Abstract
Background: Previous geographic studies of HIV infection have usually used prevalence data, which cannot indicate the hot-spot areas of current transmission. To develop quantitative analytic measures for accurately identifying hot-spot areas in growth of new HIV infection, we investigated the geographic distribution features of recent HIV infection and long-term HIV infection using data from a whole-population physical examination in four key counties in Liangshan prefecture, which are most severely affected by HIV in China.Methods: Through a whole-population physical examination during November 2017- June 2018 in the four key counties, a total of 5,555 HIV cases were diagnosed and 246 cases were classified as recently infected by laboratory HIV recency tests. The geospatial patterns of recent and long-term HIV infected cases were compared using ordinary least squares regression and Geodetector. Further, geospatial-heterogeneity was quantified and indicated using a residual map to visualize hot-spot areas where new infection is increasing.Results: The geographic location of HIV cases showed an uneven distribution along major roads and clustered at road intersections. The geographic mapping showed that several areas were clustered with more recently infected HIV cases than long-term infected cases. The quantitative analyses showed that the geospatial asymmetry between recent and long-term HIV infection was 0.30 and 0.31 in ordinary least squares regression and Geodetector analysis, respectively. The quantitative analyses found twenty-three townships showing an increase in the number of recent infections.Conclusions: Quantitative analysis of geospatial-heterogeneous areas by comparing between recent and long-term HIV infections allows accurate identification of hot-spot areas where new infections are expanding, which can be used as a potent methodological tool to guide targeted interventions and curb the spread of the epidemic.
Highlights
The human immunodeficiency virus (HIV) has caused a severe public health burden globally, with an estimated 37.9 million people living with HIV in 2018 [1]
In this study, using the geographic information of HIV cases identified from a whole population physical examination in the four key counties during November 2017 to June 2018, we explored multiple geospatial analytic measures to quantitatively compare the geographic distribution of recently infected and long-term infected cases, and developed an effective strategy to identify the hot-spot areas where new HIV infection is increasing
Our study provides important lessons for identifying hot-spot areas with expending new infection in other regions suffering from a severe HIV burden
Summary
The human immunodeficiency virus (HIV) has caused a severe public health burden globally, with an estimated 37.9 million people living with HIV in 2018 [1]. Previous geographic studies of HIV infection have usually used data on prevalence in certain areas or the number of newly diagnosed HIV cases to identify hot-spot areas of transmission [4, 5]. Based on the geographic information of recently infected HIV cases, new geospatial analysis measures can be developed to identify areas where the number of new HIV infections is increasing, accurately identifying hot-spot areas where transmission is occurring. Previous geographic studies of HIV infection have usually used prevalence data, which cannot indicate the hot-spot areas of current transmission. To develop quantitative analytic measures for accurately identifying hot-spot areas in growth of new HIV infection, we investigated the geographic distribution features of recent HIV infection and long-term HIV infection using data from a whole-population physical examination in four key counties in Liangshan prefecture, which are most severely affected by HIV in China
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