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. 2023 Mar 3;10(3):ofad107.
doi: 10.1093/ofid/ofad107. eCollection 2023 Mar.

Geospatial Analysis of Time to Human Immunodeficiency Virus (HIV) Diagnosis and Adult HIV Testing Coverage Highlights Areas for Intervention in the US Southeast

Lynn T Matthews  1 , Dustin M Long  2 , John Bassler  2 , Ariann Nassel  3 , Emily B Levitan  4 , Sonya L Heath  1 , Jeremiah Rastegar  5 , Madeline C Pratt  1 , Mirjam-Collette Kempf  1   6   7
Affiliations

Geospatial Analysis of Time to Human Immunodeficiency Virus (HIV) Diagnosis and Adult HIV Testing Coverage Highlights Areas for Intervention in the US Southeast

Lynn T Matthews et al. Open Forum Infect Dis. .

Abstract

Background: In the United States (US), 44% of people with human immunodeficiency virus (PWH) live in the Southeastern census region; many PWH remain undiagnosed. Novel strategies to inform testing outreach in rural states with dispersed HIV epidemics are needed.

Methods: Alabama state public health HIV testing surveillance data from 2013 to 2017 were used to estimate time from infection to HIV diagnosis using CD4 T-cell depletion modeling, mapped to county. Diagnostic HIV tests performed during 2013-2021 by commercial testing entities were used to estimate HIV tests per 100 000 adults (aged 15-65 years), mapped to client ZIP Code Tabulation Area (ZCTA). We then defined testing "cold spots": those with <10% adults tested plus either (1) within or bordering 1 of the 13 counties with HIV prevalence >400 cases per 100 000 population or (2) within a county with average time to diagnosis greater than the state average to inform testing outreach.

Results: Time to HIV diagnosis was a median of 3.7 (interquartile range [IQR], 0-9.2) years across Alabama, with a range of 0.06-12.25 years. Approximately 63% of counties (n = 42) had a longer time to diagnosis compared to national US estimates. Six hundred forty-three ZCTAs tested 17.3% (IQR, 10.3%-25.0%) of the adult population from 2013 to 2017. To prioritize areas for testing outreach, we generated maps to describe 47 areas of HIV-testing cold spots at the ZCTA level.

Conclusions: Combining public health surveillance with commercial testing data provides a more nuanced understanding of HIV testing gaps in a state with a rural HIV epidemic and identifies areas to prioritize for testing outreach.

Keywords: Alabama; HIV testing; ending the HIV epidemic; geospatial analysis; rural.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts.

Figures

Figure 1.
Figure 1.
Median (interquartile range) years from human immunodeficiency virus (HIV) infection to diagnosis by state and county. A, Years to HIV diagnosis by county. B, Years to HIV diagnosis, Black Belt counties. Green lines indicate U.S. estimated time to diagnosis (3.0 years).
Figure 2.
Figure 2.
Box plot showing median, interquartile range, and range of modeled time to diagnosis for Alabama based on Alabama Department of Public Health Enhanced HIV/AIDS Reporting System data, 2013–2017.
Figure 3.
Figure 3.
Commercial human immunodeficiency virus (HIV) testing per 100 000 adults aged 15–64 years per ZIP Code Tabulation Area (ZCTA), 2013–2021.
Figure 4.
Figure 4.
A, Map of human immunodeficiency virus (HIV) tests per 100 000 adults (aged 15–65 years) by ZIP Code Tabulation Area and highest-prevalence counties [19]. B, Map of mean time to HIV diagnosis by county (2013–2017).
See this image and copyright information in PMC

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