Cuadros Diego F, Chowdhury Tuhin, Milali Masabho, Citron Daniel, Nyimbili Sulani, Vlahakis Natalie, Savory Theodora, Mulenga Lloyd, Sivile Suilanji, Zyambo Khozya, Bershteyn Anna
Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA.
Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
medRxiv. 2023 Apr 26:2023.04.24.23289044. doi: 10.1101/2023.04.24.23289044.
In sub-Saharan Africa, HIV/AIDS remains a leading cause of death. The UNAIDS established the "95-95-95" targets to improve HIV care continuum outcomes. Using geospatial data from the Zambia Population-based HIV Impact Assessment (ZAMPHIA), this study aims to investigate geospatial patterns in the "95-95-95" indicators and individual-level determinants that impede HIV care continuum in vulnerable communities, providing insights into the factors associated with gaps. This study used data from the 2016 ZAMPHIA to investigate the geospatial distribution and individual-level determinants of engagement across the HIV care continuum in Zambia. Gaussian kernel interpolation and optimized hotspot analysis were used to identify geospatial patterns in the HIV care continuum, while geospatial k-means clustering was used to partition areas into clusters. The study also assessed healthcare availability, access, and social determinants of healthcare utilization. Multiple logistic regression models were used to examine the association between selected sociodemographic and behavioral covariates and the three main outcomes of study. Varied progress towards the "95-95-95" targets were observed in different regions of Zambia. Each "95" displayed a unique geographic pattern, independent of HIV prevalence, resulting in four distinct geographic clusters. Factors associated with gaps in the "95s" include younger age, male sex, and low wealth, with younger individuals having higher odds of not being on ART and having detectable viral loads. Our study revealed significant spatial heterogeneity in the HIV care continuum in Zambia, with different regions exhibiting unique geographic patterns and levels of performance in the "95-95-95" targets, highlighting the need for geospatial tailored interventions to address the specific needs of different subnational regions. These findings underscore the importance of addressing differential regional gaps in HIV diagnosis, enhancing community-level factors, and developing innovative strategies to improve local HIV care continuum outcomes.
在撒哈拉以南非洲地区，艾滋病毒/艾滋病仍然是主要死因。联合国艾滋病规划署制定了“95-95-95”目标，以改善艾滋病毒护理连续统一体的成果。本研究利用赞比亚基于人口的艾滋病毒影响评估（ZAMPHIA）的地理空间数据，旨在调查“95-95-95”指标中的地理空间模式以及阻碍脆弱社区艾滋病毒护理连续统一体的个体层面决定因素，从而深入了解与差距相关的因素。本研究使用2016年ZAMPHIA的数据，调查赞比亚艾滋病毒护理连续统一体中参与情况的地理空间分布和个体层面决定因素。采用高斯核插值法和优化热点分析来识别艾滋病毒护理连续统一体中的地理空间模式，同时使用地理空间k均值聚类法将区域划分为不同的集群。该研究还评估了医疗服务的可及性、可获得性以及医疗服务利用的社会决定因素。使用多元逻辑回归模型来检验选定的社会人口统计学和行为协变量与研究的三个主要结果之间的关联。在赞比亚的不同地区，观察到在实现“95-95-95”目标方面取得了不同程度的进展。每个“95”都呈现出独特的地理模式，与艾滋病毒流行率无关，从而形成了四个不同的地理集群。与“95”指标差距相关的因素包括年龄较小、男性以及财富水平较低，年龄较小的个体未接受抗逆转录病毒治疗且病毒载量可检测到的几率更高。我们的研究揭示了赞比亚艾滋病毒护理连续统一体中存在显著的空间异质性，不同地区在“95-95-95”目标方面呈现出独特的地理模式和绩效水平，凸显了需要进行地理空间定制干预措施以满足不同次国家区域的特定需求。这些发现强调了解决艾滋病毒诊断方面的区域差异、加强社区层面因素以及制定创新战略以改善当地艾滋病毒护理连续统一体成果的重要性。
