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HIV Incidence and Spatial Clustering in a Rural Area of Southern Mozambique.

González R, Augusto OJ, Munguambe K, Pierrat C, Pedro EN, Sacoor C, De Lazzari E, Aponte JJ, Macete E, Alonso PL, Menendez C, Naniche D - PLoS ONE (2015)

Bottom Line: The estimated HIV prevalence in the community was 39.9% in 2010 and 39.7% in 2012.One cluster with significant excess HIV prevalence was identified at the same geographic location in both surveys.This cluster had an HIV prevalence of 79.0% in 2010 and 52.3% in 2012.

View Article: PubMed Central - PubMed

Affiliation: ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.

ABSTRACT

Background: Monitoring the HIV epidemic in a defined population is critical for planning treatment and preventive strategies. This is especially important in sub-Saharan Africa, which harbours the highest burden of the disease.

Objective: To estimate HIV incidence in adults aged 18-47 years old and to investigate spatial variations of HIV prevalence in Manhiça, a semi-rural area of southern Mozambique.

Methods: Two cross-sectional community-based surveys were conducted in 2010 and 2012 to determine HIV prevalence. Individual participants were randomly selected from the demographic surveillance system in place in the area and voluntary HIV counselling and testing was offered at the household level. HIV incidence was calculated using prevalence estimates from the two sero-surveys. Each participant's household was geocoded using a global information system. The Spatial Scan Statistics programme was used to identify areas with disproportionate excess in HIV prevalence.

Results: A total of 1511 adults were tested. The estimated HIV prevalence in the community was 39.9% in 2010 and 39.7% in 2012. The overall HIV incidence was 3.6 new infections per 100 person-years at risk (PYAR) [95CI 1.56; 7.88], assuming stable epidemic conditions, and tended to be higher in women (4.9/100 PYAR [95CI 1.74; 11.85]) than in men (3.2/PYAR [95CI 1.36; 9.92]). One cluster with significant excess HIV prevalence was identified at the same geographic location in both surveys. This cluster had an HIV prevalence of 79.0% in 2010 and 52.3% in 2012.

Conclusions: The findings of these first individually-randomised community-HIV sero-surveys conducted in Mozambique reinforce the need to combine HIV incidence estimates and research on micro geographical infection patterns to guide and consolidate effective prevention strategies.

No MeSH data available.


Related in: MedlinePlus

Maps of the 2010 and 2012 Spatial Analysis identifying HIV clusters in Manhiça district.
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pone.0132053.g002: Maps of the 2010 and 2012 Spatial Analysis identifying HIV clusters in Manhiça district.

Mentions: The spatial scan analysis identified a small cluster of significant excess of HIV prevalence in 2010 (<0.05) with 19 individuals out of the 722 included in the analysis, and an overall area of 0.2 kilometres2 (km2) (Fig 2). HIV prevalence within this cluster was 79.0% (versus 36.5% outside). When using data from the 2012 sero-survey, the spatial scan identified a cluster of higher HIV prevalence centred in the same location as in 2010 but spanning a larger geographical area with 109 individuals out of the 789 included in the analysis (Fig 2). The 2012 cluster was approximately 1.4 km from the Maragra sugar mill, had an overall perimeter of 7.6 km and spanned 2.7 km2. The HIV prevalence inside the 2012 cluster was 52.3% (95CI 42.9; 61.7) as compared to 34.7% (95CI 31.1; 38.3) outside (p = 0.002; OR = 2.05 [95CI 1.36; 3.08]; p = 0.001). S2 Fig shows a map of the Manhiça DSS population density in 2012 and location of the cluster, which is independent of population density. There were no significant differences in sex, age, marital status education orliteracy between individuals from the high HIV prevalence cluster and those from the lower prevalence surrounding area (Table 3). There was however a significant difference in the proportion of immigrants within the cluster (56.9%) compared to that outside (39.6%; p = 0.001).


