistically significant increase in the number of previous reported sickness episodes (OR = 1.38, 95%CI: 0.79–2.42; p = 0.257), ART interruptions (OR = 1.73; 95%CI: 0.82–3.63; p = 0.142) and lost-to-follow-up episodes (OR = 1.53; 95%CI: 0.80–2.94; p = 0.193). Conclusions Nearly one third of the children attend their HIV care appointments unaccompanied by an adult. The caregiver mobility was not found to significantly affect child’s retention on ART. Migrant caregivers adopted strategies such as the transportation of ART to the mobility destination to avoid impact of mobility on the child’s HIV care. However this may have implications on ART stability and effectiveness that should be investigated in rural areas.
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Affiliation(s)
- Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde (INS), Maputo, Mozambique
- * E-mail:
| | - Sheila Fernández-Luis
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Laura Fuente-Soro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Edson Bernardo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Serviço Distrital de Saúde, Mulher e Acção Social de Manhiça, Maputo, Mozambique
| | - Arsenio Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anna Saura-Lázaro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Elisa Lopez-Varela
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Denise Naniche
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Barcelona, Spain
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Muttai H, Guyah B, Achia T, Musingila P, Nakhumwa J, Oyoo R, Olweny W, Odeny R, Ohaga S, Agot K, Oruenjo K, Awino B, Joseph RH, Miruka F, Zielinski-Gutierrez E. Mapping geographic clusters of new HIV diagnoses to inform granular-level interventions for HIV epidemic control in western Kenya. BMC Public Health 2021; 21:1926. [PMID: 34688267 PMCID: PMC8542332 DOI: 10.1186/s12889-021-11890-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND As countries make progress towards HIV epidemic control, there is increasing need to identify finer geographic areas to target HIV interventions. We mapped geographic clusters of new HIV diagnoses, and described factors associated with HIV-positive diagnosis, in order to inform targeting of HIV interventions to finer geographic areas and sub-populations. METHODS We analyzed data for clients aged > 15 years who received home-based HIV testing as part of a routine public health program between May 2016 and July 2017 in Siaya County, western Kenya. Geospatial analysis using Kulldorff's spatial scan statistic was used to detect geographic clusters (radius < 5 kilometers) of new HIV diagnoses. Factors associated with new HIV diagnosis were assessed in a spatially-integrated Bayesian hierarchical model. RESULTS Of 268,153 clients with HIV test results, 2906 (1.1%) were diagnosed HIV-positive. We found spatial variation in the distribution of new HIV diagnoses, and identified nine clusters in which the number of new HIV diagnoses was significantly (1.56 to 2.64 times) higher than expected. Sub-populations with significantly higher HIV-positive yield identified in the multivariable spatially-integrated Bayesian model included: clients aged 20-24 years [adjusted relative risk (aRR) 3.45, 95% Bayesian Credible Intervals (CI) 2.85-4.20], 25-35 years (aRR 4.76, 95% CI 3.92-5.81) and > 35 years (aRR 2.44, 95% CI 1.99-3.00); those in polygamous marriage (aRR 1.84, 95% CI 1.55-2.16), or separated/divorced (aRR 3.36, 95% CI 2.72-4.08); and clients who reported having never been tested for HIV (aRR 2.35, 95% CI 2.02-2.72), or having been tested > 12 months ago (aRR 1.53, 95% CI 1.41-1.66). CONCLUSION Our study used routine public health program data to identify granular geographic clusters of higher new HIV diagnoses, and sub-populations with higher HIV-positive yield in the setting of a generalized HIV epidemic. In order to target HIV testing and prevention interventions to finer granular geographic areas for maximal epidemiologic impact, integrating geospatial analysis into routine public health programs can be useful.
