A Spatial Approach for Ending the Human Immunodeficiency Virus Epidemic for the United States - A DC Model

Abstract

Background: Mode of transmission-based hotspots is a smart approach to HIV mitigation, yet remains poorly evaluated and implemented in the United States. The primary aim was to identifying mode of transmission-based hotspots and populations at risk of lower viral suppression to assist in targeted planning and implementation of programs. Methods: We implemented spatial statistics to identify global-local hotspots and regression analysis to find populations at risk of lower viral suppression within hotspots. Data were obtained from the District of Columbia's (DC's) active surveillance system, which were geocoded based on current residence address. Results: The analysis identified 6001 HIV-positive men who have sex with men (MSM) and 6077 HIV-positive non-MSM (N=12 078) living in DC at the end of 2018. The hotspots for MSM were central DC and non-MSM in south DC. Trends of viral suppression within MSM hotspots showed plateauing and, among non-MSM, showed decline. Regression analysis showed MSM aged 21-25 (RR: 3.199; 95% CI: 1.832-5.586) and not linked to care (8.592; 2.907-25.398) were at higher risk of being virally unsuppressed within the hotspots. For non-MSM we found those aged 12-18 (9.025; 3.314-2.581) and with unknown linkages (6.087; 3.346-13.848) were at higher risk of being virally unsuppressed within the hotspots. Conclusions: Our analysis provides a model that may be used by other jurisdictions to identify areas of priority and plan treatment-adherence programs using surveillance data. Attaining viral suppression is crucial in reducing new diagnoses; a spatial approach can be an important tool in Ending the HIV Epidemic.