Are Geographical "Cold Spots" of Male Circumcision Driving Differential HIV Dynamics in Tanzania?

Growing evidence suggests significant geographic clustering of male circumcision (MC) in Tanzania. The impact of spatial heterogeneity of MC prevalence on HIV transmission dynamics in this country is not well documented. The aim of this study was to assess the spatial association between MC and HIV infection in Tanzania.

Data from three Demographic and Health Survey rounds conducted in Tanzania were analyzed to identify spatial associations between MC and HIV using bivariate local indicators of spatial association (LISA). Spatial clusters with low MC prevalence (MC cold spots) were identified using scan statistics. HIV incidence rates for males and females within and outside the MC cold spots were calculated.

Local indicators of spatial association analysis indicated a significant association between MC and HIV in the northern and southwestern regions of Tanzania. Scan statistics identified two MC cold spots in the same locations. Males located outside the MC cold spots had the lowest HIV incidence rate at 0.28 per 100 person-years at risk (pyar). HIV incidence in females located outside the MC cold spots increased from 0.40/100 pyar during 2004-2008 to 0.68/100 pyar in 2008-2012.

Our study provides evidence for a geographic association between MC and HIV in Tanzania. MC could be one of the key factors driving the geographical distribution of the HIV epidemic in the country. Furthermore, in areas where most males are circumcised, the HIV infection burden could be concentrating in the female population. Therefore, along with the voluntary medical MC program, efforts targeting the female population should also be considered.

Below:  Tanzania districts (A), and sample locations for the TDHS 2011–12 (B)

Below:  Continuous surface maps of male circumcision (MC) prevalence (A) and HIV prevalence (B) in Tanzania estimated in the year 2012. Black circles in (A) indicate the location of the MC cold spots identified by spatial scan statistics. Areas with significant association between MC and HIV prevalence are shown in (C), and the type of the association is identified in (D).

Below:  HIV prevalence for males (blue bars) and females (red bars) outside and within the male circumcision cold spots. Continuous lines (purple and gray) illustrate the relative risk of HIV infection in females compared to males

Below:  HIV incidence rate for males and females outside and within the male circumcision cold spots during 2004–2008 (red bars) and 2008–2012 (blue bars)

Full article at: http://goo.gl/KWkLMh

By: Diego F. Cuadros,1,2,* Adam J. Branscum,3 F. DeWolfe Miller,4 Susanne F. Awad,1 and Laith J. Abu-Raddad1,2,5

¹Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Qatar Foundation, Cornell University, Doha, Qatar

²Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, Ithaca, NY, USA

³College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA

⁴Department of Tropical Medicine and Medical Microbiology and Pharmacology, University of Hawaii, Honolulu, HI, USA

⁵Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

Edited by: Shabnam Asghari, Memorial University of Newfoundland, Canada

Reviewed by: Ahmed Mohamed, Maricopa County Department of Public Health, USA; Jing Yao, University of Glasgow, UK

*Correspondence: Diego F. Cuadros, Weill Cornell Medical College – Qatar, Qatar Foundation – Education City, P. O. Box 24144, Doha Qatar,Email: ude.llenroc.dem-rataq@2002cfd

  

More at:  https://twitter.com/hiv_insight