Office of Infectious Disease, Washington State Department of Health, Olympia, WA.
Department of Epidemiology, University of Washington, Seattle, WA.
J Acquir Immune Defic Syndr. 2021 Jul 1;87(3):912-917. doi: 10.1097/QAI.0000000000002675.
Pillar 4 of the United States' End the HIV Epidemic plan is to respond quickly to HIV outbreaks, but the utility of CDC's tool for identifying HIV outbreaks through time-space cluster detection has not been evaluated. The objective of this evaluation is to quantify the ability of the CDC time-space cluster criterion to predict future HIV diagnoses and to compare it to a space-time permutation statistic implemented in SaTScan software.
Washington State from 2017 to 2019.
We applied both cluster criteria to incident HIV cases in Washington State to identify clusters. Using a repeated-measures Poisson model, we calculated a rate ratio comparing the 6 months after cluster detection with a baseline rate from 24 to 12 months before the cluster was detected. We also compared the demographics of cases within clusters with all other incident cases.
The CDC criteria identified 17 clusters containing 192 cases in the 6 months after cluster detection, corresponding to a rate ratio of 1.25 (95% confidence interval: 0.95 to 1.65) relative to baseline. The time-space permutation statistic identified 5 clusters containing 25 cases with a rate ratio of 2.27 (95% confidence interval: 1.28 to 4.03). Individuals in clusters identified by the new criteria were more likely to be of Hispanic origin (61% vs 20%) and in rural areas (51% vs 12%).
The space-time permutation cluster analysis is a promising tool for identification of clusters with the largest growth potential for whom interruption may prove most beneficial.
美国终结艾滋病流行计划的第四支柱是迅速应对艾滋病毒疫情，但尚未评估疾病预防控制中心（CDC）通过时空聚类检测识别艾滋病毒疫情的工具的实用性。本评估的目的是量化 CDC 时空聚类标准预测未来艾滋病毒诊断的能力，并将其与 SaTScan 软件中实施的时空置换统计进行比较。
2017 年至 2019 年的华盛顿州。
我们将这两种聚类标准应用于华盛顿州的新发艾滋病毒病例，以识别出集群。使用重复测量泊松模型，我们计算了一个比率比，将集群检测后 6 个月与集群检测前 24 至 12 个月的基线率进行比较。我们还比较了集群内病例的人口统计学特征与所有其他新发病例。
CDC 标准在集群检测后 6 个月内确定了 17 个包含 192 例病例的集群，与基线相比，比率比为 1.25（95%置信区间：0.95 至 1.65）。时空置换统计确定了包含 25 例病例的 5 个集群，比率比为 2.27（95%置信区间：1.28 至 4.03）。新标准确定的集群中的个体更有可能具有西班牙裔血统（61%比 20%）和居住在农村地区（51%比 12%）。
时空置换聚类分析是一种很有前途的工具，可用于识别最有可能具有最大增长潜力的集群，中断这些集群可能被证明是最有益的。
