Análise da distribuição espacial de doenças: o HIV/SIDA como modelo

Abstract

This study addresses the spatial distribution of HIV/AIDS in Mozambique and its determinants based on data from the 2021 National AIDS Impact Survey (INSIDA). A descriptive mapping was carried out considering the National Epidemiological Situation, prevalence and incidence by age group and gender, and the variability of HIV/AIDS determinants in the different provinces. The analysis revealed that the provinces of Zambézia, Sofala, Manica, Maputo and Gaza have a high incidence and prevalence of HIV/AIDS, with a higher concentration of cases in the 15-49 age group, with emphasis on the 15-24 and 35-49 age groups. A gender disparity was also observed, with the highest incidence among women, especially in the reproductive ages. In mapping the determinants, it was found that male circumcision, population and the number of health facilities with ART services have uneven spatial distributions. Male circumcision was higher in provinces such as Sofala, Zambézia and Tete, while Gaza, Inhambane and Maputo showed lower rates. The population tends to be denser in Zambézia, Nampula and Sofala, while the less populous provinces face greater challenges in accessing treatment, reflected in the lower supply of facilities with ART services. Spatial analysis of the distribution of HIV/AIDS using methods such as the Moran Index and the Getis-Ord G* Index revealed hotspots and clusters of high concentration of the disease, especially in the central and northern provinces of the country, such as Zambézia and Nampula. Spatial autoregressive regression (SAR) indicated that the variable "Population" has a significant association with the number of HIV cases, with an increase in the population being correlated with an increase in the number of cases. The variable "Health Units with ART" also had a significant impact, suggesting that the expansion of testing and treatment services is associated with an increase in diagnosed cases. Finally, the study demonstrated that, while male circumcision did not have a significant impact, population growth and the expansion of ART services are important determinants of the dynamics of the epidemic. The SAR model, with its negative spatial lag coefficient, highlighted the complexity and heterogeneity of the spread of HIV/AIDS, suggesting the need for regional strategies adapted to local specificities for more effective control of the disease. This work contributes to the understanding of the spatial distribution of HIV/AIDS in Mozambique, highlighting the importance of demographic factors and health infrastructure in controlling the epidemic.(TRADUÇAO NOSSA)