Introduction Human immunodeficiency virus HIV persue to be
Human immunodeficiency 3 methyladenine (HIV) persue to be a major global public health problem (Joint United Nations Programme on HIV/AIDS, 2018). Globally, 36.9 million (range, 31.1 million–43.9 million) people were living with HIV in 2017 (UNAIDS, 2018a). The burden of the epidemic varies considerably among countries and regions (World Health Organization, 2017). The vast majority of people living with HIV (PLHIV) are in low- and middle-income countries (UNAIDS, 2018b, World Health Organization, 2017). In 2017, about 50% (19.6 million) of PLHIV were living in eastern and southern Africa, and 1.8 million people were newly diagnosed with HIV (UNAIDS, 2018a).
In many high HIV prevalence settings, concerted measures have been taken to prevent and control HIV/AIDS since 2000 (Joint United Nations Programme on HIV/AIDS, 2018). However, many PLHIV remain undiagnosed or are diagnosed late, especially in Sub-Saharan Africa (SSA), where the burden of HIV is highest (Ghosn et al., 2018). In 2017, 34% of the total estimated PLHIV had no access to antiretroviral therapy (ART) (WHO Africa, 2017). Hence, an accelerated and targeted response is needed to achieve the 90–90–90 targets by 2020, defined as follows: (1) 90% of all PLHIV will know their HIV status, (2) 90% of all people with diagnosed HIV infection will receive sustained ART, and (3) 90% of all people receiving ART will have viral suppression (Joint United Nations Programme on HIV/AIDS, 2014).
Ethiopia is one of the HIV high burden countries that has adopted the 90–90–90 fast-track targets (Joint United Nations Programme on HIV/AIDS, 2014). A recent study indicated that progress towards achieving the 2020 targets are on track: 79% PLHIV know their status, 90% PLHIV are on ART, and 88% of PLHIV have suppressed viral loads (Assefa et al., 2019). However, the prevalence of HIV and incidence of new infections remain high (Girum et al., 2018). In 2017, the number of PLHIV was estimated to be 610 000 and the number of newly HIV-infected people was estimated to be 16 000 (UNAIDS, 2018a). The national HIV prevalence in adults declined from 1.4 in 2005 to 0.9% in 2016 (CSA, 2018). However, there is a significant geographic variation in city administration and regional states, with the highest prevalence recorded in Gambela Region (4.8%) and Addis Ababa City Administration (3.4%). This is followed by Dire Dawa City Administration (2.5%) and the regions of Harari (2.4%), Afar (1.4%), and Amhara (1.2%) (CSA, 2018).
Amhara Region is the second most populous and geographically diverse region in Ethiopia (Amahar Regional State BoFED, 2017). It has a large number of most-at-risk populations for HIV (MARPs), such as truckers, migrant day labourers, and female sex workers (Deribew, 2009). As reported in the Ethiopian Demographic and Health Survey (EDHS) 2016, there are marked differences in HIV risk behaviours and knowledge of HIV/AIDS prevention methods by region and city administration. Only 22% of women and 44% of men in Amhara Region have a comprehensive knowledge of HIV. Additionally, there are widespread traditional practices in the region that disproportionately increase the risk of HIV. It was estimated in 2018 that an average of 2.8 women and 5.2 men had sexual intercourse or cohabited in their life time with a mean number of 1.8 and 2.8 sexual partners, respectively (CSA, 2018). Furthermore, about 43% of the population had no access to HIV testing in Amhara Region in 2017 (Ethiopian Ministry of Health, 2016/7).
The estimation of HIV infection rates and identification of areas with the highest HIV infection is therefore essential (Wilson and Halperin, 2008), especially in settings such as border and agricultural investment areas where unsafe sex is potentially more likely to be practised. This could assist in increasing access to HIV counselling and testing (HCT) services, and targeting and prioritizing interventions (Coburn and Blower, 2013).