Spatial clustering of all-cause and HIV-related mortality in a rural South African population (2000-2006).

<h4>Background</h4>Sub-Saharan Africa bears a disproportionate burden of HIV infection. Knowledge of the spatial distribution of HIV outcomes is vital so that appropriate public health interventions can be directed at locations most in need. In this regard, spatial clustering analysis of...

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Autores principales:	Elias Namosha, Benn Sartorius, Frank Tanser
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/371383f3fcb04d05a78bb4227cbbffa9
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spelling	oai:doaj.org-article:371383f3fcb04d05a78bb4227cbbffa92021-11-18T09:03:19ZSpatial clustering of all-cause and HIV-related mortality in a rural South African population (2000-2006).1932-620310.1371/journal.pone.0069279https://doaj.org/article/371383f3fcb04d05a78bb4227cbbffa92013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23935972/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Sub-Saharan Africa bears a disproportionate burden of HIV infection. Knowledge of the spatial distribution of HIV outcomes is vital so that appropriate public health interventions can be directed at locations most in need. In this regard, spatial clustering analysis of HIV-related mortality events has not been performed in a rural sub-Saharan African setting.<h4>Methodology and results</h4>Kulldorff's spatial scan statistic was used to identify HIV-related and all-cause mortality clusters (p<0.05) in a population-based demographic surveillance survey in rural KwaZulu Natal, South Africa (2000-2006). The analysis was split pre (2000-2003) and post (2004-2006) rollout of antiretroviral therapy, respectively. Between 2000-2006 a total of 86,175 resident individuals ≥15 years of age were under surveillance and 5,875 deaths were recorded (of which 2,938 were HIV-related) over 343,060 person-years of observation (crude all-cause mortality rate 17.1/1000). During both time periods a cluster of high HIV-related (RR = 1.46/1.51, p = 0.001) and high all-cause mortality (RR = 1.35/1.38, p = 0.001) was identified in peri-urban communities near the National Road. A consistent low-risk cluster was detected in the urban township in both time periods (RR = 0.60/0.39, p = 0.003/0.005) and in the first time period (2000-2003) a large cluster of low HIV-related and all-cause mortality in a remote rural area was identified.<h4>Conclusions</h4>HIV-related and all-cause mortality exhibit strong spatial clustering tendencies in this population. Highest HIV-related mortality and all-cause mortality occurred in the peri-urban communities along the National Road and was lowest in the urban township and remote rural communities. The geography of HIV-related mortality corresponded closely to the geography of HIV prevalence, with the notable exception of the urban township where high HIV-related mortality would have been expected on the basis of the high HIV prevalence. Our results suggest that HIV treatment and care programmes should be strengthened in easy-to-reach high density, peri-urban populations near National Roads where both HIV-related and all-cause mortality are highest.Elias NamoshaBenn SartoriusFrank TanserPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 7, p e69279 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Elias Namosha Benn Sartorius Frank Tanser Spatial clustering of all-cause and HIV-related mortality in a rural South African population (2000-2006).
description	<h4>Background</h4>Sub-Saharan Africa bears a disproportionate burden of HIV infection. Knowledge of the spatial distribution of HIV outcomes is vital so that appropriate public health interventions can be directed at locations most in need. In this regard, spatial clustering analysis of HIV-related mortality events has not been performed in a rural sub-Saharan African setting.<h4>Methodology and results</h4>Kulldorff's spatial scan statistic was used to identify HIV-related and all-cause mortality clusters (p<0.05) in a population-based demographic surveillance survey in rural KwaZulu Natal, South Africa (2000-2006). The analysis was split pre (2000-2003) and post (2004-2006) rollout of antiretroviral therapy, respectively. Between 2000-2006 a total of 86,175 resident individuals ≥15 years of age were under surveillance and 5,875 deaths were recorded (of which 2,938 were HIV-related) over 343,060 person-years of observation (crude all-cause mortality rate 17.1/1000). During both time periods a cluster of high HIV-related (RR = 1.46/1.51, p = 0.001) and high all-cause mortality (RR = 1.35/1.38, p = 0.001) was identified in peri-urban communities near the National Road. A consistent low-risk cluster was detected in the urban township in both time periods (RR = 0.60/0.39, p = 0.003/0.005) and in the first time period (2000-2003) a large cluster of low HIV-related and all-cause mortality in a remote rural area was identified.<h4>Conclusions</h4>HIV-related and all-cause mortality exhibit strong spatial clustering tendencies in this population. Highest HIV-related mortality and all-cause mortality occurred in the peri-urban communities along the National Road and was lowest in the urban township and remote rural communities. The geography of HIV-related mortality corresponded closely to the geography of HIV prevalence, with the notable exception of the urban township where high HIV-related mortality would have been expected on the basis of the high HIV prevalence. Our results suggest that HIV treatment and care programmes should be strengthened in easy-to-reach high density, peri-urban populations near National Roads where both HIV-related and all-cause mortality are highest.
format	article
author	Elias Namosha Benn Sartorius Frank Tanser
author_facet	Elias Namosha Benn Sartorius Frank Tanser
author_sort	Elias Namosha
title	Spatial clustering of all-cause and HIV-related mortality in a rural South African population (2000-2006).
title_short	Spatial clustering of all-cause and HIV-related mortality in a rural South African population (2000-2006).
title_full	Spatial clustering of all-cause and HIV-related mortality in a rural South African population (2000-2006).
title_fullStr	Spatial clustering of all-cause and HIV-related mortality in a rural South African population (2000-2006).
title_full_unstemmed	Spatial clustering of all-cause and HIV-related mortality in a rural South African population (2000-2006).
title_sort	spatial clustering of all-cause and hiv-related mortality in a rural south african population (2000-2006).
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/371383f3fcb04d05a78bb4227cbbffa9
work_keys_str_mv	AT eliasnamosha spatialclusteringofallcauseandhivrelatedmortalityinaruralsouthafricanpopulation20002006 AT bennsartorius spatialclusteringofallcauseandhivrelatedmortalityinaruralsouthafricanpopulation20002006 AT franktanser spatialclusteringofallcauseandhivrelatedmortalityinaruralsouthafricanpopulation20002006
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Spatial clustering of all-cause and HIV-related mortality in a rural South African population (2000-2006).

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