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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Geospatial patterns of progress towards UNAIDS ‘95-95-95’ targets and community vulnerability in Zambia: insights from population-based HIV impact assessments
BMJ Global Health, Volume 8, No. 10, Article e012629, Year 2023
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Description
Introduction In sub-Saharan Africa, HIV/AIDS remains a leading cause of death. The UNAIDS established the ‘95-95-95’ targets to improve HIV care continuum outcomes. Using geospatial data from the Zambia Population-based HIV Impact Assessment (ZAMPHIA), this study aims to investigate geospatial patterns in the ‘95-95-95’ indicators and individual-level determinants that impede HIV care continuum in vulnerable communities, providing insights into the factors associated with gaps. Methods This study used data from the 2016 ZAMPHIA to investigate the geospatial distribution and individual-level determinants of engagement across the HIV care continuum in Zambia. Gaussian kernel interpolation and optimised hotspot analysis were used to identify geospatial patterns in the HIV care continuum, while geospatial k-means clustering was used to partition areas into clusters. The study also assessed healthcare availability, access and social determinants of healthcare utilisation. Multiple logistic regression models were used to examine the association between selected sociodemographic and behavioural covariates and the three main outcomes of study. Results Varied progress towards the ‘95-95-95’ targets were observed in different regions of Zambia. Each ‘95’ displayed a unique geographical pattern, independent of HIV prevalence, resulting in four distinct geographical clusters. Factors associated with gaps in the ‘95s’ include younger age, male sex, and low wealth, with younger individuals having higher odds of not being on antiretroviral therapy and having detectable viral loads. Conclusions Our study revealed significant spatial heterogeneity in the HIV care continuum in Zambia, with different regions exhibiting unique geographical patterns and levels of performance in the ‘95-95-95’ targets, highlighting the need for geospatial tailored interventions to address the specific needs of different subnational regions. These findings underscore the importance of addressing differential regional gaps in HIV diagnosis, enhancing community-level factors and developing innovative strategies to improve local HIV care continuum outcomes. © Author(s) (or their employer(s)) 2023.
Authors & Co-Authors
Cuadros, Diego Fernando
United States, Cincinnati
University of Cincinnati
Milali, Masabho P.
United States, New York
New York University
Citron, Daniel T.
United States, New York
New York University
Nyimbili, Sulani
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Vlahakis, Natalie
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Savory, Theodora
Zambia, Lusaka
Centre for Infectious Disease Research in Zambia
Mulenga, Lloyd Berdad
Zambia, Lusaka
Zambian Ministry of Health
Sivile, Suilanji
Zambia, Lusaka
Zambian Ministry of Health
Zyambo, Khozya Davie
Zambia, Lusaka
Zambian Ministry of Health
Bershteyn, Anna
United States, New York
New York University
Statistics
Authors: 10
Affiliations: 4
Identifiers
Doi:
10.1136/bmjgh-2023-012629
ISSN:
20597908
Research Areas
Genetics And Genomics
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Study Locations
Zambia
Participants Gender
Male