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Verfasst von:Bulstra, Caroline A. [VerfasserIn]   i
 Hontelez, Jan [VerfasserIn]   i
 Bärnighausen, Till [VerfasserIn]   i
Titel:Mapping and characterising areas with high levels of HIV transmission in sub-Saharan Africa
Titelzusatz:A geospatial analysis of national survey data
Verf.angabe:Caroline A. Bulstra, Jan A. C. Hontelez, Federica Giardina, Richard Steen, Nico J. D. Nagelkerke, Till Bärnighausen, Sake J. de Vlas
E-Jahr:2020
Jahr:March 6, 2020
Umfang:19 S.
Teil:volume:17
 year:2020
 number:3
 extent:19
Fussnoten:Gesehen am 28.09.2020
Titel Quelle:Enthalten in: Public Library of SciencePLoS medicine
Ort Quelle:Lawrence, Kan. : PLoS, 2004
Jahr Quelle:2020
Band/Heft Quelle:17(2020,3) Artikel-Nummer e1003042, 19 Seiten
ISSN Quelle:1549-1676
Abstract:Background In the generalised epidemics of sub-Saharan Africa (SSA), human immunodeficiency virus (HIV) prevalence shows patterns of clustered micro-epidemics. We mapped and characterised these high-prevalence areas for young adults (15-29 years of age), as a proxy for areas with high levels of transmission, for 7 countries in Eastern and Southern Africa: Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia, and Zimbabwe. Methods and findings We used geolocated survey data from the most recent United States Agency for International Development (USAID) demographic and health surveys (DHSs) and AIDS indicator surveys (AISs) (collected between 2008-2009 and 2015-2016), which included about 113,000 adults—of which there were about 53,000 young adults (27,000 women, 28,000 men)—from over 3,500 sample locations. First, ordinary kriging was applied to predict HIV prevalence at unmeasured locations. Second, we explored to what extent behavioural, socioeconomic, and environmental factors explain HIV prevalence at the individual- and sample-location level, by developing a series of multilevel multivariable logistic regression models and geospatially visualising unexplained model heterogeneity. National-level HIV prevalence for young adults ranged from 2.2% in Tanzania to 7.7% in Mozambique. However, at the subnational level, we found areas with prevalence among young adults as high as 11% or 15% alternating with areas with prevalence between 0% and 2%, suggesting the existence of areas with high levels of transmission Overall, 15.6% of heterogeneity could be explained by an interplay of known behavioural, socioeconomic, and environmental factors. Maps of the interpolated random effect estimates show that environmental variables, representing indicators of economic activity, were most powerful in explaining high-prevalence areas. Main study limitations were the inability to infer causality due to the cross-sectional nature of the surveys and the likely under-sampling of key populations in the surveys. Conclusions We found that, among young adults, micro-epidemics of relatively high HIV prevalence alternate with areas of very low prevalence, clearly illustrating the existence of areas with high levels of transmission. These areas are partially characterised by high economic activity, relatively high socioeconomic status, and risky sexual behaviour. Localised HIV prevention interventions specifically tailored to the populations at risk will be essential to curb transmission. More fine-scale geospatial mapping of key populations,—such as sex workers and migrant populations—could help us further understand the drivers of these areas with high levels of transmission and help us determine how they fuel the generalised epidemics in SSA.
DOI:doi:10.1371/journal.pmed.1003042
URL:Bitte beachten Sie: Dies ist ein Bibliographieeintrag. Ein Volltextzugriff für Mitglieder der Universität besteht hier nur, falls für die entsprechende Zeitschrift/den entsprechenden Sammelband ein Abonnement besteht oder es sich um einen OpenAccess-Titel handelt.

Volltext ; Verlag: https://doi.org/10.1371/journal.pmed.1003042
 Volltext: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003042
 DOI: https://doi.org/10.1371/journal.pmed.1003042
Datenträger:Online-Ressource
Sprache:eng
K10plus-PPN:1733841741
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