RESUMO
Background: Although the human immunodeficiency virus (HIV) is spatially heterogeneous in Ethiopia, current regional estimates of HIV prevalence hide the epidemic's heterogeneity. A thorough examination of the prevalence of HIV infection using district-level data could assist to develop HIV prevention strategies. The aims of this study were to examine the spatial clustering of HIV prevalence in Jimma Zone at district level and assess the effects of patient characteristics on the prevalence of HIV infection. Methods: The 8440 files of patients who underwent HIV testing in the 22 Districts of Jimma Zone between September 2018 and August 2019 were the source of data for this study. The global Moran's index, Getis-Ord Gi* local statistic, and Bayesian hierarchical spatial modelling approach were applied to address the research objectives. Results: Positive spatial autocorrelation was observed in the districts and the local indicators of spatial analysis using the Getis-Ord statistic also identified three districts, namely Agaro, Gomma and Nono Benja, as hotspots, and two districts, namely Mancho and Omo Beyam, as coldspots with 95% and 90% confidence levels, respectively, for HIV prevalence. The results also showed eight patient-related characteristics that were considered in the study were associated with HIV prevalence in the study area. Furthermore, after accounting for these characteristics in the fitted model, there was no spatial clustering of HIV prevalence suggesting the patient characteristics had explained most of the heterogeneity in HIV prevalence in Jimma Zone for the study data. Conclusions: The identification of hotspot districts and the spatial dynamic of HIV infection in Jimma Zone at district level may allow health policymakers in the zone or Oromiya region or at national level to develop geographically specific strategies to prevent HIV transmission. Because clinic register data were used in the study, it is important to use caution when interpreting the results. The results are restricted to Jimma Zone districts and may not be generalizable to Ethiopia or the Oromiya region.
RESUMO
BACKGROUND: The distribution of HIV is not uniform in Ethiopia with some regions recording higher prevalence than others. However, reported regional HIV prevalence estimates mask the heterogeneity of the epidemic within regions. The main purpose of this study was to assess the district differences in HIV prevalence and other factors that affect the prevalence of HIV infection in Jimma zone, Oromia region of Ethiopia. We aimed to identify districts which had higher or lower than zone average HIV prevalence. Such in-depth analysis of HIV data at district level may help to develop effective strategies to reduce the HIV transmission rate. METHODS: Data collected from 8440 patients who were tested for HIV status in government clinics at the 22 Districts between September 2018 to August 2019 in Jimma zone were used for the analyses. A generalized linear mixed effects model with district random effects was applied to assess the factors associated with HIV infection and the best linear unbiased prediction was used to identify districts that had higher or lower HIV infection. Both likelihood and Bayesian methods were considered. RESULTS: The statistical test on district random effects variance suggested the need for district random effects in all the models. The results from applying both methods on full data show that the odds of HIV infection are significantly associated with covariates considered in this study. Disaggregation of prevalence by gender also highlighted the persistent features of the HIV epidemic in Jimma zone. After controlling for covariates effects, the results from both techniques revealed that there was heterogeneity in HIV infection prevalence among districts within Jimma zone, where some of them had higher and some had lower HIV infection prevalence compared to the zone average HIV infection prevalence. CONCLUSIONS: The study recommends government to give attention to those districts which had higher HIV infection and to conduct further research to improve their intervention strategies. Further, related to those districts which had lower infection, it would be advantageous to identify reasons for their performance and may apply them to overcome HIV infection among residents in those districts which had higher HIV infection. The approach used in this study can also help to assess the effect of interventions introduced by the authorities to control the epidemic and it can easily be extended to assess the regions HIV infection rate relative to the rate at the national level, or zones HIV infection rate relative to the rate at a region level.
