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JMIR Public Health Surveill. 2018 Apr 3;4(2):e35. doi: 10.2196/publichealth.8773.

HIV Clustering in Mississippi: Spatial Epidemiological Study to Inform Implementation Science in the Deep South.

Author information

1
Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States.
2
Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA, United States.
3
Department of Social Medicine, University of North Carolina, Chapel Hill, NC, United States.
4
Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, United States.
5
Mississippi State Department of Health, Jackson, MS, United States.
6
School of Public Health, Brown University, Providence, RI, United States.
7
Department of Medicine, Brown University, Providence, RI, United States.
8
College of Public Health, University of Kentucky, Lexington, KY, United States.
9
John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States.
10
Rhode Island Public Health Institute, Providence, RI, United States.

Abstract

BACKGROUND:

In recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering.

OBJECTIVE:

The goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data.

METHODS:

We used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases.

RESULTS:

There were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P<.05). In multivariable models for all HIV cases, HIV hotspots were significantly more likely to include urban census tracts (adjusted odds ratio [AOR] 2.01, 95% CI 1.20-3.37) and census tracts that had a higher proportion of African Americans (AOR 3.85, 95% CI 2.23-6.65). The HIV hotspots were less likely to include census tracts with residents who had less than a high school education (AOR 0.95, 95% CI 0.92-0.98), census tracts with residents belonging to two or more racial/ethnic groups (AOR 0.46, 95% CI 0.30-0.70), and census tracts that had a higher percentage of the population living below the poverty level (AOR 0.51, 95% CI 0.28-0.92).

CONCLUSIONS:

We used spatial epidemiology and statistical modeling to identify and characterize HIV hotspots for the general population, MSM, and African Americans. HIV clusters concentrated in Jackson and the Mississippi Delta. African American race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters. Spatial epidemiological analyses can inform implementation science and public health response strategies, including improved HIV testing, targeted prevention and risk reduction education, and tailored preexposure prophylaxis to address HIV disparities in the South.

KEYWORDS:

HIV; HIV screening; HIV treatment; hotspots; racial disparities; social determinants of health

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