Spatial analysis of factors associated with subnational HIV prevalence among female adults aged 15-49 years in Cameroon, 2004-2018

Spatial analysis of factors associated with subnational HIV prevalence among female adults aged 15-49 years in Cameroon, 2004-2018 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Spatial analysis of factors associated with subnational HIV prevalence among female adults aged 15-49 years in Cameroon, 2004-2018 Zhining Sui, Xiaoyun Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2110296/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The human immunodeficiency virus (HIV) is one of the world’s most serious health and development burdens and it is one of the most common causes of death in Cameroon. Women appear to be more vulnerable to HIV infection than men. Given that the women specific HIV/AIDS research literature is lacking in Cameroon, this study applied spatial random effects based on subnational regions to provide more accurate estimates on female HIV prevalence and related risk factors in Cameroon. Methods This study estimates trends in female HIV prevalence for 12 subnational regions in Cameroon using DHS surveys from 2004, 2011, and 2018. Direct weighted estimates of the female HIV prevalence from each survey are calculated for each region across 7-year periods. The region-specific estimates are smoothed using a Bayesian model to produce estimates that are more precise than the direct estimates for small areas. The data is fitted to both a non-spatial multivariate logistic model and a spatial random effect intrinsic conditional autoregressive (ICAR) model. Results After spatially smoothing, the subnational HIV prevalence among women have decreased consistently from 2004 to 2018, except for unexpected increments in North, South, and Douala in 2011. Also, the variations in the female HIV prevalence across regions decreased from 2004 to 2018. The non-spatial logistic analysis revealed that age, marital status, education attainment, and wealth quintile were significantly associated with the risk of being infected by HIV. According to the spatial analysis, the associations between HIV infection risk and both marital status and education attainment were generally consistent with the results from the non-spatial analysis. There was no generalizable pattern of the effects of age group, wealth quintile, employment, sexual activity, number of sexual partners, the presence of a STI or its symptoms in the past 12 month, and knowledge of HIV prevention methods over time. Conclusions The small-area estimates of female HIV prevalence can be used to identify regions where HIV prevention methods are required and prioritized. The change in effects of some risk factors over time are evaluated to decide the targeted population that requires reinforced interventions. Finally, more work can be done to improve the quality of dataset as well as the models proposed. HIV/AIDS Cameroon Women Spatial analysis Small Area estimation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Full Text Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2110296","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":140768706,"identity":"bbde28cb-3e55-4a91-a43c-9975f9191f59","order_by":0,"name":"Zhining Sui","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtUlEQVRIiWNgGAWjYJCCAwkVEnb8YCYbsVo+nLFJlmwgRQvjzJY0xg0HiNUi33/G8DBvw2Fm4xs5Bgwfyg4TYcOMHIPDvDsO85kBtTDOOEeEFmYJHqCWM4eZzW7kbmDmbSNCCxv/GaCWtsOMm2cAtfwlRgsPQ47BwZltQO9LALUwEqNFQiKtABzIEmfefzjYcy6dsBb5/sObP4Cjsj0t8cGPMmvCWlDAARLVj4JRMApGwSjABQBzCz40P8ImlAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Washington Seattle Campus: University of Washington","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Zhining","middleName":"","lastName":"Sui","suffix":""},{"id":140768707,"identity":"231ad096-d2b4-4a04-a0b2-7a594a7060e4","order_by":1,"name":"Xiaoyun Liu","email":"","orcid":"https://orcid.org/0000-0002-5483-0742","institution":"Peking University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaoyun","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2022-09-27 22:14:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2110296/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2110296/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":27371459,"identity":"c69747b1-f2dc-4e70-a803-3ad89e616962","added_by":"auto","created_at":"2022-10-05 13:29:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":99415,"visible":true,"origin":"","legend":"\u003cp\u003eA map visualizing the 10 administrative regions in Cameroon.\u003c/p\u003e","description":"","filename":"Fig.1Amapvisualizingthe10administrativeregions.png","url":"https://assets-eu.researchsquare.com/files/rs-2110296/v1/8580d54d5b1c141b186fe79f.png"},{"id":27370830,"identity":"66bb2e02-37b7-4f82-b27a-e4f8043248ad","added_by":"auto","created_at":"2022-10-05 13:24:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":193527,"visible":true,"origin":"","legend":"\u003cp\u003eSample sizes in 12 regions under analysis in 2004, 2011, 2018.\u003c/p\u003e","description":"","filename":"Fig.2Samplesizesin12regionsunderanalysis.png","url":"https://assets-eu.researchsquare.com/files/rs-2110296/v1/517e4ad07d5a8d3ebc792a7c.png"},{"id":27370829,"identity":"f90ad4b4-e417-4bec-9647-8cc8840a21f9","added_by":"auto","created_at":"2022-10-05 13:24:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":189770,"visible":true,"origin":"","legend":"\u003cp\u003eSmoothed region-specific HIV prevalence in women aged 15–49 years in Cameroon, 2004, 2011, 2018.\u003c/p\u003e","description":"","filename":"Fig.3SmoothedweightedregionspecificHIVprevalence.png","url":"https://assets-eu.researchsquare.com/files/rs-2110296/v1/857340d4945f84edc4d03b94.png"},{"id":27370828,"identity":"e4ea3921-dcd7-4d0a-8132-04cfa9f45968","added_by":"auto","created_at":"2022-10-05 13:24:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":184881,"visible":true,"origin":"","legend":"\u003cp\u003eChange in the smoothed region-specific HIV prevalence in female adults in Cameroon over time.