title: HIV Incidence and Spatial Clustering in a Rural Area of Southern Mozambique.
abstract: BACKGROUND
  Monitoring the HIV epidemic in a defined population is critical for planning treatment and preventive strategies. This is especially important in sub-Saharan Africa, which harbours the highest burden of the disease.
  
  
  OBJECTIVE
  To estimate HIV incidence in adults aged 18-47 years old and to investigate spatial variations of HIV prevalence in Manhiça, a semi-rural area of southern Mozambique.
  
  
  METHODS
  Two cross-sectional community-based surveys were conducted in 2010 and 2012 to determine HIV prevalence. Individual participants were randomly selected from the demographic surveillance system in place in the area and voluntary HIV counselling and testing was offered at the household level. HIV incidence was calculated using prevalence estimates from the two sero-surveys. Each participant's household was geocoded using a global information system. The Spatial Scan Statistics programme was used to identify areas with disproportionate excess in HIV prevalence.
  
  
  RESULTS
  A total of 1511 adults were tested. The estimated HIV prevalence in the community was 39.9% in 2010 and 39.7% in 2012. The overall HIV incidence was 3.6 new infections per 100 person-years at risk (PYAR) [95CI 1.56; 7.88], assuming stable epidemic conditions, and tended to be higher in women (4.9/100 PYAR [95CI 1.74; 11.85]) than in men (3.2/PYAR [95CI 1.36; 9.92]). One cluster with significant excess HIV prevalence was identified at the same geographic location in both surveys. This cluster had an HIV prevalence of 79.0% in 2010 and 52.3% in 2012.
  
  
  CONCLUSIONS
  The findings of these first individually-randomised community-HIV sero-surveys conducted in Mozambique reinforce the need to combine HIV incidence estimates and research on micro geographical infection patterns to guide and consolidate effective prevention strategies.
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
authors.forename: Raquel
authors.initials: R
authors.lastname: González
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
authors.forename: Orvalho J
authors.initials: OJ
authors.lastname: Augusto
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
authors.forename: Khátia
authors.initials: K
authors.lastname: Munguambe
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Pierrat
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
authors.forename: Elpidia N
authors.initials: EN
authors.lastname: Pedro
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
authors.forename: Charfudin
authors.initials: C
authors.lastname: Sacoor
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: De Lazzari
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
authors.forename: John J
authors.initials: JJ
authors.lastname: Aponte
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique; Direcção Nacional de Saúde (DNS), Ministério da Saúde, Maputo, Mozambique.
authors.forename: Eusébio
authors.initials: E
authors.lastname: Macete
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique; World Health Organization (WHO), Geneva, Switzerland.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
authors.forename: Clara
authors.initials: C
authors.lastname: Menendez
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique.
authors.forename: Denise
authors.initials: D
authors.lastname: Naniche
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002391:Catchment Area, Health; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D058872:Epidemics; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D015528:HIV Seroprevalence; D015497:HIV-1; D015498:HIV-2; D006306:Health Surveys; D006792:House Calls; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009073:Mozambique / Q000453:epidemiology; D011159:Population Surveillance; D012424:Rural Population / Q000706:statistics & numerical data*; D017678:Sex Distribution; D014171:Transients and Migrants / Q000706:statistics & numerical data; D055815:Young Adult