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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Place matters: multilevel investigation of HIV distribution in Tanzania</title><author><name sortKey="Msisha, Wezi M" sort="Msisha, Wezi M" uniqKey="Msisha W" first="Wezi M." last="Msisha">Wezi M. Msisha</name><affiliation><nlm:aff id="A1">Europe and Central Asia Human Development Sector, The World Bank, Washington, DC, USA</nlm:aff></affiliation></author><author><name sortKey="Kapiga, Saidi H" sort="Kapiga, Saidi H" uniqKey="Kapiga S" first="Saidi H." last="Kapiga">Saidi H. Kapiga</name><affiliation><nlm:aff id="A2">The Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Earls, Felton J" sort="Earls, Felton J" uniqKey="Earls F" first="Felton J." last="Earls">Felton J. Earls</name><affiliation><nlm:aff id="A3">Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA.</nlm:aff></affiliation></author><author><name sortKey="Subramanian, S V" sort="Subramanian, S V" uniqKey="Subramanian S" first="S. V." last="Subramanian">S. V. Subramanian</name><affiliation><nlm:aff id="A3">Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">18356604</idno><idno type="pmc">2789284</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789284</idno><idno type="RBID">PMC:2789284</idno><idno type="doi">10.1097/QAD.0b013e3282f3947f</idno><date when="2008">2008</date><idno type="wicri:Area/Pmc/Corpus">001072</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001072</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Place matters: multilevel investigation of HIV distribution in Tanzania</title><author><name sortKey="Msisha, Wezi M" sort="Msisha, Wezi M" uniqKey="Msisha W" first="Wezi M." last="Msisha">Wezi M. Msisha</name><affiliation><nlm:aff id="A1">Europe and Central Asia Human Development Sector, The World Bank, Washington, DC, USA</nlm:aff></affiliation></author><author><name sortKey="Kapiga, Saidi H" sort="Kapiga, Saidi H" uniqKey="Kapiga S" first="Saidi H." last="Kapiga">Saidi H. Kapiga</name><affiliation><nlm:aff id="A2">The Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Earls, Felton J" sort="Earls, Felton J" uniqKey="Earls F" first="Felton J." last="Earls">Felton J. Earls</name><affiliation><nlm:aff id="A3">Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA.</nlm:aff></affiliation></author><author><name sortKey="Subramanian, S V" sort="Subramanian, S V" uniqKey="Subramanian S" first="S. V." last="Subramanian">S. V. Subramanian</name><affiliation><nlm:aff id="A3">Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA.</nlm:aff></affiliation></author></analytic><series><title level="j">AIDS (London, England)</title><idno type="ISSN">0269-9370</idno><idno type="eISSN">1473-5571</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">To examine the extent to which the regional and neighborhood distribution of HIV in Tanzania is caused by the differential distribution of individual correlates and risk factors.</p></sec><sec sec-type="methods" id="S2"><title>Methods</title><p id="P2">Nationally representative, cross-sectional data on 12 522 women and men aged 15–49 years from the 2003–2004 Tanzanian AIDS Indicator Survey. Three-level multilevel binary logistic regression models were specified to estimate the relative contribution of regions and neighborhoods to the variation in HIV seroprevalence.</p></sec><sec id="S3"><title>Results</title><p id="P3">Spatial distribution of individual correlates (and risk factors) of HIV do not explain the neighborhood and regional variation in HIV seroprevalence. Neighborhoods and regions accounted for approximately 14 and 6% of the total variation in HIV. HIV prevalence ranged from 1.8% (Kigoma) to 6.7% (Iringa) even after adjusting for the compositional make-up of these regions. An inverse association was observed between log odds of being HIV positive and neighborhood poverty [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.09–0.61] and regional poverty (OR 0.97, 95% CI 0.95–0.99).</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">Our study provides evidence for independent contextual variations in HIV, above and beyond that which can be ascribed to geographical variations in individual-level correlates and risk factors. We emphasize the need to adopt both a group-based and a place-based approach, as opposed to the dominant high-risk group approach, for understanding the epidemiology of HIV as well as for developing HIV intervention activities.