HIV Incidence and Spatial Clustering in a Rural Area of Southern Mozambique.

González R, Augusto OJ, Munguambe K, Pierrat C, Pedro EN, Sacoor C, De Lazzari E, Aponte JJ, Macete E, Alonso PL, Menendez C, Naniche D - PLoS ONE (2015)

Maps of the 2010 and 2012 Spatial Analysis identifying HIV clusters in Manhiça district.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493140&req=5

pone.0132053.g002: Maps of the 2010 and 2012 Spatial Analysis identifying HIV clusters in Manhiça district.
Mentions: The spatial scan analysis identified a small cluster of significant excess of HIV prevalence in 2010 (<0.05) with 19 individuals out of the 722 included in the analysis, and an overall area of 0.2 kilometres2 (km2) (Fig 2). HIV prevalence within this cluster was 79.0% (versus 36.5% outside). When using data from the 2012 sero-survey, the spatial scan identified a cluster of higher HIV prevalence centred in the same location as in 2010 but spanning a larger geographical area with 109 individuals out of the 789 included in the analysis (Fig 2). The 2012 cluster was approximately 1.4 km from the Maragra sugar mill, had an overall perimeter of 7.6 km and spanned 2.7 km2. The HIV prevalence inside the 2012 cluster was 52.3% (95CI 42.9; 61.7) as compared to 34.7% (95CI 31.1; 38.3) outside (p = 0.002; OR = 2.05 [95CI 1.36; 3.08]; p = 0.001). S2 Fig shows a map of the Manhiça DSS population density in 2012 and location of the cluster, which is independent of population density. There were no significant differences in sex, age, marital status education orliteracy between individuals from the high HIV prevalence cluster and those from the lower prevalence surrounding area (Table 3). There was however a significant difference in the proportion of immigrants within the cluster (56.9%) compared to that outside (39.6%; p = 0.001).

Bottom Line: The estimated HIV prevalence in the community was 39.9% in 2010 and 39.7% in 2012.One cluster with significant excess HIV prevalence was identified at the same geographic location in both surveys.This cluster had an HIV prevalence of 79.0% in 2010 and 52.3% in 2012.

View Article: PubMed Central - PubMed

Affiliation: ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.

ABSTRACT

Background: Monitoring the HIV epidemic in a defined population is critical for planning treatment and preventive strategies. This is especially important in sub-Saharan Africa, which harbours the highest burden of the disease.

Objective: To estimate HIV incidence in adults aged 18-47 years old and to investigate spatial variations of HIV prevalence in Manhiça, a semi-rural area of southern Mozambique.

Methods: Two cross-sectional community-based surveys were conducted in 2010 and 2012 to determine HIV prevalence. Individual participants were randomly selected from the demographic surveillance system in place in the area and voluntary HIV counselling and testing was offered at the household level. HIV incidence was calculated using prevalence estimates from the two sero-surveys. Each participant's household was geocoded using a global information system. The Spatial Scan Statistics programme was used to identify areas with disproportionate excess in HIV prevalence.

Results: A total of 1511 adults were tested. The estimated HIV prevalence in the community was 39.9% in 2010 and 39.7% in 2012. The overall HIV incidence was 3.6 new infections per 100 person-years at risk (PYAR) [95CI 1.56; 7.88], assuming stable epidemic conditions, and tended to be higher in women (4.9/100 PYAR [95CI 1.74; 11.85]) than in men (3.2/PYAR [95CI 1.36; 9.92]). One cluster with significant excess HIV prevalence was identified at the same geographic location in both surveys. This cluster had an HIV prevalence of 79.0% in 2010 and 52.3% in 2012.

Conclusions: The findings of these first individually-randomised community-HIV sero-surveys conducted in Mozambique reinforce the need to combine HIV incidence estimates and research on micro geographical infection patterns to guide and consolidate effective prevention strategies.

No MeSH data available.


Related in: MedlinePlus