Combining Geospatial Analysis with HIV Care Continuum to Identify Differential HIV/AIDS Treatment Indicators in Uganda

Abstract

To control the HIV epidemic at the population level, a 90–90–90 target has been proposed for sub-Saharan Africa, whereby 90 percent of people living with HIV (PLH) should know their HIV status, 90 percent of those diagnosed should be receiving antiretroviral therapy (ART), and 90 percent of those on ART should achieve viral suppression (VS). VS occurs when ART reduces the viral load of PLH to an undetectable level with minimal risk of new infections. We present a two-pronged interdisciplinary analysis, combining geospatial and HIV care continuum techniques, to guide treatment interventions toward achieving the 90–90–90 target in Uganda. We conducted spatiotemporal analysis of VS and constructed HIV care continuums for districts using publicly available data from a centralized laboratory of the Ministry of Health, Uganda. Spatial patterns of VS revealed a distinct east–west pattern of low rates and a north–south pattern of high rates with statistically significant clusters of districts with high and low rates in southwestern and eastern Uganda, respectively. VS rates, calculated in a sequential care continuum framework, revealed local variability as well as a significant gap from the 90–90–90 target by districts. Such evident local variability of VS might indicate the importance of regionally targeted interventions for bringing the HIV epidemic to an end.

为了在种群水平上控制艾滋病, 本文建议在撒哈拉沙漠以南地区采用90-90-90目标。即, 90%的艾滋病人应当知道自己的艾滋病状况, 90%的确诊病人应当接受抗逆转录病毒治疗, 90%的接受抗逆转录病毒治疗人员应当实现病毒抑制。病毒抑制是指, 艾滋病人的病毒量降低到检测不到的水平、病人重新感染的风险最低。两个交叉学科分析（地理和艾滋病连续护理技术）可以指导干预治疗, 从而在乌干达实现90-90-90目标。采用乌干达健康部中央实验室的公开数据, 本文开展了病毒抑制的时空分析, 建立了行政区艾滋病连续护理。病毒抑制在乌干达的空间模式显示：低病毒抑制比例沿着东西方向分布, 而高病毒抑制比例沿着南北方向分布, 西南部和东部分别有低比例和高比例在行政区化上的空间聚合。采用序列连续护理框架, 计算了病毒抑制比例。病毒抑制比例有局部区域差异, 而在90-90-90目标上各行政区有很大的差异。这些局部病毒抑制的显著差异, 可能表明了为终止艾滋病流行而进行区域干预的重要性。

Para controlar la epidemia de VIH a nivel de población, se ha propuesto una meta de 90–90–90 para el África subsahariana, donde el 90 por ciento de la gente que vive con VIH (PLH) debe conocer su estatus VIH, el 90 por ciento de quienes han sido diagnosticados deben estar recibiendo terapia antirretroviral (ART), y el 90 por ciento de quienes están en ART deben alcanzar la supresión viral (VS). La VS ocurre cuando los ART reducen la carga viral de PLH a un nivel indetectable, con mínimo riesgo de nuevas infecciones. Presentamos análisis interdisciplinarios duales, combinando técnicas geoespaciales y de continuidad en cuidado del VIH, para guiar las intervenciones del tratamiento orientadas a logar una meta de 90–90–90, en Uganda. Llevamos a cabo un análisis espaciotemporal de la VS y construimos continuidad de cuidado del VIH para los distritos usando datos disponibles públicamente de un laboratorio centralizado del Ministerio de la Salud de Uganda. Los patrones espaciales de la VS revelaron un patrón distinto este–oeste de tasas bajas y un patrón norte–sur de tasas altas con agrupamientos de distritos estadísticamente significativos, con tasas altas y bajas en la Uganda del sudoeste y este, respectivamente. Las tasas de la VS, calculadas en un marco de una continuidad de cuidado secuencial, revelaron variabilidad local lo mismo que una brecha significativa en la meta 90–90–90 por distritos. Tal variabilidad local evidente de la VS podría indicar la importancia de las intervenciones orientadas regionalmente para llevar la epidemia del VIH a su final.

Key Words:

• geospatial analysis
• HIV care continuum
• Uganda
• viral suppression

关键词:

• 地理分析
• 艾滋病连续护理
• 乌干达
• 病毒抑制

Palabras clave:

• análisis geoespacial
• continuidad de cuidado del VIH
• supresión viral
• Uganda
• VIH

Additional information

Funding

We thank our funding organizations, the National Institutes of Health (Grant No. K01DA037794) and the Department of Geography at the University of Connecticut.

Notes on contributors

Diane BenBella

DIANE BENBELLA is a PhD Candidate in the Department of Geography at the University of Connecticut, Storrs, CT 06269. E-mail: [email protected]. Her research interests include health geography of vulnerable populations using geospatial analysis and mixed methods techniques.

Debarchana Ghosh

DEBARCHANA GHOSH is an Associate Professor of Geography at the University of Connecticut, Storrs, CT 06269. E-mail: [email protected]. She served as the corresponding author for this article. She is also an affiliated faculty with the Center for Interdisciplinary Research on AIDS at Yale University. Her research and teaching interests focus on the relationship between place and health, where place is a multidimensional unit, connecting people (vulnerable populations), things (facilitators and barriers), and the environment.