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Affiliation(s)
- Hellen Muttai
- Division of Global HIV & TB, United States Centers for Disease Control and Prevention, 00621, Nairobi, Kenya.
| | - Bernard Guyah
- School of Public Health, Maseno University, Kisumu, Kenya
| | - Thomas Achia
- Division of Global HIV & TB, United States Centers for Disease Control and Prevention, 00621, Nairobi, Kenya
| | - Paul Musingila
- Division of Global HIV & TB, United States Centers for Disease Control and Prevention, 00621, Nairobi, Kenya
| | - Jesse Nakhumwa
- Impact Research and Development Organization, Kisumu, Kenya
| | - Rose Oyoo
- Impact Research and Development Organization, Kisumu, Kenya
| | | | | | - Spala Ohaga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | | | - Bob Awino
- Siaya County Department of Health, Siaya, Kenya
| | - Rachael H Joseph
- Division of Global HIV & TB, United States Centers for Disease Control and Prevention, 00621, Nairobi, Kenya
| | - Fredrick Miruka
- Division of Global HIV & TB, United States Centers for Disease Control and Prevention, 00621, Nairobi, Kenya
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Mabuto T, Holzman S, Kubeka G, Hoffmann CJ. Mobile HIV testing in South Africa: maximizing yield through data-guided site selection. Public Health Action 2021; 11:155-161. [PMID: 34567992 DOI: 10.5588/pha.21.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile community HIV testing can effectively reach undiagnosed people living with HIV in southern Africa. Variable yield in HIV test positivity has been a challenge with high- and low-yield sites often being closely situated. We sought to test whether easy-to-identify, site-level characteristics were associated with HIV positivity yield in a routine mobile HIV testing program. METHODS We used routine testing program test data augmented with site-level characterization, either of the community or shopping site at which HIV testing was offered. Specifically, we described the local environment and interviewed key informants to gain additional information regarding the availability of HIV and other services in the locale. RESULTS We included 122 residential and 26 shopping sites with median HIV-positive test yields of 7.6% and 6.9%, respectively. The range for community sites was from 2 to 55% with high and low yields at geographically proximal sites. Factors related to lower income and marginalization, including informal housing and the absence of name-brand stores in shopping venues, were associated with higher HIV-positive testing yield. CONCLUSIONS Characterization of sites, particularly identifying factors related to marginalization, lack of services, and poverty, can aid in identifying sites with higher HIV-positive yield.
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Affiliation(s)
- T Mabuto
- Aurum Institute, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - S Holzman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Kubeka
- Aurum Institute, Johannesburg, South Africa
| | - C J Hoffmann
- Aurum Institute, Johannesburg, South Africa.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Mee P, Rice B, Kabudula CW, Tollman SM, Gómez-Olivé FX, Reniers G. The impact of HIV status on the distance traveled to health facilities and adherence to care. A record-linkage study from rural South Africa. J Glob Health 2021; 10:020435. [PMID: 33312502 PMCID: PMC7719896 DOI: 10.7189/jogh.10.020435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background For people living with HIV (PLWH), the burden of travelling to a clinic outside of one’s home community in order to reduce the level of stigma experienced, may impact adherence to treatment and accelerate disease progression. Methods This study is set in the Agincourt Health and Demographic Surveillance System (HDSS) in South Africa. Probabilistic and interactive methods were used to individually link HDSS data with medical records. A regression analysis was used to assess whether travel distance was correlated with the condition for which individuals were seeking care (primarily HIV, diabetes or hypertension). For PLWH, a Cox proportional hazard regression model was used to test for an association between the distance travelled to the clinic and late attendance at follow-up visits. Results The adjusted relative risk (RR) of travelling to a clinic more than 5 km from that nearest to their home for HIV patients compared to those being treated for other conditions was 2.78 (95% confidence interval (CI) = 2.23-3.48). The adjusted Cox regression model showed no evidence for an association between the distance travelled to a clinic and the rate of late visits. (RR = 1.00, 95% CI = 0.99-1.00). Conclusions The findings were consistent with the hypothesis that people living with HIV/AIDS would be willing to accept the burden of increased clinic travel distances in order to maintain anonymity and so limit their exposure to stigma from fellow community members. For those seeking HIV care the lack of an association between increased travel distances and late visit attendance suggests this may not impact treatment outcomes.
