Abstract
ObjectivesEthiopia’s HIV prevalence has decreased by 75% in the past 20 years with the implementation of antiretroviral therapy, but HIV transmission continues in high‐risk clusters. Identifying the spatial and temporal trends, and epidemiologic correlates, of these clusters can lead to targeted interventions.MethodsWe used biomarker and survey data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS). The spatial‐temporal distribution of HIV was estimated using the Kulldorff spatial scan statistic, a likelihood‐based method for determining clustering. Significant clusters (P < 0.05) were identified and compared based on HIV risk factors to non‐cluster areas.ResultsIn 2005, 2011 and 2016, respectively, 219, 568 and 408 individuals tested positive for HIV. Four HIV clusters were identified, representing 17% of the total population and 43% of all HIV cases. The clusters were centred around Addis Ababa (1), Afar (2), Dire Dawa (3) and Gambella (4). Cluster 1 had higher rates of unsafe injections (4.9% vs. 2.2%, P < 0.001) and transactional sex (6.0% vs. 1.6%, P < 0.001) than non‐cluster regions, but more male circumcision (98.5% vs. 91.3%, P < 0.001). Cluster 2 had higher levels of transactional sex (4.9% vs. 1.6%, P < 0.01), but lower levels of unsafe injections (0.8% vs. 2.2%, P < 0.01). Cluster 3 had fewer individuals with> 1 sexual partner (0% vs. 1.7%, P < 0.001) and more male circumcision (100% vs. 91.3%, P < 0.001). Cluster 4 had less male circumcision (59.1% vs. 91.3%, P < 0.01).ConclusionsIn Ethiopia, geographic HIV clusters are driven by different risk factors. Decreasing the HIV burden requires targeted interventions.
Highlights
The last twenty years have seen a dramatic increase in quality of life for people living with HIV
HIV and global positioning system (GPS) data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) were analysed using spatial statistics to assess for geographic clustering
Given the de-identification process, survey participants were associated with 535 unique GPS coordinates in 2005, with 596 in 2011 and with 643 in 2016 (Figure 1)
Summary
The last twenty years have seen a dramatic increase in quality of life for people living with HIV. In addition to increasing life expectancy, providing ART early in the course of HIV decreases the risk of HIV transmission by over 90% [3]. By expanding the use of ART and male circumcision, Ethiopia has reduced its HIV prevalence from nearly 4% in 1998 to approximately 1% today [6]. Policies such as providing free ART for eligible patients and establishing a national HIV governing body to coordinate HIV efforts have contributed to the declining HIV burden [7,8].
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