Cuadros Diego F, Branscum Adam J, Miller F DeWolfe, Awad Susanne F, Abu-Raddad Laith J
Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Qatar Foundation, Cornell University , Doha , Qatar ; Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University , Ithaca, NY , USA.
College of Public Health and Human Sciences, Oregon State University , Corvallis, OR , USA.
Front Public Health. 2015 Sep 29;3:218. doi: 10.3389/fpubh.2015.00218. eCollection 2015.
Growing evidence suggests significant geographic clustering of male circumcision (MC) in Tanzania. The impact of spatial heterogeneity of MC prevalence on HIV transmission dynamics in this country is not well documented. The aim of this study was to assess the spatial association between MC and HIV infection in Tanzania.
Data from three Demographic and Health Survey rounds conducted in Tanzania were analyzed to identify spatial associations between MC and HIV using bivariate local indicators of spatial association (LISA). Spatial clusters with low MC prevalence (MC cold spots) were identified using scan statistics. HIV incidence rates for males and females within and outside the MC cold spots were calculated.
Local indicators of spatial association analysis indicated a significant association between MC and HIV in the northern and southwestern regions of Tanzania. Scan statistics identified two MC cold spots in the same locations. Males located outside the MC cold spots had the lowest HIV incidence rate at 0.28 per 100 person-years at risk (pyar). HIV incidence in females located outside the MC cold spots increased from 0.40/100 pyar during 2004-2008 to 0.68/100 pyar in 2008-2012.
Our study provides evidence for a geographic association between MC and HIV in Tanzania. MC could be one of the key factors driving the geographical distribution of the HIV epidemic in the country. Furthermore, in areas where most males are circumcised, the HIV infection burden could be concentrating in the female population. Therefore, along with the voluntary medical MC program, efforts targeting the female population should also be considered.
越来越多的证据表明坦桑尼亚男性包皮环切术（MC）存在显著的地理聚集现象。该国MC流行率的空间异质性对艾滋病毒传播动态的影响尚无充分记录。本研究的目的是评估坦桑尼亚MC与艾滋病毒感染之间的空间关联。
分析坦桑尼亚三轮人口与健康调查的数据，使用双变量空间关联局部指标（LISA）来确定MC与艾滋病毒之间的空间关联。使用扫描统计方法识别MC流行率低的空间聚类（MC冷点）。计算MC冷点内外男性和女性的艾滋病毒发病率。
空间关联局部指标分析表明，坦桑尼亚北部和西南部地区MC与艾滋病毒之间存在显著关联。扫描统计在相同位置识别出两个MC冷点。位于MC冷点之外的男性艾滋病毒发病率最低，为每100人年风险0.28例（pyar）。位于MC冷点之外的女性艾滋病毒发病率从2004 - 2008年的0.40/100 pyar增加到2008 - 2012年的0.68/100 pyar。
我们的研究为坦桑尼亚MC与艾滋病毒之间的地理关联提供了证据。MC可能是该国艾滋病毒流行地理分布的关键因素之一。此外，在大多数男性接受包皮环切术的地区，艾滋病毒感染负担可能集中在女性人群中。因此，除了自愿医疗MC项目外，还应考虑针对女性人群的努力。
