Spatial pattern and determinants of HIV infection among adults aged 15 to 54 years in India - Evidence from National Family Health Survey-4 (2015-16).

Abstract

To assess the spatial pattern and determinants of HIV infection in India. We conducted a secondary data analysis using the National Family Health Survey-4 data obtained from the Demographic Health Survey programme. We accounted for clustering and stratification in the sampling design using the svyset command. Spatial analysis was performed by generating the Moran's I statistic and local indicators for spatial association (LISA) maps. Logistic regression was performed to identify the determinants of HIV infection. 230213 individuals were included. Prevalence of HIV infection in India was 0.24% (95% CI: 0.21%-0.28%). Being separated/widowed/divorced (aOR=2.58, 95% CI: 1.22-5.40), living in an urban area (aOR=2.46, 95% CI: 1.79-3.37), being resident in the North-Eastern (aOR=4.25, 95% CI: 2.60-6.93), Southern (aOR=3.13, 95% CI: 1.99-4.91) or Western region (aOR=2.17, 95% CI: 1.08-4.33), having a history of multiple sexual partners (aOR=1.99, 95% CI:1.42-2.79), a suspected STI (aOR=2.32, 95% CI: 1.38-3.90) or self-reported TB (aOR=7.80, 95% CI: 2.52-24.05) were significantly in association with HIV infection. Moran's I was 0.377, suggesting positive spatial autocorrelation. The LISA cluster map indicated 60 hotspot districts in India, mostly in southern states such as Karnataka, Andhra Pradesh and Telangana followed by north-eastern states such as Nagaland, Manipur, Mizoram, Tripura and Assam. HIV infection among adults aged 15-54years in India is spatially clustered with the majority occurring in southern and north-eastern states. Hence, region- or district-specific strategies with focused interventions should be adopted.