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Affiliation(s)
- Paul Mee
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK.,The MeSH Consortium, London School of Hygiene and Tropical Medicine, London, UK.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian Rice
- The MeSH Consortium, London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Chodziwadziwa Whiteson Kabudula
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Stephen M Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Georges Reniers
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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12
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Hierink F, Okiro EA, Flahault A, Ray N. The winding road to health: A systematic scoping review on the effect of geographical accessibility to health care on infectious diseases in low- and middle-income countries. PLoS One 2021; 16:e0244921. [PMID: 33395431 PMCID: PMC7781385 DOI: 10.1371/journal.pone.0244921] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Geographical accessibility to healthcare is an important component of infectious disease dynamics. Timely access to health facilities can prevent disease progression and enables disease notification through surveillance systems. The importance of accounting for physical accessibility in response to infectious diseases is increasingly recognized. Yet, there is no comprehensive review of the literature available on infectious diseases in relation to geographical accessibility to care. Therefore, we aimed at evaluating the current state of knowledge on the effect of geographical accessibility to health care on infectious diseases in low- and middle-income countries. METHODS AND FINDINGS A search strategy was developed and conducted on Web of Science and PubMed on 4 March 2019. New publications were checked until May 28, 2020. All publication dates were eligible. Data was charted into a tabular format and descriptive data analyses were carried out to identify geographical regions, infectious diseases, and measures of physical accessibility among other factors. Search queries in PubMed and Web of Science yielded 560 unique publications. After title and abstract screening 99 articles were read in full detail, from which 64 articles were selected, including 10 manually. Results of the included publications could be broadly categorized into three groups: (1) decreased spatial accessibility to health care was associated with a higher infectious disease burden, (2) decreased accessibility was associated to lower disease reporting, minimizing true understanding of disease distribution, and (3) the occurrence of an infectious disease outbreak negatively impacted health care accessibility in affected regions. In the majority of studies, poor geographical accessibility to health care was associated with higher disease incidence, more severe health outcomes, higher mortality, and lower disease reporting. No difference was seen between countries or infectious diseases. CONCLUSIONS Currently, policy-makers and scientists rely on data collected through passive surveillance systems, introducing uncertainty on disease estimates for remote communities. Our results highlight the need for increasing integration of geographical accessibility measures in disease risk modelling, allowing more realistic disease estimates and enhancing our understanding of true disease burden. Additionally, disease risk estimates could be used in turn to optimize the allocation of health services in the prevention and detection of infectious diseases.
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Affiliation(s)
- Fleur Hierink
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
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13
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Nutor JJ, Duah HO, Agbadi P, Duodu PA, Gondwe KW. Spatial analysis of factors associated with HIV infection in Malawi: indicators for effective prevention. BMC Public Health 2020; 20:1167. [PMID: 32711500 PMCID: PMC7382788 DOI: 10.1186/s12889-020-09278-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/19/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The objective of this study was to model the predictors of HIV prevalence in Malawi through a complex sample logistic regression and spatial mapping approach using the national Demographic and Health Survey datasets. METHODS We conducted a secondary data analysis using the 2015-2016 Malawi Demographic and Health Survey and AIDS Indicator Survey. The analysis was performed in three stages while incorporating population survey sampling weights to: i) interpolate HIV data, ii) identify the spatial clusters with the high prevalence of HIV infection, and iii) perform a multivariate complex sample logistic regression. RESULTS In all, 14,779 participants were included in the analysis with an overall HIV prevalence of 9% (7.0% in males and 10.8% in females). The highest prevalence was found in the southern region of Malawi (13.2%), and the spatial interpolation revealed that the HIV epidemic is worse at the south-eastern part of Malawi. The districts in the high HIV prevalent zone of Malawi are Thyolo, Zomba, Mulanje, Phalombe and Blantyre. In central and northern region, the district HIV prevalence map identified Lilongwe in the central region and Karonga in the northern region as districts that equally deserve attention. People residing in urban areas had a 2.2 times greater risk of being HIV-positive compared to their counterparts in the rural areas (AOR = 2.16; 95%CI = 1.57-2.97). Other independent predictors of HIV prevalence were gender, age, marital status, number of lifetime sexual partners, extramarital partners, the region of residence, condom use, history of STI in the last 12 months, and household wealth index. Disaggregated analysis showed in-depth sociodemographic regional variations in HIV prevalence. CONCLUSION These findings identify high-risk populations and regions to be targeted for Pre-Exposure Prophylaxis (PrEP) campaigns, HIV testing, treatment and education to decrease incidence, morbidity, and mortality related to HIV infection in Malawi.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, USA.
