Detecting spatial clusters of HIV and hepatitis coinfections

Abstract

BackgroundPeople with HIV infection in the United States are often affected by chronic viral hepatitis. These coinfected people with either HBV or HCV are at increased risk for serious, life-threatening complications. Coinfections with viral hepatitis may also complicate the delivery of anti-retroviral therapy (ART) by escalating the risk of drug-related hepatoxicity. According to the Centers for Disease Control and Prevention (CDC), approximately 10 percent of people with HIV in the United States also have HBV, and 25 percent also have HCV coinfection. With the advent of highly active antiretroviral therapy (HAART) and the increased life-expectancy of HIV patients, clinicians are more likely to be confronted with issues related to co-infection and the management challenges that they present, especially in resource-limited settings. The purpose of this analysis was to identify geographical clusters of HIV- (HBV/HCV) co-infection and compared to the geographical clusters of not co-infected using DC, Department of Health surveillance data. The results of the analysis will be used to target resources to areas at risk.MethodsHIV and Hepatitis surveillance data were matched among cases diagnosed between 1980 and 2016. HIV-hepatitis co-infected and the not co-infected spatial clusters were detected using discrete Poisson model. Kulldorff’s spatial scan statistic method was implemented in the free software tool called SaTScan which has been widely adopted for detecting disease cluster. The analysis was conducted by tracts, but for visualization, ease of interpretation and assist in policy making the tract map was overlaid with the ward map using ArcGIS 10.5.1.ResultsBetween 1980 and 2016, there were 12,965 diagnosed cases of HIV, of which 2,316 HIV/Hepatitis matches were identified. Of the 2316 co-infected people living in DC, 25 percent (N = 590) of people had HBV, and 75 percent (N = 1,726) had HCV. Out of 12,965 diagnosed cases, remaining 10,649 did not have any co-infections (not co-infected). IDU (27.16 percent) and MSM (32.86 percent) were the highest mode of transmission for co-infected population. African-American were reported 83.64 percent (N = 1,937) among co-infection population. Three clusters were identified for both co-infected population in DC. The largest cluster radius for co-infected analysis covers wards 6, 7 and 8 as well as large parts of 2 and 5 (p < 0.001). Multiple clusters were identified for not co-infected population (p < 0.001). IDU (n = 450) was the highest mode of transmission for the co-infected clusters. For all clusters combined of not co-infected population highest mode of transmission were MSM (n = 2,534). This analysis also showed racial disparity, economic deprivation and lack of education were prominent in the co-infected clusters.ConclusionWe identified locations of high risk clusters where enhanced hepatitis and HIV prevention, treatment, and care can help combat the epidemic. The clusters radius expands into the neighboring state of Maryland as well. The findings from this analy...

A spatiotemporal data mining study to identify high-risk neighborhoods for out-of-hospital cardiac arrest (OHCA) incidents

“…SaTScan™ is a free software widely employed for analyzing spatial and temporal data for detecting disease clusters, such as HIV 20 , Legionnaires’ disease 21 , OHCA cases 22 and tick-borne disease in the U.S. 23 The study applied a discrete Poisson-based model in SaTScan to examine OHCA cases in circular areas of varying diameters across Hong Kong 20 , assuming that the number of cases in a geographical location follows the Poisson distribution based on a known underlying population at risk 24 . Relative risks were calculated to reveal the risk level of each OHCA cluster.…”

“…Relative risks were calculated to reveal the risk level of each OHCA cluster. A spatial cluster with a high concentration of point locations would be regarded as a high-risk OHCA area 20 . Monte Carlo simulation using 1000 replications was used to detect statistically significant ( p < 0.05) clusters 22 , 25 .…”

Economic and Health Care Burdens of Hepatitis Delta: A Study of Commercially Insured Adults in the United States

“…Multiple studies found that HDV is more common in individuals with HBV/HCV co-infection than in those with HBV infection alone as a result of shared modes of transmissions between HCV and HDV in high-risk populations with HBV (e.g., drug users, homeless individuals, HIV-positive individuals). (27,28) Compared to patients with chronic HBV, substance abuse, specifically cocaine and opioid abuse, was significantly more prevalent among patients with HDV. Recent data indicate that the prevalence of HDV infection has increased among injection-drug users in the United States and is, in some regions, an increasingly important mode of transmission for HDV among HBV carriers.…”