Spatial patterns of tuberculosis and HIV co-infection in Ethiopia

Autoři: Kefyalew Addis Alene aff001;  Kerri Viney aff003;  Hannah C. Moore aff002;  Maereg Wagaw aff004;  Archie C. A. Clements aff001
Působiště autorů: Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia aff001;  Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia aff002;  Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia aff003;  Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



Tuberculosis (TB) and human immunodeficiency virus (HIV) are the leading causes of infectious-disease-related deaths in Ethiopia, but little is known about their spatial distribution across the country. The aim of this study was to investigate the spatial patterns of TB and HIV co-infection in Ethiopia at the district level.


We conducted an ecological study using TB and HIV data reported from all regions of Ethiopia through the national Health Management Information System (HMIS), between June 2015 and June 2017. Spatial clustering was assessed using Moran’s I statistic and Getis-Ord statistic. Spatial binomial regression models were constructed separately for the prevalence of TB among people living with HIV and for the prevalence of HIV among TB patients, with and without spatial components using a Bayesian approach.


A total of 1,830,880 HIV and 192,359 TB patients were included in the analysis. The prevalence of HIV among TB patients was 7.34%; hotspots were observed in districts located in Amhara, Afar, and Gambela regions, and cold spots were observed in Oromiya and Southern Nations, Nationalities, and People (SNNP) regions. The prevalence of TB among people living with HIV varied from 0.7% in Oromia region to 14.5% in Afar region. Hotspots of TB prevalence among people living with HIV were observed in districts located in Gambela, Afar, Somali, and Oromiya regions; whereas the cold spots were observed in districts located in Amhara and Tigray regions. The ecological-level factors associated with the prevalence of TB among people living with HIV were low wealth index (OR: 1.49; 95% CrI: 1.05, 2.05), low adult literacy rate (OR: 0.67; 95% CrI: 0.46, 0.94), and distance to an international border (OR: 0.61; 95% CrI: 0.40, 0.91). The factors associated with the prevalence of HIV among TB patients were poor health care access (OR: 0.76; 95% CrI: 0.59, 0.95), low wealth index (OR: 1.31; 95% CrI: 1.01, 1.67), and low adult literacy rate (OR: 1.37; 95% CrI: 1.03, 1.78).


Our study provides evidence for geographic clustering of TB/HIV co-infection in Ethiopia. Health care access, proximity to international borders, and demographic factors such as low wealth index and adult literacy were significantly associated with the prevalence of TB/HIV co-infection.

Klíčová slova:

Co-infections – Ethiopia – HIV diagnosis and management – HIV epidemiology – HIV infections – Literacy – Tuberculosis


1. Bruchfeld J, Correia-Neves M, Källenius G. Tuberculosis and HIV coinfection. Cold Spring Harbor perspectives in medicine. 2015;5(7):a017871. doi: 10.1101/cshperspect.a017871 25722472

2. Pawlowski A, Jansson M, Sköld M, Rottenberg ME, Källenius G. Tuberculosis and HIV co-infection. PLoS pathogens. 2012;8(2):e1002464. doi: 10.1371/journal.ppat.1002464 22363214

3. Alene KA, Viney K, McBryde ES, Gray DJ, Melku M, Clements ACA. Risk factors for multidrug-resistant tuberculosis in northwest Ethiopia: A case-control study. Transbound Emerg Dis. 2019;66(4):1611–8. doi: 10.1111/tbed.13188 30924283

4. HIV/AIDS JUNPo. UNAIDS data 2017. Geneva: Switzerland: UNAIDS 2017. 2018.

5. Kyu HH, Maddison ER, Henry NJ, Ledesma JR, Wiens KE, Reiner R Jr, et al. Global, regional, and national burden of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study. The Lancet Infectious Diseases. 2018;18(12):1329–49. doi: 10.1016/S1473-3099(18)30625-X 30507459

6. Kyu HH, Maddison ER, Henry NJ, Mumford JE, Barber R, Shields C, et al. The global burden of tuberculosis: results from the Global Burden of Disease Study 2015. The Lancet Infectious Diseases. 2018;18(3):261–84. doi: 10.1016/S1473-3099(17)30703-X 29223583

7. WHO. Global tuberculosis report 2018. Geneva: World Health Organization; 2018.

8. WHO. Use of high burden country lists for TB by WHO in the post-2015 era. Geneva: World Health Organization, 2015.

9. WHO. Global tuberculosis report 2018. World Health Organization. Geneva: 2018.

10. UNAIDS. UNAIDS data 2018. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2018.

11. Deribew A, Tesfaye M, Hailmichael Y, Negussu N, Daba S, Wogi A, et al. Tuberculosis and HIV co-infection: its impact on quality of life. Health and quality of life outcomes. 2009;7(1):105.