| | | | - Pascal Agbadi
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Kaboni W Gondwe
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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14
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Holmes CB, Rabkin M, Ford N, Preko P, Rosen S, Ellman T, Ehrenkranz P. Tailored HIV programmes and universal health coverage. Bull World Health Organ 2019; 98:87-94. [PMID: 32015578 PMCID: PMC6986224 DOI: 10.2471/blt.18.223495] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 06/08/2019] [Accepted: 09/06/2019] [Indexed: 12/15/2022] Open
Abstract
Improvements in geospatial health data and tailored human immunodeficiency virus (HIV) testing, prevention and treatment have led to greater microtargeting of the HIV response, based on location, risk, clinical status and disease burden. These approaches show promise for achieving control of the HIV epidemic. At the same time, United Nations Member States have committed to achieving broader health and development goals by 2030, including universal health coverage (UHC). HIV epidemic control will facilitate UHC by averting the need to commit ever-increasing resources to HIV services. Yet an overly targeted HIV response could also distort health systems, impede integration and potentially threaten broader health goals. We discuss current approaches to achieving both UHC and HIV epidemic control, noting potential areas of friction between disease-specific microtargeting and integrated health systems, and highlighting opportunities for convergence that could enhance both initiatives. Examples of these programmatic elements that could be better aligned include: improved information systems with unique identifiers to track and monitor individuals across health services and the life course; strengthened subnational data use; more accountable supply chains that supply a broad range of services; and strengthened community-based services and workforces. We argue that the response both to HIV and to broader health threats should use these areas of convergence to increase health systems efficiency and mitigate the harm of any potential decrease in health funding. Further investments in implementation and monitoring of these programme elements will be needed to make progress towards both UHC and HIV epidemic control.
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Affiliation(s)
- Charles B Holmes
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007, United States of America (USA)
| | - Miriam Rabkin
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | - Nathan Ford
- Department of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Peter Preko
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | - Sydney Rosen
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Tom Ellman
- Medical Department, Médecins Sans Frontières, Cape Town, South Africa
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15
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Schaefer R, Thomas R, Nyamukapa C, Maswera R, Kadzura N, Gregson S. Accuracy of HIV Risk Perception in East Zimbabwe 2003-2013. AIDS Behav 2019; 23:2199-2209. [PMID: 30569314 PMCID: PMC6647479 DOI: 10.1007/s10461-018-2374-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Risk perception for HIV infection is an important determinant for engaging in HIV prevention behaviour. We investigate the degree to which HIV risk perception is accurate, i.e. corresponds to actual HIV infection risks, in a general-population open-cohort study in Zimbabwe (2003-2013) including 7201 individuals over 31,326 person-years. Risk perception for future infection (no/yes) at the beginning of periods between two surveys was associated with increased risk of HIV infection (Cox regression hazard ratio = 1.38 [1.07-1.79], adjusting for socio-demographic characteristics, sexual behaviour, and partner behaviour). The association was stronger among older people (25+ years). This suggests that HIV risk perception can be accurate but the higher HIV incidence (1.27 per 100 person-years) illustrates that individuals may face barriers to HIV prevention behaviour even when they perceive their risks. Gaps in risk perception are underlined by the high incidence among those not perceiving a risk (0.96%), low risk perception even among those reporting potentially risky sexual behaviour, and, particularly, lack of accuracy of risk perception among young people. Innovative interventions are needed to improve accuracy of risk perception but barriers to HIV prevention behaviours need to be addressed too, which may relate to the partner, community, or structural factors.
