Identifying groups of people with similar sociobehavioural characteristics in Malawi to inform HIV interventions: a Latent Class Analysis

Abstract

Background: Within many sub-Saharan African countries including Malawi, HIV prevalence varies widely between regions. This variability may be related to the distribution of population groups with specific sociobehavioural characteristics that influence the transmission of HIV and the uptake of prevention. In this study, we intended to identify groups of people in Malawi with similar risk profiles. Methods: We used data from the Demographic and Health Survey in Malawi from 2016, and stratified the analysis by sex. We considered demographic, socio-behavioural and HIV-related variables. Using Latent Class Analysis (LCA), we identified clusters of people sharing common sociobehavioural characteristics. The optimal number of clusters was selected based on the Bayesian information criterion. We compared the proportions of individuals belonging to the different clusters across the three regions and 28 districts of Malawi. Results: We found nine clusters of women and six clusters of men. Most women in the clusters with highest risk of being HIV infected were living in female-headed households and were formerly married or in a union. Among men, older men had the highest risk of being HIV infected, followed by young (20-25) single men. Generally, low HIV testing uptake correlated with lower risk of having HIV. However, rural adolescent girls had a low probability of being tested (48.7%) despite a relatively high HIV prevalence. Urban districts and Southern region had a higher percentage of high-prevalence and less tested clusters of individuals than other areas. Conclusions: LCA is an efficient method to find clusters of people sharing common HIV risk profiles, identify particularly vulnerable population groups, and plan targeted interventions focusing on these groups. Tailored support, prevention and HIV testing programmes should focus particularly on female household heads, adolescent girls living in rural areas, older married men, and young men who have never been married.

Sexual Behaviors and HIV Status: A Population-Based Study among Youths and Adults in Tanzania

“…Moreover, it is possible that sexual partners may contribute to a commitment to getting an HIV testing done. Analyses of survey data from Malawi and Uganda revealed higher HIV prevalence among people who were not in marital unions [8,22,25,26]. This is consistent with our findings and suggests need to encourage more testing and safer sexual practices among sexually active individuals who are not in committed relationships.…”

Social, behavioural, and cultural factors of HIV in Malawi: a semi-automated systematic review

“…We designed the review to be broad and inclusive to capture all possibly relevant factors and expected it to identify known factors, neglected factors, and some factors that may never have been identified or analyzed in quantitative studies. We chose Malawi because 1) Malawi has relatively high HIV prevalence that varies substantially between regions [16]; 2) the country is socio-culturally diverse because it is home to many ethnic groups (e.g., Chewa, Nyanja, Tumbuka, Yao, Lomwe, Sena, Tonga, Ngoni, Ngonde, Asians, and Europeans); 3) a preliminary search revealed that Malawi was the focus of many scientific studies on HIV, including some by our group [17][18][19].…”

Social, Behavioral, and Cultural factors of HIV in Malawi: Semi-Automated Systematic Review (Preprint)

“…We designed the review to be broad and inclusive to capture all possible relevant factors and expected it to identify known factors, neglected factors, and some factors that may never have been identified or analyzed in quantitative studies. We chose Malawi for several reasons: (1) Malawi has a relatively high HIV prevalence that varies substantially between regions [16], (2) the country is socioculturally diverse because it is home to many ethnic groups (eg, Chewa, Nyanja, Tumbuka, Yao, Lomwe, Sena, Tonga, Ngoni, Ngonde, Asians, and Europeans), and (3) a preliminary search revealed that Malawi was the focus of many scientific studies on HIV, including some by our group [17][18][19].…”