12. Deribew A, Tesfaye M, Hailmichael Y, Apers L, Abebe G, Duchateau L, et al. Common mental disorders in TB/HIV co-infected patients in Ethiopia. BMC infectious diseases. 2010;10(1):201.

13. Alene KA, Clements ACA, McBryde ES, Jaramillo E, Lonnroth K, Shaweno D, et al. Mental health disorders, social stressors, and health-related quality of life in patients with multidrug-resistant tuberculosis: A systematic review and meta-analysis. The Journal of infection. 2018;77(5):357–67. doi: 10.1016/j.jinf.2018.07.007 30036607

14. Belay M, Bjune G, Abebe F. Prevalence of tuberculosis, HIV, and TB-HIV co-infection among pulmonary tuberculosis suspects in a predominantly pastoralist area, northeast Ethiopia. Global health action. 2015;8(1):27949.

15. Fite RO, Chichiabellu TY, Demissie BW, Hanfore LK. Tuberculosis and HIV Co-infection and associated factors among HIV reactive patients in Ethiopia. Journal of Nursing and Midwifery Sciences. 2019;6(1):15.

16. Aturinde A, Farnaghi M, Pilesjö P, Mansourian A. Spatial analysis of HIV-TB co-clustering in Uganda. BMC infectious diseases. 2019;19(1):612. doi: 10.1186/s12879-019-4246-2 31299907

17. Wei W, Wei-Sheng Z, Ahan A, Ci Y, Wei-Wen Z, Ming-Qin C. The characteristics of TB epidemic and TB/HIV co-infection epidemic: a 2007–2013 retrospective study in Urumqi, Xinjiang Province, China. PloS one. 2016;11(10):e0164947. doi: 10.1371/journal.pone.0164947 27768740

18. Otiende V, Achia T, Mwambi H. Bayesian modeling of spatiotemporal patterns of TB-HIV co-infection risk in Kenya. BMC infectious diseases. 2019;19(1):902. doi: 10.1186/s12879-019-4540-z 31660883

19. Alene KA, Nega A, Taye BW. Incidence and predictors of tuberculosis among adult people living with human immunodeficiency virus at the University of Gondar Referral Hospital, Northwest Ethiopia. BMC infectious diseases. 2013;13(1):292.

20. Ayalaw SG, Alene KA, Adane AA. Incidence and predictors of tuberculosis among HIV positive children at University of Gondar Referral Hospital, northwest Ethiopia: a Retrospective Follow-Up Study. International scholarly research notices. 2015;2015.

21. Cuadros DF, Li J, Branscum AJ, Akullian A, Jia P, Mziray EN, et al. Mapping the spatial variability of HIV infection in Sub-Saharan Africa: Effective information for localized HIV prevention and control. Scientific reports. 2017;7(1):9093. doi: 10.1038/s41598-017-09464-y 28831171

22. Tadesse K, Gebeyoh E, Tadesse G. Assessment of health management information system implementation in Ayder referral hospital, Mekelle, Ethiopia. Int J Intell Inf Syst. 2014;3(4):34.

23. Belay H, Azim T, Kassahun H. Assessment of health management information system (HMIS) performance in SNNPR, Ethiopia. Measure Evaluation. 2013.

