Geographical Disparities in HIV Seroprevalence Among Men Who Have Sex with Men and People Who Inject Drugs in Nigeria: Exploratory Spatial Data Analysis.

Amobi Onovo,Moses Katbi,Otse Ogorry,Antoine Jaquet,Olivia Keiser,Abiye Kalaiwo

doi:10.2196/19587

Amobi Onovo, Moses Katbi + Show 4 more

Open Access

https://doi.org/10.2196/19587

Copy DOI

Abstract

BackgroundThe 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.ObjectiveWe aimed to measure HIV seroprevalence and identify hotspots of HIV infection among MSM and PWID in Nigeria.MethodsWe included all MSM and PWID accessing HIV testing services across 7 prioritized states (Lagos, Nasarawa, Akwa Ibom, Cross Rivers, Rivers, Benue, and the Federal Capital Territory) in 3 geographic regions (North Central, South South, and South West) between October 1, 2016, and September 30, 2017. We extracted data from national testing registers, georeferenced all HIV test results aggregated at the local government area level, and calculated HIV seroprevalence. We calculated and compared HIV seroprevalence from our study to the 2014 integrated biological and behavioural surveillance survey and used global spatial autocorrelation and hotspot analysis to highlight patterns of HIV infection and identify areas of significant clustering of HIV cases.ResultsMSM and PWID had HIV seroprevalence rates of 12.14% (3209/26,423) and 11.88% (1126/9474), respectively. Global spatial autocorrelation Moran I statistics revealed a clustered distribution of HIV infection among MSM and PWID 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 and South South regions were identified among MSM and PWID. Compared to the 2014 integrated biological and behavioural surveillance survey, our results suggest an increased HIV seroprevalence among PWID and a substantial decrease among MSM.ConclusionsThis 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 targeting epidemic control of HIV infection.

Highlights

Geographic variation in HIV seroprevalence has been demonstrated in many sub-Saharan African countries [1,2,3,4,5,6,7]
We showed that there is significant clustering and subnational variation in HIV seroprevalence among men who have sex with men (MSM) and people who inject drugs (PWID)
The geographical variations in HIV seroprevalence revealed by our analysis mean that HIV infection is disproportionately spread across Nigeria and confined to a particular region

Summary

Introduction

Geographic variation in HIV seroprevalence has been demonstrated in many sub-Saharan African countries [1,2,3,4,5,6,7]. The spatial distribution of HIV infection in key populations (KPs), including in men who have sex with men (MSM) and people who inject drugs (PWID), is much less understood. According to the 2010 integrated biological and behavioral surveillance survey (IBBSS) in Nigeria, female injecting drug users had a 7-fold higher HIV prevalence than male injecting drug users [12]. We calculated and compared HIV seroprevalence from our study to the 2014 integrated biological and behavioural surveillance survey and used global spatial autocorrelation and hotspot analysis to highlight patterns of HIV infection and identify areas of significant clustering of HIV cases. Conclusions: This study identified geographical areas to prioritize for control of HIV infection among MSM and PWID, demonstrating that geographical information system technology is a useful tool to inform public health planning for interventions targeting epidemic control of HIV infection

Objectives

Methods

Results

Discussion

Conclusion