{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:35:52Z","timestamp":1784133352156,"version":"3.55.0"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T00:00:00Z","timestamp":1483228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["084401\/Z\/07\/B"],"award-info":[{"award-number":["084401\/Z\/07\/B"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Introduction<\/jats:bold>: Focusing resources for HIV control on geographic areas of greatest need in countries with generalized epidemics has been recommended to increase cost\u2010effectiveness. However, socioeconomic inequalities between areas of high and low prevalence could raise equity concerns and have been largely overlooked. We describe spatial patterns in HIV prevalence in east Zimbabwe and test for inequalities in accessibility and uptake of HIV services prior to the introduction of spatially\u2010targeted programmes.<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>: 8092 participants in an open\u2010cohort study were geo\u2010located to 110 locations. HIV prevalence and HIV testing and counselling (HTC) uptake were mapped with ordinary kriging. Clusters of high or low HIV prevalence were detected with Kulldorff statistics, and the socioeconomic characteristics and sexual risk behaviours of their populations, and levels of local HIV service availability (measured in travel distance) and uptake were compared. Kulldorff statistics were also determined for HTC, antiretroviral therapy (ART), and voluntary medical male circumcision (VMMC) uptake.<\/jats:p><jats:p><jats:bold>Results<\/jats:bold>: One large and one small high HIV prevalence cluster (relative risk [RR]\u00a0=\u00a01.78, 95% confidence interval [CI]\u00a0=\u00a01.53\u20132.07; RR\u00a0=\u00a02.50, 95% CI\u00a0=\u00a02.08\u20133.01) and one low\u2010prevalence cluster (RR\u00a0=\u00a00.70, 95% CI\u00a0=\u00a00.60\u20130.82) were detected. The larger high\u2010prevalence cluster was urban with a wealthier population and more high\u2010risk sexual behaviour than outside the cluster. Despite better access to HIV services, there was lower HTC uptake in the high\u2010prevalence cluster (odds ratio [OR] of HTC in past three\u00a0years: OR\u00a0=\u00a00.80, 95% CI\u00a0=\u00a00.66\u20130.97). The low\u2010prevalence cluster was predominantly rural with a poorer population and longer travel distances to HIV services; however, uptake of HIV services was not reduced.<\/jats:p><jats:p><jats:bold>Conclusions<\/jats:bold>: High\u2010prevalence clusters can be identified to which HIV control resources could be targeted. To date, poorer access to HIV services in the poorer low\u2010prevalence areas has not resulted in lower service uptake, whilst there is significantly lower uptake of HTC in the high\u2010prevalence cluster where health service access is better. Given the high levels of risky sexual behaviour and lower uptake of HTC services, targeting high\u2010prevalence clusters may be cost\u2010effective in this setting. If spatial targeting is introduced, inequalities in HIV service uptake may be avoided through mobile service provision for lower prevalence areas.<\/jats:p>","DOI":"10.7448\/ias.20.1.21409","type":"journal-article","created":{"date-parts":[[2017,3,9]],"date-time":"2017-03-09T07:16:22Z","timestamp":1489043782000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Spatial patterns of HIV prevalence and service use in East Zimbabwe: implications for future targeting of interventions"],"prefix":"10.1002","volume":"20","author":[{"given":"Robin","family":"Schaefer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Gregson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Takaruza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Rhead","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tidings","family":"Masoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Schur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah\u2010Jane","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance","family":"Nyamukapa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,1]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyp148"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1228160"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000034"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-2652-13-41"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-555"},{"key":"e_1_2_13_7_1","volume-title":"Local epidemics issues brief.","author":"UNAIDS.","year":"2014"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001075"},{"key":"e_1_2_13_9_1","volume-title":"How AIDS changed everything.","author":"UNAIDS.","year":"2015"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60658-4"},{"key":"e_1_2_13_11_1","first-page":"1","article-title":"From people to places: overview of the PLACE method and lessons learned","volume":"4","author":"Weir SS","year":"2002","journal-title":"MEASURE Eval Bull."},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61053-9"},{"key":"e_1_2_13_13_1","volume-title":"South Africa: Country Operational Plan 2014.","author":"The United States President's Emergency Plan for AIDS Relief (PEPFAR)","year":"2014"},{"key":"e_1_2_13_14_1","volume-title":"Mozambique: Country Operational Plan 2014.","author":"The United States President's Emergency Plan for AIDS Relief (PEPFAR)","year":"2014"},{"key":"e_1_2_13_15_1","volume-title":"UNAIDS\/WHO working group on global HIV\/AIDS and STI surveillance: conducting HIV surveillance based on routine programme data among pregnant women attending antenatal clinics.","author":"UNAIDS, World Health Organization","year":"2015"},{"key":"e_1_2_13_16_1","unstructured":"Bhatt S New spatially\u2010specific HIV estimates for South Africa AIDS ConferenceJuly 18\u201022 2016.Durban South Africa:2016."},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0020050"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0509689103"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2005.043265"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-10-585"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0130216"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000914"},{"key":"e_1_2_13_23_1","volume-title":"Zimbabwe National HIV and AIDS Strategic Plan (ZNASP) 2015\u20102018.","author":"Ministry of Health and Child Care, National AIDS Council.","year":"2015"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1121054"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0140818"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/03610929708831995"},{"key":"e_1_2_13_27_1","unstructured":"WringeA ChurchK MachiyamaK OtiS MwangomeM ZabaB et al.Identifying gaps in HIV service delivery across the diagnosis\u2010to\u2010treatment cascade: findings from health facility surveys in six sub\u2010Saharan countries. 8th IAS Conference on HIV Pathogenesis Treatment & Prevention. 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