Running Header: Matching HIV Transmission in Sub Saharan Africa

Benito Rumbo

Bio 432

Professor Htway

Matching HIV Transmission in Sub Saharan Africa

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A. Collection of data

1. What was the context of this study?

The context of the study was to map and characterized high prevalence areas in 7

countries in Eastern and Southern Africa. These including areas in Kenya, Malawi,

Mozambique, Tanzania, Uganda, Zambia, and Zimbabwe. These countries were analyzed

to predict the prevalence of HIV transmission in young adults.

2. What were the objectives of this study?

To locate areas in sub-Saharan Africa where HIV prevalence in young adults is more

common. The areas of location underlined high prevalence areas. By locating these are

tailored intervention can reduce the transmission of HIV. The study indicates that the key

dynamic for HIV transmission in Africa is related to seasonal and economic migration

and associated sex workers. These two factors can play a role to fuel HIV transmission.

The collection of data was by a questionnaire survey in those 7 regions of Africa.

3. What was the primary exposure of interest? Was this accurately measured?

The primary exposure was young adults being diagnosed with HIV. The measured data

was obtained by using geolocated survey data and United states agency for international

development. The data was able to detect areas of higher exposure to HIV, it was

accurately measured data. The study was to assure a healthier life among young adults

with high exposure to the pandemic. People living in the region of sub-Saharan Africa
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had greater exposure to living with HIV. Over 37 million people are currently living with

HIV.

4. What was the primary outcome of interest? Was this accurately measured?

The primary outcome displayed that country in Zambia and Zimbabwe had a higher

prevalence of HIV exposure. It is valuable data because it shows that the African

government or the World Health Organization should intervene in educating the country

with high exposure to HIV safety.

5. What type of study was conducted?

The study used geolocated service data from recent United States agencies that were

collected in seven countries with high levels of transmission of HIV are eastern and

southern Africa, Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia, and

Zimbabwe. These areas all had high prevalence areas for young adults ranging in ages 15

- 29 years of age. Maps of random effect estimates show the environmental variables can

increase high prevalence areas for HIV transmission.

6. Describe the source of the study population, the process of selection, and the ratio

of proposition to the comparison of subjects.

The population of the study was young adults ranging in ages 15 - 29 years of age. The

data was able to conclude that young adults between the seven-country regions had a high

prevalence of HIV pandemic. The data concluded that young adults had interplay of

behavioral, social economics, and environmental factors for high transmission locations.
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The study’s findings were that seasonal and economic migration is associated with sex

work which is a factor that can fuel HIV transmission. Young adults in prevalent areas

should be the tailored demographics to reduce the HIV pandemic. Targeting this

demographic can reach the fast track commitments to ending the pandemic of HIV. High

prevalent HIV areas can be tailored interventions to reduce transmission. An example

would be to have more providers educating the community in high exposure areas by

explaining how to take HIV prevention. 

7. Could there have been bias in the selection of the study subjects? How likely was

this bias?

The article mentioned that the surveyors could have reported an inaccurate number of

lifetime sex partners or reported a false description of HIV or STI symptoms. The

likelihood of reporting bias could have been confirmed.

8. Could there have been bias in the collection of information? How likely was this

bias?

The article mentioned that bias from the reporters could have provided false information.

In surveys it can be difficult to know what the person is reporting is the correct

information. The likelihood of the surveyors could have reported bias information.

9. What provisions were made to minimize the influence of confounding factors

prior to the analysis of data? Were these provisions sufficient?

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The survey developed a logistics regression model. This regression model was able to

monitor behavioral, socioeconomic, and environmental determinants of HIV. In the

study, they imputed multi imputation. The HIV prevalence was the dependent variable.

The confounding in the main analysis was not adjusted. The study knew that associations

between HIV and the predictor variables to be similar across countries.

