BACKGROUND: South Africa contains more than one in seven of the world's HIV-positive population. Knowledge of local variation in levels of HIV infection is important for prioritization of areas for intervention. We apply two spatial analytical techniques to investigate the micro-geographical patterns and clustering of HIV infections in a high prevalence, rural population in KwaZulu-Natal, South Africa. METHODS: All 12,221 participants who consented to an HIV test in a population under continuous demographical surveillance were linked to their homesteads and geo-located in a geographical information system (accuracy of <2 m). We then used a two-dimensional Gaussian kernel of radius 3 km to produce robust estimates of HIV prevalence that vary across continuous geographical space. We also applied a Kulldorff spatial scan statistic (Bernoulli model) to formally identify clusters of infections (P < 0.05). RESULTS: The results reveal considerable geographical variation in local HIV prevalence (range = 6-36%) within this relatively homogenous population and provide clear empirical evidence for the localized clustering of HIV infections. Three high-risk, overlapping spatial clusters [Relative Risk (RR) = 1.34-1.62] were identified by the Kulldorff statistic along the National Road (P < or = 0.01), whereas three low risk clusters (RR = 0.2-0.38) were identified elsewhere in the study area (P < or = 0.017). CONCLUSIONS: The findings show the existence of several localized HIV epidemics of varying intensity that are partly contained within geographically defined communities. Despite the overall high prevalence of HIV in many rural South African settings, the results support the need for interventions that target socio-geographic spaces (communities) at greatest risk to supplement measures aimed at the general population.
BACKGROUND: South Africa contains more than one in seven of the world's HIV-positive population. Knowledge of local variation in levels of HIV infection is important for prioritization of areas for intervention. We apply two spatial analytical techniques to investigate the micro-geographical patterns and clustering of HIV infections in a high prevalence, rural population in KwaZulu-Natal, South Africa. METHODS: All 12,221 participants who consented to an HIV test in a population under continuous demographical surveillance were linked to their homesteads and geo-located in a geographical information system (accuracy of <2 m). We then used a two-dimensional Gaussian kernel of radius 3 km to produce robust estimates of HIV prevalence that vary across continuous geographical space. We also applied a Kulldorff spatial scan statistic (Bernoulli model) to formally identify clusters of infections (P < 0.05). RESULTS: The results reveal considerable geographical variation in local HIV prevalence (range = 6-36%) within this relatively homogenous population and provide clear empirical evidence for the localized clustering of HIV infections. Three high-risk, overlapping spatial clusters [Relative Risk (RR) = 1.34-1.62] were identified by the Kulldorff statistic along the National Road (P < or = 0.01), whereas three low risk clusters (RR = 0.2-0.38) were identified elsewhere in the study area (P < or = 0.017). CONCLUSIONS: The findings show the existence of several localized HIV epidemics of varying intensity that are partly contained within geographically defined communities. Despite the overall high prevalence of HIV in many rural South African settings, the results support the need for interventions that target socio-geographic spaces (communities) at greatest risk to supplement measures aimed at the general population.
Authors: Miguel A Arroyo; Warren B Sateren; David Serwadda; Ronald H Gray; Maria J Wawer; Nelson K Sewankambo; Noah Kiwanuka; Godfrey Kigozi; Fred Wabwire-Mangen; Michael Eller; Leigh Anne Eller; Deborah L Birx; Merlin L Robb; Francine E McCutchan Journal: J Acquir Immune Defic Syndr Date: 2006-12-01 Impact factor: 3.731
Authors: M J Wawer; N K Sewankambo; S Berkley; D Serwadda; S D Musgrave; R H Gray; M Musagara; R Y Stallings; J K Konde-Lule Journal: BMJ Date: 1994-01-15
Authors: Kyle T Bernstein; Frank C Curriero; Jacky M Jennings; Glen Olthoff; Emily J Erbelding; Jonathan Zenilman Journal: Am J Epidemiol Date: 2004-07-01 Impact factor: 4.897
Authors: Kobus Herbst; Matthew Law; Pascal Geldsetzer; Frank Tanser; Guy Harling; Till Bärnighausen Journal: Curr Opin HIV AIDS Date: 2015-11 Impact factor: 4.283
Authors: Ingrid V Bassett; Susan Regan; Hlengiwe Mbonambi; Jeffrey Blossom; Stacy Bogan; Benjamin Bearnot; Marion Robine; Rochelle P Walensky; Bright Mhlongo; Kenneth A Freedberg; Hilary Thulare; Elena Losina Journal: AIDS Behav Date: 2015-10
Authors: Andrew Tomita; Alain Vandormael; Till Bärnighausen; Andrew Phillips; Deenan Pillay; Tulio De Oliveira; Frank Tanser Journal: AIDS Date: 2019-03-01 Impact factor: 4.177
Authors: Elvin H Geng; Mwebesa B Bwana; Winnie Muyindike; David V Glidden; David R Bangsberg; Torsten B Neilands; Ingrid Bernheimer; Nicolas Musinguzi; Constantin T Yiannoutsos; Jeffrey N Martin Journal: J Acquir Immune Defic Syndr Date: 2013-06-01 Impact factor: 3.731
Authors: Catherine F Houlihan; Portia C Mutevedzi; Richard J Lessells; Graham S Cooke; Frank C Tanser; Marie-Louise Newell Journal: BMC Infect Dis Date: 2010-02-10 Impact factor: 3.090
Authors: James Ndirangu; Till Bärnighausen; Frank Tanser; Khin Tint; Marie-Louise Newell Journal: Trop Med Int Health Date: 2009-09-07 Impact factor: 2.622