</p></sec></div></front></TEI><pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8710219</journal-id><journal-id journal-id-type="pubmed-jr-id">1493</journal-id><journal-id journal-id-type="nlm-ta">AIDS</journal-id><journal-title>AIDS (London, England)</journal-title><issn pub-type="ppub">0269-9370</issn><issn pub-type="epub">1473-5571</issn></journal-meta><article-meta><article-id pub-id-type="pmid">18356604</article-id><article-id pub-id-type="pmc">2789284</article-id><article-id pub-id-type="doi">10.1097/QAD.0b013e3282f3947f</article-id><article-id pub-id-type="manuscript">NIHMS160374</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Place matters: multilevel investigation of HIV distribution in Tanzania</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Msisha</surname><given-names>Wezi M.</given-names></name><xref ref-type="aff" rid="A1">a</xref></contrib><contrib contrib-type="author"><name><surname>Kapiga</surname><given-names>Saidi H.</given-names></name><xref ref-type="aff" rid="A2">b</xref></contrib><contrib contrib-type="author"><name><surname>Earls</surname><given-names>Felton J.</given-names></name><xref ref-type="aff" rid="A3">c</xref></contrib><contrib contrib-type="author"><name><surname>Subramanian</surname><given-names>S.V.</given-names></name><xref ref-type="aff" rid="A3">c</xref></contrib></contrib-group><aff id="A1"><label>a</label>Europe and Central Asia Human Development Sector, The World Bank, Washington, DC, USA</aff><aff id="A2"><label>b</label>The Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts, USA</aff><aff id="A3"><label>c</label>Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA.</aff><author-notes><corresp id="cor1">Correspondence to S. V. Subramanian, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA 02115-6096, USA., Tel: +1 617 432 6299; fax: +1 617 432 1135; <email>svsubram@hsph.harvard.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>19</day><month>11</month><year>2009</year></pub-date><pub-date pub-type="ppub"><day>30</day><month>3</month><year>2008</year></pub-date><pub-date pub-type="pmc-release"><day>5</day><month>12</month><year>2009</year></pub-date><volume>22</volume><issue>6</issue><fpage>741</fpage><lpage>748</lpage><permissions><copyright-statement>© 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins</copyright-statement><copyright-year>2008</copyright-year></permissions><abstract><sec id="S1"><title>Objective</title><p id="P1">To examine the extent to which the regional and neighborhood distribution of HIV in Tanzania is caused by the differential distribution of individual correlates and risk factors.</p></sec><sec sec-type="methods" id="S2"><title>Methods</title><p id="P2">Nationally representative, cross-sectional data on 12 522 women and men aged 15–49 years from the 2003–2004 Tanzanian AIDS Indicator Survey. Three-level multilevel binary logistic regression models were specified to estimate the relative contribution of regions and neighborhoods to the variation in HIV seroprevalence.</p></sec><sec id="S3"><title>Results</title><p id="P3">Spatial distribution of individual correlates (and risk factors) of HIV do not explain the neighborhood and regional variation in HIV seroprevalence. Neighborhoods and regions accounted for approximately 14 and 6% of the total variation in HIV. HIV prevalence ranged from 1.8% (Kigoma) to 6.7% (Iringa) even after adjusting for the compositional make-up of these regions. An inverse association was observed between log odds of being HIV positive and neighborhood poverty [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.09–0.61] and regional poverty (OR 0.97, 95% CI 0.95–0.99).</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">Our study provides evidence for independent contextual variations in HIV, above and beyond that which can be ascribed to geographical variations in individual-level correlates and risk factors. We emphasize the need to adopt both a group-based and a place-based approach, as opposed to the dominant high-risk group approach, for understanding the epidemiology of HIV as well as for developing HIV intervention activities.</p></sec></abstract><kwd-group><kwd>Africa</kwd><kwd>epidemiology</kwd><kwd>geography</kwd><kwd>HIV</kwd><kwd>seroprevalence</kwd><kwd>socioeconomic status</kwd></kwd-group><contract-num rid="HL1">K25 HL081275-01
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