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Affiliation(s)
- Robin Schaefer
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Ranjeeta Thomas
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Constance Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Noah Kadzura
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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16
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Boyda DC, Holzman SB, Berman A, Grabowski MK, Chang LW. Geographic Information Systems, spatial analysis, and HIV in Africa: A scoping review. PLoS One 2019; 14:e0216388. [PMID: 31050678 PMCID: PMC6499437 DOI: 10.1371/journal.pone.0216388] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Geographic Information Systems (GIS) and spatial analysis are emerging tools for global health, but it is unclear to what extent they have been applied to HIV research in Africa. To help inform researchers and program implementers, this scoping review documents the range and depth of published HIV-related GIS and spatial analysis research studies conducted in Africa. METHODS A systematic literature search for articles related to GIS and spatial analysis was conducted through PubMed, EMBASE, and Web of Science databases. Using pre-specified inclusion criteria, articles were screened and key data were abstracted. Grounded, inductive analysis was conducted to organize studies into meaningful thematic areas. RESULTS AND DISCUSSION The search returned 773 unique articles, of which 65 were included in the final review. 15 different countries were represented. Over half of the included studies were published after 2014. Articles were categorized into the following non-mutually exclusive themes: (a) HIV geography, (b) HIV risk factors, and (c) HIV service implementation. Studies demonstrated a broad range of GIS and spatial analysis applications including characterizing geographic distribution of HIV, evaluating risk factors for HIV, and assessing and improving access to HIV care services. CONCLUSIONS GIS and spatial analysis have been widely applied to HIV-related research in Africa. The current literature reveals a diversity of themes and methodologies and a relatively young, but rapidly growing, evidence base.
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Affiliation(s)
- Danielle C. Boyda
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Samuel B. Holzman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Amanda Berman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, United States of America
| | - M. Kathyrn Grabowski
- Department of Pathology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Larry W. Chang
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- * E-mail:
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17
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Towards UNAIDS Fast-Track goals: targeting priority geographic areas for HIV prevention and care in Zimbabwe. AIDS 2019; 33:305-314. [PMID: 30557161 DOI: 10.1097/qad.0000000000002052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Zimbabwe has made substantial progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) targets of 90-90-90 by 2020, with 73% of people living with HIV diagnosed, 87% of those diagnosed on antiretroviral therapy (ART) and 86% of those on ART virally suppressed. Despite this exceptional response, more effort is needed to completely achieve the UNAIDS targets. Here, we conducted a detailed spatial analysis of the geographical structure of the HIV epidemic in Zimbabwe to include geographical prioritization as a key component of their overall HIV intervention strategy. METHODS Data were obtained from Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2015 as well as estimations from the Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2016 report, and other published literature. Data were used to produce high-resolution maps of HIV prevalence. Using these maps combined with the population density maps, we mapped the HIV-infected population lacking ART coverage and viral suppression. RESULTS HIV maps for both sexes illustrated similar geographical variation of HIV prevalence within the country. HIV-infected populations lacking ART coverage and viral suppression were concentrated in the main cities and urban settlements such as Bulawayo, Harare, Ruwa and Chitungwiza. CONCLUSION Our study showed extensive local variation in HIV disease burden across Zimbabwe for both women and men. The high-resolution maps generated here identified areas wherein high density of HIV-infected individuals are lacking ART coverage and viral suppression. These results suggest that there is need to tailor HIV programmes to address specific local needs to efficiently achieve epidemic control in Zimbabwe.
