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Correlates of high HIV transmission areas in a generalized hyperendemic setting: findings from a national survey in Eswatini.(ORAL ABSTRACTS)
Journal article   Open access

Correlates of high HIV transmission areas in a generalized hyperendemic setting: findings from a national survey in Eswatini.(ORAL ABSTRACTS)

G.S Lovasi, N.M Philip, J Justman, B Mathema, R Nkambule and Q. Abdool Karim
Journal of the International AIDS Society, v 24(S1), p3
01 Jan 2021
DOI: https://doi.org/10.1002/jia2.25659
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https://doi.org/10.1002/jia2.25659View
Published, Version of Record (VoR)CC BY V4.0,  Open

Abstract

Disease transmission HIV infection Risk factors Statistics
Background: Small areas with high uncontrolled HIV infection promote ongoing transmission and micro-epidemics. Whether they result from geographic clustering of multiple HIV risk factors is unknown but key to designing place-based, combination interventions for epidemic control. Methods: A nationally representative, household-based sample of adults, ages 18 to 49 years, was enrolled from December 2010 to June 2011 from 575 enumeration areas in Eswatini. Consenting adults completed an interview and rapid HIV testing. Viral load was quantified using the COBAS AmpliPrep/Taqman HIV-1 Test, v 2.0. Multi-level latent class modeling identified statistically significant combinations of biomedical and behavioral risk factors and classified the combinations into small (enumeration) area risk profiles, categorized by HIV risk types. Linear regression assessed the correlation between area profiles and area prevalence of detectable viremia ([greater than or equal to]20 copies/milliliter) among all adults regardless of HIV status. Results: 18,172 surveyed adults were categorized into one of six HIV risk types, each showing a unique pattern of five risk factors that conveyed HIV transmission and/or acquisition risk propensity. The three most frequent composite prevalences of HIV risk types were categorized into area profiles: low-moderate acquisition (low), moderate acquisition/transmission (moderate), and high acquisition/transmission (high). Detectable viremia prevalence increased from low [17.7%], moderate [25.4%], and high [35.1%] profiles and was 7.4% [p < .001] and 17.1% [p < .001] higher in moderate and high profile areas, respectively, when compared with low profile areas. High profile areas comprised the largest proportions of the highest transmission/acquisition risk types. The two highest risk types, high acquisition and very high transmission risk adults, were seronegative and undiagnosed seropositive, respectively, with the greatest likelihood of no prior HIV testing, multiple partnerships, and partners with unknown status. Conclusions: Area HIV risk profiles can explain variation in area HIV viral measures. Co-location of higher transmission and acquisition risk types in small areas may enable uncontrolled HIV viremia and geolocated sources of transmission.

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