title: Changing spatial patterns and increasing rurality of HIV prevalence in the Democratic Republic of the Congo between 2007 and 2013.
abstract: The Democratic Republic of the Congo (DRC) has one of the lowest HIV prevalence in sub-Saharan Africa, estimated at 1.1% [0.9-1.3] of adults aged 15-49 in 2013 (UNAIDS). Within the 2 million km(2) country, however, there exists spatial variation in HIV prevalence, with the highest HIV prevalence observed in the large cities of Kinshasa and Lubumbashi. Globally, HIV is an increasingly rural disease, diffusing outwards from urban centers of high HIV prevalence to places where HIV was previously absent or present at very low levels. Utilizing data collected during Demographic and Health Surveillance (DHS) in 2007 and 2013 in the DRC, we sought to update the map of HIV prevalence in the DRC as well as to explore whether HIV in the DRC is an increasingly rural disease or remains confined to urban areas. Bayesian kriging and regression indicate that HIV prevalence in rural areas of the DRC is higher in 2013 than in 2007 and that increased distance to an urban area is no longer protective against HIV as it was in 2007. These findings suggest that HIV education, testing and prevention efforts need to diffuse from urban to rural areas just as HIV is doing.
authors.affiliation: Department of Geographical & Sustainability Sciences, 303 Jessup Hall, University of Iowa, Iowa City, IA 52245, USA; Department of Epidemiology, University of Iowa, Iowa City, IA, USA. Electronic address: margaret-carrel@uiowa.edu.
authors.forename: Margaret
authors.initials: M
authors.lastname: Carrel
authors.affiliation: Department of Geography, CB3220, Carolina Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA; Department of Biostatistics, CB7420, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Janko
authors.affiliation: Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Melchior Kashamuka
authors.initials: MK
authors.lastname: Mwandagalirwa
authors.affiliation: Department of Biostatistics, CB7420, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Camille
authors.initials: C
authors.lastname: Morgan
authors.affiliation: National AIDS Control Program (PNLS), Kinshasa, Democratic Republic of the Congo.
authors.forename: Franck
authors.initials: F
authors.lastname: Fwamba
authors.affiliation: National AIDS Control Program (PNLS), Kinshasa, Democratic Republic of the Congo.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Muwonga
authors.affiliation: Ecole de Sante Publique, Faculte de Medecine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
authors.forename: Antoinette K
authors.initials: AK
authors.lastname: Tshefu
authors.affiliation: Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Meshnick
authors.affiliation: Department of Geography, CB3220, Carolina Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, CB7435, McGavran-Greenberg Hall, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Emch
mesh_terms: D000293:Adolescent; D000328:Adult; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data* / Q000639:trends; D062206:Spatial Analysis
keywords: Bayesian kriging; Democratic Republic of the Congo; HIV; Protective; Rural; Urban