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18
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Skovdal M, Maswera R, Kadzura N, Nyamukapa C, Rhead R, Wringe A, Gregson S. Parental obligations, care and HIV treatment: How care for others motivates self-care in Zimbabwe. J Health Psychol 2018; 25:2178-2187. [PMID: 30027764 PMCID: PMC7583436 DOI: 10.1177/1359105318788692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article examines how parental obligations of care intersect with HIV treatment-seeking behaviours and retention. It draws on qualitative data from eastern Zimbabwe, produced from 65 interviews. Drawing on theories of practice and care ethics, our analysis revealed that norms of parental obligation and care acted as key motivators for ongoing engagement with HIV services and treatment. Parents' attentiveness to the future needs of their children (caring about), and sense of obligation (taking care of) and improved ability to care (caregiving) following treatment initiation, emerged as central to understanding their drive for self-care and engagement with HIV services.
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Affiliation(s)
| | | | - Noah Kadzura
- Biomedical Research and Training Institute, Zimbabwe
| | - Constance Nyamukapa
- Biomedical Research and Training Institute, Zimbabwe.,Imperial College London, UK
| | | | | | - Simon Gregson
- Biomedical Research and Training Institute, Zimbabwe.,Imperial College London, UK
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19
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Weir SS, Baral SD, Edwards JK, Zadrozny S, Hargreaves J, Zhao J, Sabin K. Opportunities for Enhanced Strategic Use of Surveys, Medical Records, and Program Data for HIV Surveillance of Key Populations: Scoping Review. JMIR Public Health Surveill 2018; 4:e28. [PMID: 29789279 PMCID: PMC5989065 DOI: 10.2196/publichealth.8042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/14/2017] [Accepted: 12/20/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Normative guidelines from the World Health Organization recommend tracking strategic information indicators among key populations. Monitoring progress in the global response to the HIV epidemic uses indicators put forward by the Joint United Nations Programme on HIV/AIDS. These include the 90-90-90 targets that require a realignment of surveillance data, routinely collected program data, and medical record data, which historically have developed separately. OBJECTIVE The aim of this study was to describe current challenges for monitoring HIV-related strategic information indicators among key populations ((men who have sex with men [MSM], people in prisons and other closed settings, people who inject drugs, sex workers, and transgender people) and identify future opportunities to enhance the use of surveillance data, programmatic data, and medical record data to describe the HIV epidemic among key populations and measure the coverage of HIV prevention, care, and treatment programs. METHODS To provide a historical perspective, we completed a scoping review of the expansion of HIV surveillance among key populations over the past three decades. To describe current efforts, we conducted a review of the literature to identify published examples of SI indicator estimates among key populations. To describe anticipated challenges and future opportunities to improve measurement of strategic information indicators, particularly from routine program and health data, we consulted participants of the Third Global HIV Surveillance Meeting in Bangkok, where the 2015 World Health Organization strategic information guidelines were launched. RESULTS There remains suboptimal alignment of surveillance and programmatic data, as well as routinely collected medical records to facilitate the reporting of the 90-90-90 indicators for HIV among key populations. Studies (n=3) with estimates of all three 90-90-90 indicators rely on cross-sectional survey data. Programmatic data and medical record data continue to be insufficiently robust to provide estimates of the 90-90-90 targets for key populations. CONCLUSIONS Current reliance on more active data collection processes, including key population-specific surveys, remains warranted until the quality and validity of passively collected routine program and medical record data for key populations is optimized.
