Identifying the Factors Associated With Spatial Clustering of Incident HIV Infection Cases in High-Prevalence Regions: Quantitative Geospatial Study
Bibliographic record
Abstract
BACKGROUND: Incident HIV infection is a critical indicator of an ongoing epidemic, particularly in high-burden regions such as Liangshan Yi Autonomous Prefecture in China, where HIV prevalence exceeds 1% in 4 key counties (Butuo, Zhaojue, Meigu, and Yuexi). Identifying spatial clusters and drivers of recent infections is essential for implementing targeted interventions. Despite advancements in geospatial analyses of HIV prevalence, studies identifying drivers of incident HIV clustering remain limited, especially in low-resource settings. OBJECTIVE: This study aims to identify spatial clusters of recent HIV infections and investigate potential driving factors in 4 key counties of the Liangshan Yi Autonomous Prefecture to inform targeted intervention strategies. METHODS: From November 2017 to June 2018, we identified 246 (4.42%) recent HIV infection cases from 5555 newly diagnosed cases through expanded testing of the whole population in 4 key counties of Liangshan Yi Autonomous Prefecture. Recent infection cases were confirmed using limiting antigen avidity enzyme immunoassays or documented seroconversion within 6 months. The spatial distribution of incident HIV infection cases was analyzed using kernel density. Potential drivers, including population density, HIV prevalence, elevation, nighttime light index, urban proximity, and antiretroviral therapy (ART) coverage, were analyzed. The spatial lag regression model was used to identify factors associated with clustering of recent infection cases. The Geodetector q-statistic was used to quantify nonlinear interactive effects among these factors. RESULTS: Significant spatial autocorrelation was observed in the distribution of recent HIV cases (Moran I=0.11; P<.01). Six spatial clusters were identified, and all were located near urban centers or major roads. Furthermore, 5 factors were identified by the spatial lag regression model as being significantly correlated with the clustering of recent HIV infection cases, including population density (β=0.59; P<.001), HIV prevalence (β=0.02; P<.001), distance to local urban area (β=-3.10; P=.01), SD of elevation (β=-0.15; P=.02), and ART coverage rate (β=183.80; P<.01). Geodetector analysis revealed strong interactive effects among these 5 factors, with population density and HIV prevalence exhibiting the largest interactive effect (q=0.69). CONCLUSIONS: This study reveals that besides HIV prevalence, urbanization-related factors (population density and proximity to urban area) and transportation accessibility drive incident HIV clustering in Liangshan Yi Autonomous Prefecture. Paradoxically, higher ART coverage was associated with increased transmission, suggesting the need for integrated prevention strategies beyond ART expansion. Furthermore, the township-level geospatial approach provides a valuable model for pinpointing transmission hot spots and tailoring interventions in high-burden regions globally.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".