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Int. J. Environ. Res. Public Health 2016, 13(9), 865; doi:10.3390/ijerph13090865

Geographical Patterns of HIV Sero-Discordancy in High HIV Prevalence Countries in Sub-Saharan Africa

1
Department of Geography, University of Cincinnati, Cincinnati, OH 45221, USA
2
Infectious Disease Epidemiology Group, Weill Cornell Medicine—Qatar, Cornell University, Qatar Foundation, Education City, Doha 24144, Qatar
3
Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
4
College of Public Health, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha 24144, Qatar
*
Author to whom correspondence should be addressed.
Academic Editor: Peter Congdon
Received: 9 June 2016 / Revised: 17 August 2016 / Accepted: 24 August 2016 / Published: 31 August 2016
(This article belongs to the Special Issue Spatio-temporal Frameworks for Infectious Disease Epidemiology)
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Abstract

Introduction: Variation in the proportion of individuals living in a stable HIV sero-discordant partnership (SDP), and the potential drivers of such variability across sub Saharan Africa (SSA), are still not well-understood. This study aimed to examine the spatial clustering of HIV sero-discordancy, and the impact of local variation in HIV prevalence on patterns of sero-discordancy in high HIV prevalence countries in SSA. Methods: We described the spatial patterns of sero-discordancy among stable couples by analyzing Demographic and Health Survey data from Cameroon, Kenya, Lesotho, Tanzania, Malawi, Zambia, and Zimbabwe. We identified spatial clusters of SDPs in each country through a Kulldorff spatial scan statistics analysis. After a geographical cluster was identified, epidemiologic measures of sero-discordancy were calculated and analyzed. Results: Spatial clusters with significantly high numbers of SDPs were identified and characterized in Kenya, Malawi, and Tanzania, and they largely overlapped with the clusters with high HIV prevalence. There was a positive correlation between HIV prevalence and the proportion of SDPs among all stable couples across within and outside clusters. Conversely, there was a negative, but weak and not significant, correlation between HIV prevalence and the proportion of SDPs among all stable couples with at least one HIV-infected individual in the partnership. Discussion: There does not appear to be distinct spatial patterns for HIV sero-discordancy that are independent of HIV prevalence patterns. The variation of the sero-discordancy measures with HIV prevalence across clusters and outside clusters demonstrated similar patterns to those observed at the national level. The spatial variable does not appear to be a fundamental nor independent determinant of the observed patterns of sero-discordancy in high HIV prevalence countries in SSA. View Full-Text
Keywords: HIV; serodiscordancy; geographical clustering; sub Saharan Africa HIV; serodiscordancy; geographical clustering; sub Saharan Africa
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MDPI and ACS Style

Cuadros, D.F.; Abu-Raddad, L.J. Geographical Patterns of HIV Sero-Discordancy in High HIV Prevalence Countries in Sub-Saharan Africa. Int. J. Environ. Res. Public Health 2016, 13, 865.

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