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Affiliation(s)
- Sharon Stucker Weir
- Carolina Population Center, Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Stefan D Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Jessie K Edwards
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Sabrina Zadrozny
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, United States
| | - James Hargreaves
- Department of Social and Environmental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jinkou Zhao
- Technical.Advice and Partnerships Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Keith Sabin
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
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20
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Rhead R, Elmes J, Otobo E, Nhongo K, Takaruza A, White PJ, Nyamukapa CA, Gregson S. Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe. BMJ Open 2018; 8:e018751. [PMID: 29490957 PMCID: PMC5855339 DOI: 10.1136/bmjopen-2017-018751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/01/2017] [Accepted: 11/29/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake. METHODS Data from a household survey conducted in 2009-2011 and a parallel snowball sample survey of FSWs were matched using probability methods to reduce under-reporting of FSWs. HIV treatment cascades were constructed and compared for FSWs (n=174) and NSWs (n=2555). Determinants of service uptake were identified a priori in a theoretical framework and tested using logistic regression. RESULTS HIV prevalence was higher in FSWs than in NSWs (52.6% vs 19.8%; age-adjusted OR (AOR) 4.0; 95% CI 2.9 to 5.5). In HIV-positive women, FSWs were more likely to have been diagnosed (58.2% vs 42.6%; AOR 1.62; 1.02-2.59) and HIV-diagnosed FSWs were more likely to initiate ART (84.9% vs 64.0%; AOR 2.33; 1.03-5.28). No difference was found for antiretroviral treatment (ART) adherence (91.1% vs 90.5%; P=0.9). FSWs' greater uptake of HIV treatment services became non-significant after adjusting for intermediate factors including HIV knowledge and risk perception, travel time to services, physical and mental health, and recent pregnancy. CONCLUSION FSWs are more likely to take up testing and treatment services and were closer to achieving optimal outcomes along the cascade compared with NSWs. However, ART coverage was low in all women at the time of the survey. FSWs' need for, knowledge of and proximity to HIV testing and treatment facilities appear to increase uptake.
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Affiliation(s)
- Rebecca Rhead
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Jocelyn Elmes
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Eloghene Otobo
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Kundai Nhongo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Albert Takaruza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Peter J White
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Imperial College London School of Public Health, London, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - Constance Anesu Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
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Might ART Adherence Estimates Be Improved by Combining Biomarker and Self-Report Data? PLoS One 2016; 11:e0167852. [PMID: 27973550 PMCID: PMC5156419 DOI: 10.1371/journal.pone.0167852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/21/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND As we endeavour to examine rates of viral suppression in PLHIV, reliable data on ART adherence are needed to distinguish between the respective contributions of poor adherence and treatment failure on high viral load. Self-reported data are susceptible to response bias and although biomarker data on drug presence and concentration can provide a superior, alternative method of measurement, complications due to drug-drug interactions and genetic variations can cause some inaccuracies. We investigate the feasibility of combining both biomarker and self-report data to produce a potentially more accurate measure of ART adherence. METHODS Data were taken from a large general-population survey in the Manicaland province, Zimbabwe, conducted in 2009-2011. HIV-infected adults who had initiated ART (N = 560) provided self-report data on adherence and dried blood spot samples that were analysed for traces of ART medication. A new three-category measure of ART adherence was constructed, based on biomarker data but using self-report data to adjust for cases with abnormally low and high drug concentrations due to possible drug-drug interactions and genetic factors, and was assessed for plausibility using survey data on socio-demographic correlates. RESULTS 94.3% (528/560) and 92.7% (519/560) of the sample reported faithful adherence to their medication and had traces of ART medication, respectively. The combined measure estimated good evidence of ART adherence at 69% and excellent evidence of adherence at 53%. The regression analysis results showed plausible patterns of ART adherence by socio-demographic status with men and younger participants being more likely to adhere poorly to medication, and higher socio-economic status individuals and those living in more urban locations being more likely to adhere well. CONCLUSION Biomarker and self-reported measures of adherence can be combined in a meaningful way to produce a potentially more accurate measure of ART adherence. Results indicate that ART adherence in Manicaland is at best 69%, which not only allows for considerable room for improvement but also suggests that the area may be falling short of the UNAIDS' 90% target regarding viral suppression. Increased efforts are needed to improve ART adherence particularly amongst the young male population in rural areas of east Zimbabwe.
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