Spatial patterns of tuberculosis and HIV co-infection in Ethiopia

Abstract

BackgroundTuberculosis (TB) and human immunodeficiency virus (HIV) are the leading causes of infectious-disease-related deaths in Ethiopia, but little is known about their spatial distribution across the country. The aim of this study was to investigate the spatial patterns of TB and HIV co-infection in Ethiopia at the district level.MethodsWe conducted an ecological study using TB and HIV data reported from all regions of Ethiopia through the national Health Management Information System (HMIS), between June 2015 and June 2017. Spatial clustering was assessed using Moran’s I statistic and Getis-Ord statistic. Spatial binomial regression models were constructed separately for the prevalence of TB among people living with HIV and for the prevalence of HIV among TB patients, with and without spatial components using a Bayesian approach.ResultsA total of 1,830,880 HIV and 192,359 TB patients were included in the analysis. The prevalence of HIV among TB patients was 7.34%; hotspots were observed in districts located in Amhara, Afar, and Gambela regions, and cold spots were observed in Oromiya and Southern Nations, Nationalities, and People (SNNP) regions. The prevalence of TB among people living with HIV varied from 0.7% in Oromia region to 14.5% in Afar region. Hotspots of TB prevalence among people living with HIV were observed in districts located in Gambela, Afar, Somali, and Oromiya regions; whereas the cold spots were observed in districts located in Amhara and Tigray regions. The ecological-level factors associated with the prevalence of TB among people living with HIV were low wealth index (OR: 1.49; 95% CrI: 1.05, 2.05), low adult literacy rate (OR: 0.67; 95% CrI: 0.46, 0.94), and distance to an international border (OR: 0.61; 95% CrI: 0.40, 0.91). The factors associated with the prevalence of HIV among TB patients were poor health care access (OR: 0.76; 95% CrI: 0.59, 0.95), low wealth index (OR: 1.31; 95% CrI: 1.01, 1.67), and low adult literacy rate (OR: 1.37; 95% CrI: 1.03, 1.78).ConclusionOur study provides evidence for geographic clustering of TB/HIV co-infection in Ethiopia. Health care access, proximity to international borders, and demographic factors such as low wealth index and adult literacy were significantly associated with the prevalence of TB/HIV co-infection.

Spatial distribution of Mycobacterium Tuberculosis in metropolitan Harare, Zimbabwe

“…The high HIV co-infection across all districts maybe driving the TB epidemic. However, despite a similar average HIV prevalence, there were differences in TB prevalence, (cases per capita) by district and also spatial distribution suggesting that HIV alone was not the cause of the observed TB distribution as reported from a study from Ethiopia [26].…”

“…Studies from China and Ethiopia also reported that low access to health care services was associated with increased number of TB cases. [26,33].…”

Mapping tuberculosis prevalence in Ethiopia: protocol for a geospatial meta-analysis

“…Previous studies conducted in Ethiopia have shown a substantial geographical variation of TB incidence at district level. [6][7][8][9] Such small-area variations of TB may have important implications for local and national health policy in that policymakers, clinicians and public health professionals might benefit from evidence to target interventions to those areas and communities at the highest risk. However, previous spatial analyses of TB have been generally conducted using routinely collected TB notification data.…”

Estudo clínico-epidemiológico da coinfecção TB-HIV em município prioritário: análise de 10 anos

“…En relación al grupo de edad, se observó que la coinfección afecta a personas de 25 a 44 años, que viven en el área urbana. El perfil de coinfección ha ido cambiando en Brasil, a pesar de la alta prevalencia en las regiones sur y sureste, las tasas de incidencia han aumentado en las regiones norte y noreste, con un predominio de casos en pacientes de 25 a 59 años que viven en la zona urbana, un hecho asociado con el estilo de vida de los adultos jóvenes a menudo vinculado a la falta de conciencia de su vulnerabilidad, exponiéndolos al virus del VIH y a la tuberculosis; también se destacan los patrones espaciales basados en categorías de edad que mostraron un riesgo de coinfección generalizado para las edades de 25 a 34 años, seguido de 35 a 44 años (21,22) .…”

“…También se detectaron debilidades con respecto al relleno de los formularios que presentaban información ignorada que obstaculizaba el uso de estos datos y perjudicaba la calidad de la información, ya que la posible utilidad de los datos de notificación de casos proporciona estimaciones sólidas para la amplia estructura espaciotemporal de la coinfección TB-HIV (22) .…”