Abstract
BackgroundThe HIV/AIDS pandemic has had a very devastating impact at a global level, with the Eastern and Southern African region being the hardest hit. The considerable geographical variation in the pandemic means varying impact of the disease in different settings, requiring differentiated interventions. While information on the prevalence of HIV at regional and national levels is readily available, the burden of the disease at smaller area levels, where health services are organized and delivered, is not well documented. This affects the targeting of HIV resources. There is need, therefore, for studies to estimate HIV prevalence at appropriate levels to improve HIV-related planning and resource allocation.MethodsWe estimated the district-level prevalence of HIV using Small-Area Estimation (SAE) technique by utilizing the 2016 Zambia Population-Based HIV Impact Assessment Survey (ZAMPHIA) data and auxiliary data from the 2010 Zambian Census of Population and Housing and the HIV sentinel surveillance data from selected antenatal care clinics (ANC). SAE models were fitted in R Programming to ascertain the best HIV predicting model. We then used the Fay–Herriot (FH) model to obtain weighted, more precise and reliable HIV prevalence for all the districts.ResultsThe results revealed variations in the district HIV prevalence in Zambia, with the prevalence ranging from as low as 4.2% to as high as 23.5%. Approximately 32% of the districts (n = 24) had HIV prevalence above the national average, with one district having almost twice as much prevalence as the national level. Some rural districts have very high HIV prevalence rates.ConclusionsHIV prevalence in Zambian is highest in districts located near international borders, along the main transit routes and adjacent to other districts with very high prevalence. The variations in the burden of HIV across districts in Zambia point to the need for a differentiated approach in HIV programming within the country. HIV resources need to be prioritized toward districts with high population mobility.
Highlights
The HIV/AIDS pandemic has had a very devastating impact at a global level, with the Eastern and Southern African region being the hardest hit
Data sources The outcome variable was HIV prevalence—obtained from the Zambia Population-Based HIV Impact Assessment Survey (ZAMPHIA) of 2016, while auxiliary predictors included HIV prevalence among pregnant women, the 2010 Zambian population; proportion of the population aged 15–36 years; dependence ratio; the proportion of the population in formal dwelling; proportion of the population with higher education attainment; proportion of the population residing in the urban area, population density and the proportion of females in the population
Data on HIV prevalence among pregnant women were obtained from selected antenatal care clinics (ANC) facilities in the 74 districts in 2017 and 2018, while the rest of the auxiliary predictors were obtained from the 2010 Census of Population and Housing for Zambia
Summary
The HIV/AIDS pandemic has had a very devastating impact at a global level, with the Eastern and Southern African region being the hardest hit. The information on the geographical variation in HIV prevalence at provincial level is certainly important for guiding government policy, prioritization of interventions and resource allocation both across and within countries It should, be noted that the burden of diseases within the provinces can be heterogeneous. A study that modeled district-level estimates for HIV prevalence in South Africa found variations in the prevalence within the South African provinces [6] This means that effective preventive and control strategies to combat HIV require knowledge of the burden of the disease at smaller and more similar areas such as districts [7]. This is challenging, because most data currently in use are not sufficiently powered to provide reliable estimates at the small-area levels such as districts [7]
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