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Predicting High HIV Incidence Areas Using Geospatial Risk Profiles: A National Prospective Cohort Study in Eswatini
20 Pages Posted: 1 Feb 2022More...
Background: The cause of HIV incidence variation in generalized epidemics is poorly understood. We assessed the role of geospatial clustering of HIV risk factors within nationally representative census enumeration areas (EAs) to predict prospectively observed incident infections in the hyperendemic setting of Eswatini.
Methods: A household-based sample of 18,172 adults, ages 18-49 years, from 575 EAs in 2011 was interviewed and received HIV testing. HIV-seronegative adults were retested six months later. Multi-level latent class modeling of seven HIV risk factors was conducted to identify EA risk profiles of composite EA prevalences of HIV risk factors. Generalized linear regression was used to assess whether EA-level HIV seroconversion was associated with EA risk profiles.
Findings: Four EA risk profiles were identified, ranging from lowest (Profile A) to highest (Profile D) risk of new infections. Prevalence of EA-level HIV seroconversion increased across profiles: A (14·3%), B (21·8%), C (24·6%) and D (30·8%). EA-level HIV seroconversion was twofold higher in Profile D than Profile A areas [relative risk 2·13, 95% confidence interval (1·13, 4·00), p=0·02]. The prevalences of unknown partner HIV status and detectable viremia in Profile D were 28% and 24%, respectively, compared to 8% and 31% in Profile A.
Interpretation: In a generalized epidemic, a composite geospatial measure of concurrent HIV risk factors predicted HIV incidence at an EA level. Tailoring HIV prevention interventions to area patterns of HIV risk factors may optimize the impact of national HIV response efforts.
Funding Information: This research was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreement U2GPS002005 (NMP, JJ).
Declaration of Interests: All authors declare no competing interests.
Ethics Approval Statement: The ethical review boards at Columbia University Irving Medical Center, the Eswatini Ministry of Health, and the US Centers for Disease Control and Prevention provided ethical approval.
Keywords: HIV, viremia, viral load, viral suppression, incidence, risk profiles, area risk profiles, geospatial, population-based, risk factor, multi-level latent class analysis
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