Mapping geographic clusters of new HIV diagnoses to inform granular-level interventions for HIV epidemic control in western Kenya

Abstract

Abstract Background As countries make progress towards HIV epidemic control, there is increasing need to identify finer geographic areas to target HIV interventions. We mapped geographic clusters of new HIV diagnoses, and described factors associated with HIV-positive diagnosis, in order to inform targeting of HIV interventions to finer geographic areas and sub-populations. Methods We analyzed data for clients aged > 15 years who received home-based HIV testing as part of a routine public health program between May 2016 and July 2017 in Siaya County, western Kenya. Geospatial analysis using Kulldorff’s spatial scan statistic was used to detect geographic clusters (radius 35 years (aRR 2.44, 95% CI 1.99–3.00); those in polygamous marriage (aRR 1.84, 95% CI 1.55–2.16), or separated/divorced (aRR 3.36, 95% CI 2.72–4.08); and clients who reported having never been tested for HIV (aRR 2.35, 95% CI 2.02–2.72), or having been tested > 12 months ago (aRR 1.53, 95% CI 1.41–1.66). Conclusion Our study used routine public health program data to identify granular geographic clusters of higher new HIV diagnoses, and sub-populations with higher HIV-positive yield in the setting of a generalized HIV epidemic. In order to target HIV testing and prevention interventions to finer granular geographic areas for maximal epidemiologic impact, integrating geospatial analysis into routine public health programs can be useful.

Keywords

• Geospatial analysis
• Mapping geographic clusters
• New HIV diagnoses
• Kenya