B. Analysis of data

1. What methods were used to control confounding bias during data analysis?

The people who conducted the study combined the data from multiple countries. They

provided a questionnaire survey to gather the collection of data. The questionnaire survey

provided the same questions to all the participants. It followed the same protocol to

gather data information.

2. What measures of association were reported in the study?

The measurement of the study provided a variable to confirm the accuracy of the data

was by testing the participants. Each participant that filled out the survey of their HIV

status was tested by using a finger prick with an enzyme by collecting a blood sample.

This measurement of blood testing allowed confirmation of reliable data.

3. What measures of statistical stability were reported in this study?

The study used surface maps to create HIV prevalence and multiple multilevel logistics

regression models. The demographic surveys had about 113,000 adults. There were

53,000 young adults. By using kriging the study was able to predict HIV prevalence at an
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unmeasured location. Since the total number of participants that were collected in the

study was high it provided a well develop sample size.

C. Interpretation of data

1. What were the major results of this study?

There was evidence of areas having higher exposure in different regions. Young adults

that had more inclusion in behavioral, socioeconomic, and environmental factors were

more likely to participate in sexual activity. This sexual activity could lead to HIV

infection. Areas with higher exposure also showed little understanding of HIV

prevention.  

2. How is the interpretation of these results affected by information bias, selection

bias, and confounding? Discuss both the direction and magnitude of any bias.

I believe that the study tried its best to maintain as little bias as possible. Again, with

being a questioner survey people are more likely to share information of bias. The survey

did, however, confirm so of the bias by the testing participants. They tested the members

who filled out the survey by collecting a blood sample.

3. How is the interpretation of these results affected by nondifferential

misclassification? Discuss both the direction and magnitude of this

misclassification.
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The magnitude of the study had a sample size of 53,234.  They performed nonrandom

cross-validation. In the study, they tested the final fitted model for each of the countries

separately. By testing each country separately, the study showed similarities to 6 of the 8

countries that participated in the study. Two countries conclude a combined model,

however, the results were not as alarming.

4. Did the discussion section adequately address the limitations of the study?

The limitation of the study was the inability to infer causality. The cross-section of the

surveys.  There is no way to make a definitive conclusion on economic activity. Some

groups were unrepresentative such as sex workers, seasonal workers, and truck drivers.

The survey didn’t tailor the participants answering the questioner for people who were

represented in that category.

5. What were the authors’ main conclusions? Were they justified by the findings?

The main conclusion is that in young adults living in Eastern and Western Africa data

was collected in high prevalence HIV exposure and low prevalence. Regions in Africa

with a high prevalence of HIV exposure are characterized as high economic activity, high

socioeconomic status, and risky sexual behavior. Geospatial mapping can further

understand the high level of transmission. It can also determine what fuels HIV

epidemics.

6. To what larger population can the results of this study be generalized?

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The study can conclude that geospatial mapping can lead to the future of improving the

study of epidemiology. Geospatial mapping was able to analyze areas of high and low

HIV transmission. By understanding areas that have high transmission groups can be

tailored for advancing treatment. Tailoring groups can lead to a high chance of ending the

pandemic of HIV. By targeting these groups, the scientific community can have a better

understanding of the population dynamic. In regions with high exposure more providers

or testing centers could be a resource within that community. By having more resources

that the community can start to see a drastic change of HIV transmission and decline the

exposure of HIV. Increasing access can be effective to HIV prevention interventions.

Educating can cause a strongly proactive against HIV.  Having preventative programs

can improve exposure such as pre-exposure prophylaxis, condoms, volunteer mail

medical circumcision programs need to be prioritized in high areas.  Creating accessible,

affordable, and youth-friendly HIV testing and counseling service can decrease the high

level of HIV transmission.

 
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Reference

Bulstra,C., Hontelez,J., Giardina, F., Steen, R ., Nagelkerke, N., Bärnighausen, T ., De

Vlas,S. (2020). Mapping and characterizing areas with high levels of HIV transmission in

sub-Saharan Africa: A geospatial analysis of national survey data. PloS.

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003042