\u003c/p\u003e","description":"","filename":"Fig.4ChangeinthesmoothedHIVprevalence.png","url":"https://assets-eu.researchsquare.com/files/rs-2110296/v1/b63ce0c996714bbda022964b.png"},{"id":27371462,"identity":"573900e9-913a-46ff-b2e4-6f148e629eaa","added_by":"auto","created_at":"2022-10-05 13:29:52","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":144570,"visible":true,"origin":"","legend":"\u003cp\u003eComparisons between estimates and standard errors of HIV prevalence before and after smoothing. (Red line: the diagonal line)\u003c/p\u003e","description":"","filename":"Fig.5Comparisonsbetweendirectandsmoothedestimates.png","url":"https://assets-eu.researchsquare.com/files/rs-2110296/v1/c1e1bfd6cbc803c4a9e81227.png"},{"id":27371793,"identity":"640b40ac-e108-494b-8308-bb98a0fc84dc","added_by":"auto","created_at":"2022-10-05 13:34:52","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":144501,"visible":true,"origin":"","legend":"\u003cp\u003eDifference in the odds of HIV infection per 1% difference in risk factors. (Points above the red dashed line: higher percentage of the risk factor was associated with higher risk of HIV infection; Points below the red dashed line: higher percentage of the risk factor was associated with lower risk of HIV infection)\u003c/p\u003e","description":"","filename":"Fig.6DifferenceintheoddsofHIVinfection.png","url":"https://assets-eu.researchsquare.com/files/rs-2110296/v1/a812b6b2b350fb191317709e.png"},{"id":27371955,"identity":"0c9817b7-ad7c-4ed3-972e-9cc91e6bd1c6","added_by":"auto","created_at":"2022-10-05 13:39:52","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":175547,"visible":true,"origin":"","legend":"\u003cp\u003eComparison between region-specific fitted random effects in models without and with covariates.\u003c/p\u003e","description":"","filename":"Fig.7Comparisonoffittedrandomeffectsinmodels.png","url":"https://assets-eu.researchsquare.com/files/rs-2110296/v1/33e3823c6991d21db10db783.png"},{"id":27371956,"identity":"d199acdd-6f41-4a72-83cd-bba1b2696fad","added_by":"auto","created_at":"2022-10-05 13:40:06","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":862529,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptSpatialanalysisoffactorsassociatedwithHIV.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2110296/v1_covered.pdf"}],"financialInterests":"","formattedTitle":"Spatial analysis of factors associated with subnational HIV prevalence among female adults aged 15-49 years in Cameroon, 2004-2018","fulltext":[{"header":"Full Text","content":"This preprint is available for \u003ca href='/article/rs-2110296/latest.pdf' target='_blank'\u003edownload as a PDF\u003c/a\u003e."}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HIV/AIDS, Cameroon, Women, Spatial analysis, Small Area estimation","lastPublishedDoi":"10.21203/rs.3.rs-2110296/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2110296/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe human immunodeficiency virus (HIV) is one of the world’s most serious health and development burdens and it is one of the most common causes of death in Cameroon. Women appear to be more vulnerable to HIV infection than men. Given that the women specific HIV/AIDS research literature is lacking in Cameroon, this study applied spatial random effects based on subnational regions to provide more accurate estimates on female HIV prevalence and related risk factors in Cameroon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study estimates trends in female HIV \u0026nbsp;prevalence for 12 subnational regions in Cameroon using DHS surveys from 2004, 2011, and 2018. Direct weighted estimates of the female HIV prevalence from each survey are calculated for each region across 7-year periods. The region-specific estimates are smoothed using a Bayesian model to produce estimates that are more precise than the direct estimates for small areas. The data is fitted to both a non-spatial multivariate logistic model and a spatial random effect intrinsic conditional autoregressive (ICAR) model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter spatially smoothing, the subnational HIV prevalence among women have decreased consistently from 2004 to 2018, except for unexpected increments in North, South, and Douala in 2011. Also, the variations in the female HIV prevalence across regions decreased from 2004 to 2018. The non-spatial logistic analysis revealed that age, marital status, education attainment, and wealth quintile were significantly associated with the risk of being infected by HIV. According to the spatial analysis, the associations between HIV infection risk and both marital status and education attainment were generally consistent with the results from the non-spatial analysis. There was no generalizable pattern of the effects of age group, wealth quintile, employment, sexual activity, number of sexual partners, the presence of a STI or its symptoms in the past 12 month, and knowledge of HIV prevention methods over time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe small-area estimates of female HIV prevalence can be used to identify regions where HIV prevention methods are required and prioritized. The change in effects of some risk factors over time are evaluated to decide the targeted population that requires reinforced interventions. Finally, more work can be done to improve the quality of dataset as well as the models proposed.\u003c/p\u003e","manuscriptTitle":"Spatial analysis of factors associated with subnational HIV prevalence among female adults aged 15-49 years in Cameroon, 2004-2018","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-10-05 13:24:50","doi":"10.21203/rs.3.rs-2110296/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e587b73b-0ad0-4eed-b093-f346158254fc","owner":[],"postedDate":"October 5th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-10-18T07:01:52+00:00","versionOfRecord":[],"versionCreatedAt":"2022-10-05 13:24:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2110296","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2110296","identity":"rs-2110296","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}