PDF(Pubmed)
Abstract：
We aim to explore spatial variations in socioeconomic inequalities in HIV testing uptake in sub-Saharan Africa (SSA) at different geographical scales to identify potential geographical hotspots of inequalities. Additionally, to evaluate the potential benefits of HIV testing programmes, we assess whether local levels of HIV testing match the local levels of HIV prevalence.
A multi-country analysis of population-based cross-sectional surveys in SSA.
We analysed data from 25 SSA countries with Demographic and Health Surveys between 2011 and 2019.
Country-level analysis included 473 775 participants (312 104 women and 161 671 men) and cluster-level analysis included 328 283 individuals (241 084 women and 87 199 men). Women aged 15-49 years and men aged 15-54/59 years in selected households who were tested for HIV in the last 12 months were eligible. We quantified inequalities in self-reported recent HIV testing with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) across geographical scales to capture sex-specific within-country spatial variations. We also conducted local Getis-Ord Gi* statistics to consider the autocorrelation in fine-scale SII and RII across countries. To assess the efficiency of HIV testing programmes, we measured the correlation between recent HIV testing and HIV prevalence through Spearman correlation across geographical scales.
We observed varying inequalities in recent HIV testing in magnitude and spatial distribution on both absolute and relative scales in many countries for both sexes at national and subnational levels. Hotspots of absolute and relative inequalities were mostly observed in Western and Central Africa with a few regions in Eastern and Southern Africa. Despite significant sex-specific correlations between testing and prevalence in all countries when assessed at the national level, we report an absence of such a correlation at fine scale in 17 of 50 sex-country combinations.
We highlight the importance of investigating the spatial variability of various HIV indicators and related inequalities across different geographical levels. Results may help inform an equitable distribution of HIV testing services.
A multi-country analysis of population-based cross-sectional surveys in SSA.
We analysed data from 25 SSA countries with Demographic and Health Surveys between 2011 and 2019.
Country-level analysis included 473 775 participants (312 104 women and 161 671 men) and cluster-level analysis included 328 283 individuals (241 084 women and 87 199 men). Women aged 15-49 years and men aged 15-54/59 years in selected households who were tested for HIV in the last 12 months were eligible. We quantified inequalities in self-reported recent HIV testing with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) across geographical scales to capture sex-specific within-country spatial variations. We also conducted local Getis-Ord Gi* statistics to consider the autocorrelation in fine-scale SII and RII across countries. To assess the efficiency of HIV testing programmes, we measured the correlation between recent HIV testing and HIV prevalence through Spearman correlation across geographical scales.
We observed varying inequalities in recent HIV testing in magnitude and spatial distribution on both absolute and relative scales in many countries for both sexes at national and subnational levels. Hotspots of absolute and relative inequalities were mostly observed in Western and Central Africa with a few regions in Eastern and Southern Africa. Despite significant sex-specific correlations between testing and prevalence in all countries when assessed at the national level, we report an absence of such a correlation at fine scale in 17 of 50 sex-country combinations.
We highlight the importance of investigating the spatial variability of various HIV indicators and related inequalities across different geographical levels. Results may help inform an equitable distribution of HIV testing services.
摘要：
目的：我们的目标是探索撒哈拉以南非洲（SSA）在不同地理尺度的艾滋病毒检测中社会经济不平等的空间变化，以确定不平等的潜在地理热点。此外,评估艾滋病毒检测计划的潜在好处，我们评估当地的HIV检测水平是否与当地的HIV流行水平相匹配.
方法：对SSA中基于人口的横断面调查的多国家分析。
方法：我们分析了2011年至2019年25个SSA国家的人口与健康调查数据。
方法：国家层面的分析包括473775名参与者（312104名女性和161671名男性），集群层面的分析包括328283名个体（241084名女性和87199名男性）。在过去12个月内接受艾滋病毒检测的选定家庭中，年龄在15-49岁的女性和年龄在15-54/59岁的男性符合资格。我们使用地理尺度上的不平等斜率指数（SII）和不平等相对指数（RII）对自我报告的最近HIV测试中的不平等进行了量化，以捕获特定性别的国内空间变化。我们还进行了本地Getis-OrdGi*统计，以考虑各国精细SII和RII的自相关。评估艾滋病毒检测计划的效率，我们通过跨地理尺度的Spearman相关性测量了近期HIV检测与HIV患病率之间的相关性.
结果：我们观察到，在许多国家，在国家和国家以下各级，男女在绝对和相对尺度上，最近的艾滋病毒检测在幅度和空间分布上存在不同的不平等。绝对和相对不平等的热点主要出现在西非和中非以及东部和南部非洲的一些地区。尽管在国家一级评估时，所有国家的检测和流行率之间存在显著的性别特异性相关性，我们报告50个性别-国家组合中的17个在精细尺度上没有这种相关性.
结论：我们强调了在不同地理水平上调查各种HIV指标的空间变异性和相关不平等的重要性。结果可能有助于公平分配艾滋病毒检测服务。
方法：对SSA中基于人口的横断面调查的多国家分析。
方法：我们分析了2011年至2019年25个SSA国家的人口与健康调查数据。
方法：国家层面的分析包括473775名参与者（312104名女性和161671名男性），集群层面的分析包括328283名个体（241084名女性和87199名男性）。在过去12个月内接受艾滋病毒检测的选定家庭中，年龄在15-49岁的女性和年龄在15-54/59岁的男性符合资格。我们使用地理尺度上的不平等斜率指数（SII）和不平等相对指数（RII）对自我报告的最近HIV测试中的不平等进行了量化，以捕获特定性别的国内空间变化。我们还进行了本地Getis-OrdGi*统计，以考虑各国精细SII和RII的自相关。评估艾滋病毒检测计划的效率，我们通过跨地理尺度的Spearman相关性测量了近期HIV检测与HIV患病率之间的相关性.
结果：我们观察到，在许多国家，在国家和国家以下各级，男女在绝对和相对尺度上，最近的艾滋病毒检测在幅度和空间分布上存在不同的不平等。绝对和相对不平等的热点主要出现在西非和中非以及东部和南部非洲的一些地区。尽管在国家一级评估时，所有国家的检测和流行率之间存在显著的性别特异性相关性，我们报告50个性别-国家组合中的17个在精细尺度上没有这种相关性.
结论：我们强调了在不同地理水平上调查各种HIV指标的空间变异性和相关不平等的重要性。结果可能有助于公平分配艾滋病毒检测服务。
