A Spatiotemporal Analysis of HIV-Associated Mortality in Rural Western Kenya 2011–2015

Abstract

Background: Reliable data on the HIV epidemic is critical for the measurement of the impact of HIV response and for the implementation of further interventions. Methods: We used mortality data from the Kombewa health and demographic surveillance systems (HDSS) from January 1, 2011 to December 31, 2015 to examine the space–time pattern of HIVassociated mortality. HIV mortality rate was calculated per 1000 persons living with HIV (for comparison with regional and national averages) and per 1000 person-years (p-y) for comparison with data from other HDSS sites. We used the Optimized Hot Spot Analysis to examine whether HIV-associated deaths would form statistically significant local aggregation in the 5-year period. P-value of ,0.05 and ,0.01 was considered significant. Results: The HIV-associated mortality rate over the 5-year period was 9.8 per 1000 persons living with HIV (PLHIV). Mortality declined from 11.6 per 1000 PLHIV in 2011 to 7.3 per 1000 PLHIV by the end of 2015. The rates of HIV were highest among infants [hazard ratio (HR) = 2.39 (,0.001)]. Tuberculosis mortality rates were highest in the age group 5–14 years [HR = 2.29 (0.002)] and the age group 50–64 years [HR = 1.18 (0.531)]. The overall trend in HIV-associated mortality showed a decline from 1.8 per 1000 p-y in 2011 to 1.3 per 1000 p-y by the end of 2015. The hotspot analysis showed that 20.0% of the study area (72 km2) was detected as hotspots (Z = 2.382–3.143, P # 0.001) and 4.2% of the study area as cold spots (15 km2). Conclusions: HIV attributable death in the HDSS population is substantial, although it is lower than both the national and the regional estimates.