Chowdhury Md Tuhin, Bershteyn Anna, Milali Masabho, Citron Daniel, Nyimbili Sulani, Musuka Godfrey, Cuadros Diego F
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 Jul 28:2023.07.26.23293207. doi: 10.1101/2023.07.26.23293207.
The HIV/AIDS epidemic remains critical in sub-Saharan Africa, with UNAIDS establishing "95-95-95" targets to optimize HIV care. Using the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) geospatial data, this study aimed to identify patterns in these targets and determinants impacting the HIV care continuum in underserved Zimbabwean communities. Analysis techniques, including Gaussian kernel interpolation, optimized hotspot, and multivariate geospatial k-means clustering, were utilized to establish spatial patterns and cluster regional HIV care continuum needs. Further, we investigated healthcare availability, access, and social determinants and scrutinized the association between socio-demographic and behavioral covariates with HIV care outcomes. Disparities in progress toward the "95-95-95" targets were noted across different regions, with each target demonstrating unique geographic patterns, resulting in four distinct clusters with specific HIV care needs. Key factors associated with gaps in achieving targets included younger age, male sex, employment, and minority or no religious affiliation. Our study uncovers significant spatial heterogeneity in the HIV care continuum in Zimbabwe, with unique regional patterns in "95-95-95" targets. The spatial analysis of the UNAIDS targets presented here could prove instrumental in designing effective control strategies by identifying vulnerable communities that are falling short of these targets and require intensified efforts. Our result provides insights for designing region-specific interventions and enhancing community-level factors, emphasizing the need to address regional gaps and improve HIV care outcomes in vulnerable communities lagging behind.
在撒哈拉以南非洲地区，艾滋病毒/艾滋病疫情依然严峻，联合国艾滋病规划署制定了“95-95-95”目标以优化艾滋病毒治疗。本研究利用基于津巴布韦人口的艾滋病毒影响评估（ZIMPHIA）地理空间数据，旨在确定这些目标中的模式以及影响津巴布韦服务不足社区艾滋病毒治疗连续体的决定因素。采用了包括高斯核插值、优化热点分析和多变量地理空间k均值聚类在内的分析技术，以建立空间模式并对区域艾滋病毒治疗连续体需求进行聚类。此外，我们调查了医疗服务的可及性、可获得性以及社会决定因素，并审视了社会人口统计学和行为协变量与艾滋病毒治疗结果之间的关联。不同地区在实现“95-95-95”目标方面存在差异，每个目标都呈现出独特的地理模式，形成了四个具有特定艾滋病毒治疗需求的不同聚类。与目标差距相关的关键因素包括年龄较小、男性、就业以及少数群体或无宗教信仰。我们的研究揭示了津巴布韦艾滋病毒治疗连续体中存在显著的空间异质性，“95-95-95”目标呈现出独特的区域模式。本文对联合国艾滋病规划署目标进行的空间分析，通过识别未达这些目标且需要加大力度的脆弱社区，可能有助于设计有效的控制策略。我们的结果为设计针对特定区域的干预措施和强化社区层面因素提供了见解，强调了应对区域差距以及改善落后脆弱社区艾滋病毒治疗结果的必要性。
