Bayesian Spatial Modelling of HIV Prevalence in Jimma Zone, Ethiopia.

Background: Although the human immunodeficiency virus (HIV) is spatially heterogeneous in Ethiopia, current regional estimates of HIV prevalence hide the epidemic's heterogeneity. A thorough examination of the prevalence of HIV infection using district-level data could assist to develop HIV prevention strategies. The aims of this study were to examine the spatial clustering of HIV prevalence in Jimma Zone at district level and assess the effects of patient characteristics on the prevalence of HIV infection. Methods: The 8440 files of patients who underwent HIV testing in the 22 Districts of Jimma Zone between September 2018 and August 2019 were the source of data for this study. The global Moran's index, Getis-Ord Gi* local statistic, and Bayesian hierarchical spatial modelling approach were applied to address the research objectives. Results: Positive spatial autocorrelation was observed in the districts and the local indicators of spatial analysis using the Getis-Ord statistic also identified three districts, namely Agaro, Gomma and Nono Benja, as hotspots, and two districts, namely Mancho and Omo Beyam, as coldspots with 95% and 90% confidence levels, respectively, for HIV prevalence. The results also showed eight patient-related characteristics that were considered in the study were associated with HIV prevalence in the study area. Furthermore, after accounting for these characteristics in the fitted model, there was no spatial clustering of HIV prevalence suggesting the patient characteristics had explained most of the heterogeneity in HIV prevalence in Jimma Zone for the study data. Conclusions: The identification of hotspot districts and the spatial dynamic of HIV infection in Jimma Zone at district level may allow health policymakers in the zone or Oromiya region or at national level to develop geographically specific strategies to prevent HIV transmission. Because clinic register data were used in the study, it is important to use caution when interpreting the results. The results are restricted to Jimma Zone districts and may not be generalizable to Ethiopia or the Oromiya region.