Geographic Core Areas of Coinfections in Washington, District of Columbia: Recommendations for Planning Prevention-Intervention to Mitigate Human Immunodeficiency Virus Burden.

Abstract

Research suggests that human immunodeficiency virus (HIV)-positive individuals with a sexually transmitted infection (STI) may be at increased risk of transmitting HIV to someone else through unprotected sex. The primary aim of the analysis is to identify the high-risk geographic areas of transmission of coinfections and factors that may be associated with poor outcomes of viral suppression within these higher-risk geographic areas, thus important in transmission prevention. We used surveillance data reported by all providers and laboratories in the District of Columbia (DC). Applied discrete Poisson scan model in SaTScan to identify the geographic areas. The relative risk (RR) for the scan statistic was calculated based on events inside the cluster, and P values evaluated statistical significance. We used multinomial logistical regression to explore care and demographical characteristics associated with being virally unsuppressed within and outside the geographic areas. The coinfected areas (RR, >1; P < .001) were located in the tracts of central and southern DC. Black population (RR, 3.154 [95% confidence interval {CI}, 1.736-5.729]), age 13-19 years (RR, 4.598 [95% CI, 3.176-6.657]), repeat STIs (RR, 1.387 [95% CI, 1.096-1.754]), and not retained in care (RR, 2.546 [95% CI, 1.997-3.245]) were found to be at higher risk of being virally unsuppressed within the coinfected clusters. Those with unknown linkages were found to be at higher risk of being virally unsuppressed outside the coinfected clusters (RR, 5.162 [95% CI, 2.289-11.640]). This is DC's first effort to identify the geographic core areas of coinfections and factors that may be sustaining them. These results will be used by the health department to plan for prevention-intervention strategies. This model be replicated by any local jurisdiction similar.