title: Geographical Patterns of HIV Sero-Discordancy in High HIV Prevalence Countries in Sub-Saharan Africa.
abstract: Variation in the proportion of individuals living in a stable HIV sero-discordant partnership (SDP), and the potential drivers of such variability across sub Saharan Africa (SSA), are still not well-understood. This study aimed to examine the spatial clustering of HIV sero-discordancy, and the impact of local variation in HIV prevalence on patterns of sero-discordancy in high HIV prevalence countries in SSA.
  
  
  
  We described the spatial patterns of sero-discordancy among stable couples by analyzing Demographic and Health Survey data from Cameroon, Kenya, Lesotho, Tanzania, Malawi, Zambia, and Zimbabwe. We identified spatial clusters of SDPs in each country through a Kulldorff spatial scan statistics analysis. After a geographical cluster was identified, epidemiologic measures of sero-discordancy were calculated and analyzed.
  
  
  
  Spatial clusters with significantly high numbers of SDPs were identified and characterized in Kenya, Malawi, and Tanzania, and they largely overlapped with the clusters with high HIV prevalence. There was a positive correlation between HIV prevalence and the proportion of SDPs among all stable couples across within and outside clusters. Conversely, there was a negative, but weak and not significant, correlation between HIV prevalence and the proportion of SDPs among all stable couples with at least one HIV-infected individual in the partnership.
  
  
  
  There does not appear to be distinct spatial patterns for HIV sero-discordancy that are independent of HIV prevalence patterns. The variation of the sero-discordancy measures with HIV prevalence across clusters and outside clusters demonstrated similar patterns to those observed at the national level. The spatial variable does not appear to be a fundamental nor independent determinant of the observed patterns of sero-discordancy in high HIV prevalence countries in SSA.
authors: Department of Geography, University of Cincinnati, Cincinnati, OH 45221, USA. diego.cuadros@uc.edu.|Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation, Education City, Doha 24144, Qatar. diego.cuadros@uc.edu.|Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA. diego.cuadros@uc.edu.
authors: Diego F
authors: DF
authors: Cuadros
authors: Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation, Education City, Doha 24144, Qatar. lja2002@qatar-med.cornell.edu.|Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA. lja2002@qatar-med.cornell.edu.|College of Public Health, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha 24144, Qatar. lja2002@qatar-med.cornell.edu.
authors: Laith J
authors: LJ
authors: Abu-Raddad
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D016000:Cluster Analysis; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology / Q000821:virology; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012747:Sexual Partners; D062206:Spatial Analysis; D055815:Young Adult
keywords: HIV; geographical clustering; serodiscordancy; sub Saharan Africa