Abstract
Background : Adequate resource allocation is critical in the battle against HIV/AIDS, especially in Africa. Thedetermination of the location and nature of HIV services to implement must comply with the geographic,social and behavioral characteristics of patients. We therefore investigated the spatial heterogeneity of HIVprevalence in Burundi and then assessed the association of social and behavioral characteristics with HIVinfection accounting for the spatial heterogeneity. Methods : We used data from the 2010 Demographic and Health Survey. We analyzed these data with ageostatistical approach (which takes into account spatial autocorrelation) by i) interpolating HIV data using thekernel density estimation, ii) identifying the spatial clusters with high and low HIV prevalence using theKulldorff spatial scan statistics, and then iii) performing a multivariate spatial logistic regression. Results : Overall HIV prevalence was 1.4 %. The interpolated data showed the great spatial heterogeneity ofHIV prevalence (from 0 to 10 %), independently of administrative boundaries. A cluster with high HIVprevalence was found in the capital city and adjacent areas (3.9 %; relative risk 3.7,p< 0.001) whereas acluster with low prevalence straddled two southern provinces (0 %;p= 0.02). By multivariate spatial analysis,HIV infection was significantly associated with the female sex (posterior odds ratio [POR] 1.36, 95 % credibleinterval [CrI] 1.13-1.64), an older age (POR 1.97, 95 % CrI 1.26-3.08), the level of education (POR 1.50, 95 % CrI1.22-1.84), the marital status (POR 1.86, 95 % CrI 1.23-2.80), a higher wealth index (POR 2.11, 95 % CrI 1.77-2.51), the sexual activity (POR 1.76, 95 % CrI 1.04-2.96), and a history of sexually transmitted infection (POR2.03, 95 % CrI 1.56-2.64). Conclusions : Our study, which shows where and towards which populations HIV resources should be allocated,could help national health policy makers develop an effective HIV intervention in Burundi. Our findings support thestrategy of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for country-specific, in-depth analyses of HIVepidemics to tailor national prevention responses.