Abstract
BackgroundAdequate resource allocation is critical in the battle against HIV/AIDS, especially in Africa. The determination of the location and nature of HIV services to implement must comply with the geographic, social and behavioral characteristics of patients. We therefore investigated the spatial heterogeneity of HIV prevalence in Burundi and then assessed the association of social and behavioral characteristics with HIV infection accounting for the spatial heterogeneity.MethodsWe used data from the 2010 Demographic and Health Survey. We analyzed these data with a geostatistical approach (which takes into account spatial autocorrelation) by i) interpolating HIV data using the kernel density estimation, ii) identifying the spatial clusters with high and low HIV prevalence using the Kulldorff spatial scan statistics, and then iii) performing a multivariate spatial logistic regression.ResultsOverall HIV prevalence was 1.4 %. The interpolated data showed the great spatial heterogeneity of HIV prevalence (from 0 to 10 %), independently of administrative boundaries. A cluster with high HIV prevalence was found in the capital city and adjacent areas (3.9 %; relative risk 3.7, p < 0.001) whereas a cluster with low prevalence straddled two southern provinces (0 %; p = 0.02). By multivariate spatial analysis, HIV infection was significantly associated with the female sex (posterior odds ratio [POR] 1.36, 95 % credible interval [CrI] 1.13-1.64), an older age (POR 1.97, 95 % CrI 1.26-3.08), the level of education (POR 1.50, 95 % CrI 1.22-1.84), the marital status (POR 1.86, 95 % CrI 1.23-2.80), a higher wealth index (POR 2.11, 95 % CrI 1.77-2.51), the sexual activity (POR 1.76, 95 % CrI 1.04-2.96), and a history of sexually transmitted infection (POR 2.03, 95 % CrI 1.56-2.64).ConclusionsOur study, which shows where and towards which populations HIV resources should be allocated, could help national health policy makers develop an effective HIV intervention in Burundi. Our findings support the strategy of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for country-specific, in-depth analyses of HIV epidemics to tailor national prevention responses.
Highlights
Adequate resource allocation is critical in the battle against human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), especially in Africa
Adequate resource allocation is critical in the battle against HIV/AIDS, especially in sub-Saharan African countries where 70 % of the people living with HIV worldwide currently reside [1]
Because half HIV cases only are diagnosed in subSaharan Africa [4], most countries rely on Demographic and Health Surveys (DHS) to estimate HIV prevalence along with other data including social and behavioral characteristics [5]
Summary
Adequate resource allocation is critical in the battle against HIV/AIDS, especially in Africa. Adequate resource allocation is critical in the battle against HIV/AIDS, especially in sub-Saharan African countries where 70 % of the people living with HIV worldwide currently reside [1]. These countries face major financial constraints, shortages of healthcare workers, and poorly developed healthcare systems [1, 2]. Because half HIV cases only are diagnosed in subSaharan Africa [4], most countries rely on Demographic and Health Surveys (DHS) to estimate HIV prevalence along with other data including social and behavioral characteristics [5]. The spatial heterogeneity of HIV prevalence has seldom been taken into account when examining the factors associated with HIV infection
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