Are Geographical “Cold Spots” of Male Circumcision Driving Differential HIV Dynamics in Tanzania?
Identifieur interne : 001860 ( Main/Exploration ); précédent : 001859; suivant : 001861Are Geographical “Cold Spots” of Male Circumcision Driving Differential HIV Dynamics in Tanzania?
Auteurs : Diego F. Cuadros [Qatar, États-Unis] ; Adam J. Branscum [États-Unis] ; F. Dewolfe Miller [États-Unis] ; Susanne F. Awad [Qatar] ; Laith J. Abu-Raddad [Qatar, États-Unis]Source :
- Frontiers in Public Health [ 2296-2565 ] ; 2015.
Abstract
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.
Url:
DOI: 10.3389/fpubh.2015.00218
PubMed: 26484339
PubMed Central: 4586325
Affiliations:
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Le document en format XML
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<front><div type="abstract" xml:lang="en"><sec id="ST1"><title>Background</title>
<p>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.</p>
</sec>
<sec id="ST2"><title>Methods</title>
<p>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.</p>
</sec>
<sec id="ST3"><title>Results</title>
<p>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.</p>
</sec>
<sec id="ST4"><title>Conclusion</title>
<p>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.</p>
</sec>
</div>
</front>
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</author>
<author><name sortKey="Barrere, B" uniqKey="Barrere B">B Barrere</name>
</author>
<author><name sortKey="Hong, R" uniqKey="Hong R">R Hong</name>
</author>
<author><name sortKey="Khan, S" uniqKey="Khan S">S Khan</name>
</author>
</analytic>
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<biblStruct><analytic><author><name sortKey="Burget, C" uniqKey="Burget C">C Burget</name>
</author>
<author><name sortKey="Colston, J" uniqKey="Colston J">J Colston</name>
</author>
<author><name sortKey="Roy, T" uniqKey="Roy T">T Roy</name>
</author>
<author><name sortKey="Zachary, B" uniqKey="Zachary B">B Zachary</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Lilienfeld, Am" uniqKey="Lilienfeld A">AM Lilienfeld</name>
</author>
<author><name sortKey="Graham, S" uniqKey="Graham S">S Graham</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Urassa, M" uniqKey="Urassa M">M Urassa</name>
</author>
<author><name sortKey="Todd, J" uniqKey="Todd J">J Todd</name>
</author>
<author><name sortKey="Boerma, Jt" uniqKey="Boerma J">JT Boerma</name>
</author>
<author><name sortKey="Hayes, R" uniqKey="Hayes R">R Hayes</name>
</author>
<author><name sortKey="Isingo, R" uniqKey="Isingo R">R Isingo</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Dodge, O" uniqKey="Dodge O">O Dodge</name>
</author>
<author><name sortKey="Kaviti, J" uniqKey="Kaviti J">J Kaviti</name>
</author>
</analytic>
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<affiliations><list><country><li>Qatar</li>
<li>États-Unis</li>
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</list>
<tree><country name="Qatar"><noRegion><name sortKey="Cuadros, Diego F" sort="Cuadros, Diego F" uniqKey="Cuadros D" first="Diego F." last="Cuadros">Diego F. Cuadros</name>
</noRegion>
<name sortKey="Abu Raddad, Laith J" sort="Abu Raddad, Laith J" uniqKey="Abu Raddad L" first="Laith J." last="Abu-Raddad">Laith J. Abu-Raddad</name>
<name sortKey="Awad, Susanne F" sort="Awad, Susanne F" uniqKey="Awad S" first="Susanne F." last="Awad">Susanne F. Awad</name>
</country>
<country name="États-Unis"><noRegion><name sortKey="Cuadros, Diego F" sort="Cuadros, Diego F" uniqKey="Cuadros D" first="Diego F." last="Cuadros">Diego F. Cuadros</name>
</noRegion>
<name sortKey="Abu Raddad, Laith J" sort="Abu Raddad, Laith J" uniqKey="Abu Raddad L" first="Laith J." last="Abu-Raddad">Laith J. Abu-Raddad</name>
<name sortKey="Abu Raddad, Laith J" sort="Abu Raddad, Laith J" uniqKey="Abu Raddad L" first="Laith J." last="Abu-Raddad">Laith J. Abu-Raddad</name>
<name sortKey="Branscum, Adam J" sort="Branscum, Adam J" uniqKey="Branscum A" first="Adam J." last="Branscum">Adam J. Branscum</name>
<name sortKey="Miller, F Dewolfe" sort="Miller, F Dewolfe" uniqKey="Miller F" first="F. Dewolfe" last="Miller">F. Dewolfe Miller</name>
</country>
</tree>
</affiliations>
</record>
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