埃塞俄比亚 2015-2017 年 HIV 感染的空间聚集性和社会人口学决定因素。

Spatial clustering and socio-demographic determinants of HIV infection in Ethiopia, 2015-2017.

机构信息

School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Brisbane, Queensland, Australia; Institute of Public Health, College of Medicine and Health Science, University of Gondar, 196, Gondar, Ethiopia.

UQ Spatial Epidemiology Laboratory, School of Veterinary Science, Faculty of Science, The University of Queensland, Gatton 4343, Queensland, Australia; Children's Health and Environment Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane 4101, Queensland, Australia.

出版信息

Int J Infect Dis. 2019 May;82:33-39. doi: 10.1016/j.ijid.2019.02.046. Epub 2019 Mar 5.

DOI:10.1016/j.ijid.2019.02.046

PMID:30844516

Abstract

BACKGROUND

Amhara Region has the largest at-risk population in Ethiopia, with widespread traditional practices that are likely to increase transmission of HIV. However, the identification and characterization of HIV hotspots within this region have not been undertaken. This study aimed to explore and describe the geographical pattern of HIV infection using notification data in Amhara Region, Ethiopia.

METHODS

Data on HIV infection at the district level were obtained from the Amhara Regional Health Bureau. A Bayesian conditional autoregressive (CAR) model was used to explore the association between HIV infection and socio-demographic variables in OpenBUGS.

RESULTS

A total of 35 210 new HIV cases were reported during 2015-2017 in Amhara Region, Ethiopia. Metema and Mirab Armacho districts were found to be hotspots throughout the study period. There was a decrease in HIV infection in 2016 (odds ratio 0.77, 95% credible interval (CrI) 0.72-0.82) and 2017 (odds ratio 0.71, 95% CrI 0.60-0.76) as compared with HIV infection in 2015. HIV infection increased by 1.004 (95% CrI 1.001-1.008) and 1.47 (95% CrI 1.11-3.59) for a one-unit increase in the proportion of the population who had never attended school and migrants, respectively.

CONCLUSIONS

This study identified spatial clustering of HIV infection in Amhara Region, with a slight reduction in the annual infection rates from 2015 to 2017. The proportion of the population who were migrants or who had a low educational status was associated with a high risk of infection. Access to HIV counselling and the promotion of condom utilization, integrated with other health care services, targeting those with a lower level of education and seasonal migrants, are important strategies for the prevention of new HIV infections.

摘要

背景

阿姆哈拉地区是埃塞俄比亚感染风险最大的地区，广泛存在的传统习俗可能会增加艾滋病毒的传播。然而，该地区尚未确定艾滋病毒热点的位置和特征。本研究旨在利用埃塞俄比亚阿姆哈拉地区的疫情通报数据，探索和描述艾滋病毒感染的地理模式。

方法

从阿姆哈拉地区卫生局获得了区县级艾滋病毒感染数据。使用 OpenBUGS 中的贝叶斯条件自回归（CAR）模型来探索艾滋病毒感染与社会人口统计学变量之间的关系。

结果

2015-2017 年期间，埃塞俄比亚阿姆哈拉地区共报告了 35210 例新的艾滋病毒感染病例。梅特马和米拉博-阿玛乔区在整个研究期间一直是热点地区。与 2015 年相比，2016 年（比值比 0.77，95%可信区间（CrI）0.72-0.82）和 2017 年（比值比 0.71，95% CrI 0.60-0.76）的艾滋病毒感染率有所下降。与从未上过学的人群比例每增加一个单位相比，艾滋病毒感染增加 1.004（95% CrI 1.001-1.008），与移民比例每增加一个单位相比，艾滋病毒感染增加 1.47（95% CrI 1.11-3.59）。

结论

本研究发现，阿姆哈拉地区的艾滋病毒感染存在空间聚集现象，2015 年至 2017 年期间，每年的感染率略有下降。移民比例或教育程度低的人群与较高的感染风险相关。为新感染艾滋病毒的人群提供艾滋病毒咨询和促进安全套的使用，结合其他卫生保健服务，针对教育程度较低的人群和季节性移民，是预防新的艾滋病毒感染的重要策略。