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. 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

Thomas J Stopka  1   2 , Lauren Brinkley-Rubinstein  3   4 , Kendra Johnson  5 , Philip A Chan  6   7 , Marga Hutcheson  1 , Richard Crosby  8 , Deirdre Burke  1 , Leandro Mena  9 , Amy Nunn  6   7   10
Affiliations

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

Thomas J Stopka et al. JMIR Public Health Surveill. .

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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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Locations of free HIV testing services that receive support for HIV screening from the Mississippi State Department of Health, 2014. Green points represent Ryan White clinics; Blue points represent County Health Departments.
Figure 2
Figure 2
HIV rates per 100,000 population in Mississippi, 2008-2014.
Figure 3
Figure 3
HIV rates per 100,000 African Americans in Mississippi, 2008-2014.
Figure 4
Figure 4
Hotspot cluster map for HIV rates per 100,000 population in Mississippi, 2008-2014. Clusters are based on HIV rates aggregated at the census tract level. Census tracts with elevated HIV rates (red) represent hotspots (P<.05); census tracts with low HIV rates (blue) represent coldspots (P<.05); census tracts with mean HIV rates are represented in yellow. The Jackson Metropolitan Area is outlined in green.
Figure 5
Figure 5
Hotspot cluster map for HIV rates per 100,000 African Americans in Mississippi, 2008-2014. Clusters are based on African American HIV rates aggregated at the census tract level. Census tracts with elevated African American HIV rates (red) represent hotspots (P<.05); census tracts with low African American HIV rates (blue) represent coldspots (P<.05); census tracts with mean African American HIV rates are represented in yellow. The Jackson Metropolitan Area is outlined in green.
Figure 6
Figure 6
Hotspot cluster map for HIV case counts among MSM in Mississippi, 2008-2014. Clusters are based on MSM case counts aggregated at the census tract level. Census tracts with elevated numbers of MSM living with HIV (red) represent hotspots (P<.05); census tracts with low numbers of MSM living with HIV (blue) represent coldspots (P<.05); census tracts with mean numbers of MSM living with HIV are represented in yellow. The Jackson Metropolitan Area is outlined in green.
Figure 7
Figure 7
Hotspot cluster map for HIV case counts among African American MSM in Mississippi, 2008-2014. Clusters are based on African American MSM case counts aggregated at the census tract level. Census tracts with elevated numbers of African American MSM living with HIV (red) represent hotspots (P<.05); census tracts with low numbers of African American MSM living with HIV (blue) represent coldspots (P<.05); census tracts with mean numbers of African American MSM living with HIV counts are represented in yellow. The Jackson Metropolitan Area is outlined in green.
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