Combining Geospatial Analysis with HIV Care Continuum to Identify Differential HIV/AIDS Treatment Indicators in Uganda

Abstract

To control the HIV epidemic at the population level, a 90–90–90 target has been proposed for sub-Saharan Africa, whereby 90 percent of people living with HIV (PLH) should know their HIV status, 90 percent of those diagnosed should be receiving antiretroviral therapy (ART), and 90 percent of those on ART should achieve viral suppression (VS). VS occurs when ART reduces the viral load of PLH to an undetectable level with minimal risk of new infections. We present a two-pronged interdisciplinary analysis, combining geospatial and HIV care continuum techniques, to guide treatment interventions toward achieving the 90–90–90 target in Uganda. We conducted spatiotemporal analysis of VS and constructed HIV care continuums for districts using publicly available data from a centralized laboratory of the Ministry of Health, Uganda. Spatial patterns of VS revealed a distinct east–west pattern of low rates and a north–south pattern of high rates with statistically significant clusters of districts with high and low rates in southwestern and eastern Uganda, respectively. VS rates, calculated in a sequential care continuum framework, revealed local variability as well as a significant gap from the 90–90–90 target by districts. Such evident local variability of VS might indicate the importance of regionally targeted interventions for bringing the HIV epidemic to an end.