24. ESRI. ArcGIS Desktop: Release 10. 3.1 In: Institute ESR, editor. 2015.

25. Alene KA, Clements AC. Spatial Clustering of Notified Tuberculosis in Ethiopia: A Nationwide Study. PLoS One. 2019;14(8):e0221027. doi: 10.1371/journal.pone.0221027 31398220

26. Alene KA, Viney K, Gray DJ, McBryde ES, Wagnew M, Clements AC. Mapping tuberculosis treatment outcomes in Ethiopia. BMC infectious diseases. 2019;19(1):474. doi: 10.1186/s12879-019-4099-8 31138129

27. Shaweno D, Karmakar M, Alene KA, Ragonnet R, Clements AC, Trauer JM, et al. Methods used in the spatial analysis of tuberculosis epidemiology: a systematic review. BMC medicine. 2018;16(1):193. doi: 10.1186/s12916-018-1178-4 30333043

28. Van Rie A, Beyers N, Gie R, Kunneke M, Zietsman L, Donald P. Childhood tuberculosis in an urban population in South Africa: burden and risk factor. Archives of disease in childhood. 1999;80(5):433–7. doi: 10.1136/adc.80.5.433 10208948

29. Yonge S, Otieno M, Sharma R, Omedo R. Risk factors in transmission of tuberculosis infection in Mombasa, Kenya: an epidemiological descriptive study. 2016.

30. Wang X, Yin S, Li Y, Wang W, Du M, Guo W, et al. Spatiotemporal epidemiology of, and factors associated with, the tuberculosis prevalence in northern China, 2010–2014. BMC infectious diseases. 2019;19(1):365. doi: 10.1186/s12879-019-3910-x 31039734

31. Harling G, Castro MC. A spatial analysis of social and economic determinants of tuberculosis in Brazil. Health & place. 2014;25:56–67.

32. Alene KA, Viney K, McBryde ES, Clements AC. Spatiotemporal transmission and socio-climatic factors related to paediatric tuberculosis in north-western Ethiopia. Geospatial health. 2017.

33. Alene KA, Viney K, McBryde ES, Clements AC. Spatial patterns of multidrug resistant tuberculosis and relationships to socio-economic, demographic and household factors in northwest Ethiopia. PloS one. 2017;12(2):e0171800. doi: 10.1371/journal.pone.0171800 28182726

34. International CSAEaI. Ethiopia Demographic and Health Survey 2016. Ethiopia, Addis Ababa 2016.

35. Raizada N, Chauhan LS, Khera A, Sokhey J, Wares DF, Sahu S, et al. HIV seroprevalence among tuberculosis patients in India, 2006–2007. PLoS One. 2008;3(8):e2970. doi: 10.1371/journal.pone.0002970 18714335

36. Chanda-Kapata P, Kapata N, Klinkenberg E, Grobusch MP, Cobelens F. The prevalence of HIV among adults with pulmonary TB at a population level in Zambia. BMC infectious diseases. 2017;17(1):236. doi: 10.1186/s12879-017-2345-5 28356081

37. Gelaw YA, Williams G, Magalhães RJS, Gilks CF, Assefa Y. HIV Prevalence Among Tuberculosis Patients in Sub-Saharan Africa: A Systematic Review and Meta-analysis. AIDS and Behavior. 2019:1–15.

38. Cuadros DF, Awad SF, Abu-Raddad LJ. Mapping HIV clustering: a strategy for identifying populations at high risk ofHIV infection in sub-Saharan Africa. International journal of health geographics. 2013;12(1):28.

39. Ghanbarnezhad A, Roustazadeh A, Alizadeh A, Abbastabar H, Nazarnezhad M, Mohseni S. Spatial distribution of TB and HIV co-infection in south of Iran. The AYER. 2015;4:177–83.

40. Maore NK, Kirui NK, Kireki O, Ogutu O, Owino M, Ogaro T, et al. Spatial and temporal distribution of notified tuberculosis cases in Nairobi County, Kenya, between 2012 and 2016. East African Medical Journal. 2017;94(10):28–40.

41. Sifuna P, Ouma C, Atieli H, Owuoth J, Onyango D, Andagalu B, et al. Spatial epidemiology of tuberculosis in the high-burden counties of Kisumu and Siaya, Western Kenya, 2012–2015. The International Journal of Tuberculosis and Lung Disease. 2019;23(3):363–70. doi: 10.5588/ijtld.18.0245 30871668

42. Deribew A, Biadgilign S, Berhanu D, Defar A, Deribe K, Tekle E, et al. Capacity of health facilities for diagnosis and treatment of HIV/AIDS in Ethiopia. BMC health services research. 2018;18(1):535. doi: 10.1186/s12913-018-3347-8 29996821

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden