Geographical Disparities in HIV Prevalence Among Men Who Have Sex with Men and People Who Inject Drugs in Nigeria

Abstract

Background: Assessment of geographical heterogeneity of HIV among men who have sex with men (MSM) and people who inject drugs (PWID) can usefully inform targeted HIV prevention and care strategies. We aimed to measure HIV prevalence and identify hotspots of HIV infection among MSM and PWID in Nigeria. Methods: We included all MSM and PWID accessing HIV testing services across seven prioritized states (Lagos, Nasarawa, Akwa Ibom, Cross Rivers, Rivers, Benue and the Federal Capital Territory) in three geographic regions (North Central, South South, South West) between Oct 1, 2016 and Sept 30, 2017. We extracted data from national testing registers, georeferenced all HIV test results aggregated at the level of Local Government Areas (LGAs), and calculated HIV prevalence. We calculated and compared HIV prevalence from our study to the integrated biological and behavioral surveillance survey (IBBSS) 2014 and used global spatial autocorrelation and hotspot analysis to highlight patterns of HIV infection, and to identify areas of significant clustering of HIV cases. Findings: A positive HIV test was reported in 12.1% (95%CI 9.7-13.1) and 11.8% (95%CI 9.3-12.7) of the 26,423 MSMs and 9,474 PWIDs, respectively. Global spatial autocorrelation Moran's I statistics revealed a clustered distribution of HIV infection among MSMs and PWIDs with a <5% and <1% likelihood that this clustered pattern could be due to chance respectively. Significant clusters of HIV infection (Getis-Ord-Gi* statistics) confined to the North Central, South-South regions were identified among MSM and PWID. Compared to the 2014 IBBSS our results suggest an increased HIV prevalence among PWID and a substantial decrease among MSM. Interpretation: This study identified geographical areas to prioritize for control of HIV infection among MSM and PWID, thus demonstrating that geographical information system technology is a useful tool to inform public health planning for interventions for epidemic control of HIV infection. Funding Statement: Data used for this study was collected from Key Population program in Nigeria through PEPFAR/USAID. OK was funded by the Swiss National Science Foundation (grant no 163878). Declaration of Interests: The authors report no financial or non-financial competing interests. Ethics Approval Statement: Informed consent was obtained for all clients who were tested for HIV in line with the Nigeria HTS policy. Ethical approval was obtained from the Federal Capital Territory, Health Research Ethics Committee, Nigeria (Approval Number: FHREC/2019/01/122/23-12-19). This study only analyzed anonymized and de-identified data.