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Article ; Online: Unlocking the potential of telehealth in Africa for HIV: opportunities, challenges, and pathways to equitable healthcare delivery.

Cuadros, Diego F / Huang, Qian / Mathenjwa, Thulile / Gareta, Dickman / Devi, Chayanika / Musuka, Godfrey

Frontiers in digital health

2024 Volume 6, Page(s) 1278223

Language	English
Publishing date	2024-03-04
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-253X
ISSN (online)	2673-253X
DOI	10.3389/fdgth.2024.1278223
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Syndemics of intimate partner violence among women in HIV endemic South Africa: geospatial analysis of nationally representative data.

Tomita, Andrew / Cuadros, Diego F / Gibbs, Andrew

Scientific reports

2022 Volume 12, Issue 1, Page(s) 18083

Abstract: Despite some improvement in lowering HIV incidence, HIV-related challenges, such as intimate partner violence (IPV), remain unacceptably high among women in South Africa. For decades, researchers and activists have pointed to the complex and intertwined ... ...

Abstract	Despite some improvement in lowering HIV incidence, HIV-related challenges, such as intimate partner violence (IPV), remain unacceptably high among women in South Africa. For decades, researchers and activists have pointed to the complex and intertwined reality of the substance abuse, violence and AIDS (SAVA) syndemic that endangers women. However, more recent systematic review/meta-analysis evidence points to inconclusive association between IPV and alcohol use. Furthermore, much of the evidence is often non-population-based that focuses on the co-occurrence rather than synergistic SAVA interaction. In this study, using the latest data from the South Africa Demographic and Health Survey (SA-DHS), we identified geographic synergistic clustering of IPV associated with HIV and substance abuse in South Africa as a measure of population-level interactions among these factors. The SA-DHS is a nationally representative sample that includes wide-ranging data on health, social challenges and household geo-locations of 5,874 women who participated in the domestic violence module. First, geographical IPV, harmful alcohol use (as the substance abuse measure available in SA-DHS) and HIV clusters were identified using the Kulldorff spatial scan statistic in SaTScan. Second, synergistic interactions related to recent IPV (i.e. recent physical, sexual, emotional violence during the last 12 months) with harmful alcohol use and HIV challenge were measured using RERI [Relative excess risk due to interaction], AP [attributable proportion] and S [Synergy index]. In our results, we spatially identified geographical physical IPV syndemic interactions in parts of the Eastern Cape/Free State Provinces (RERI = 4.42 [95% CI: 2.34-6.51], AP = 0.56 [95% CI: 0.44-0.68], S = 2.77 [95% CI: 2.01-3.84], but not in other forms of IPV. Although IPV, based on decade old concept of SAVA syndemic, was less common/widespread than expected from the national scale population-based data, we identified population-level physical violence syndemic occurring in South Africa. Our study highlights the need to prioritize public health response targeting vulnerable populations residing in these high-risk areas of syndemic mechanisms linking these synergistic epidemics that women face in South Africa.
MeSH term(s)	Female ; Humans ; Acquired Immunodeficiency Syndrome ; Alcoholism ; HIV Infections/epidemiology ; HIV Infections/psychology ; Intimate Partner Violence ; Meta-Analysis as Topic ; Prevalence ; Risk Factors ; Sexual Partners/psychology ; South Africa/epidemiology ; Substance-Related Disorders/epidemiology ; Substance-Related Disorders/psychology ; Syndemic ; Systematic Reviews as Topic
Language	English
Publishing date	2022-10-27
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-20230-7
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Article ; Online: Water, sanitation and depression in rural communities: evidence from nationally representative study data in South Africa.

Mngadi, Lindiwe C / Cuadros, Diego F / Tanser, Frank / Burns, Jonathan K / Slotow, Rob / Tomita, Andrew

Psychology, health & medicine

2023 Volume 28, Issue 9, Page(s) 2441–2449

Abstract: Clean water and sanitation provisions are essential for good hygiene and health, with rural South Africa facing a simultaneous access crisis of both, the direct health effect of restricted access to both on mental health remaining scarce and largely ... ...

Abstract	Clean water and sanitation provisions are essential for good hygiene and health, with rural South Africa facing a simultaneous access crisis of both, the direct health effect of restricted access to both on mental health remaining scarce and largely overlooked. This study investigated the association between access to clean water and sanitation on depression in rural South Africa utilizing the most recent data (year 2017) from the South African National Income Dynamics Study. Our study outcome was depression, based on the 10-item abridged version of the Center for Epidemiologic Studies Depression Scale (data available in SA-NIDS), the main exposures being access to clean water and adequate sanitation facilities (i.e. flushing toilets). Two types of analyses were conducted: first, adjusted logistic regression models were fitted to assess the relationship between lack of access to clean water and adequate sanitation to depression. Second, we conducted mediation analysis to investigate whether access to clean water mediated the relationship between lack of access to toilets and depression. A high proportion of rural participants lacked access to clean water (
MeSH term(s)	Humans ; Sanitation ; Water Supply ; South Africa/epidemiology ; Rural Population ; Water ; Depression/epidemiology ; Quality of Life
Chemical Substances	Water (059QF0KO0R)
Language	English
Publishing date	2023-02-23
Publishing country	England
Document type	Journal Article
ZDB-ID	1477841-5
ISSN	1465-3966 ; 1354-8506
ISSN (online)	1465-3966
ISSN	1354-8506
DOI	10.1080/13548506.2023.2179643
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Article ; Online: Syndemics of intimate partner violence among women in HIV endemic South Africa

Andrew Tomita / Diego F. Cuadros / Andrew Gibbs

Scientific Reports, Vol 12, Iss 1, Pp 1-

geospatial analysis of nationally representative data

2022 Volume 8

Abstract: Abstract Despite some improvement in lowering HIV incidence, HIV-related challenges, such as intimate partner violence (IPV), remain unacceptably high among women in South Africa. For decades, researchers and activists have pointed to the complex and ... ...

Abstract	Abstract Despite some improvement in lowering HIV incidence, HIV-related challenges, such as intimate partner violence (IPV), remain unacceptably high among women in South Africa. For decades, researchers and activists have pointed to the complex and intertwined reality of the substance abuse, violence and AIDS (SAVA) syndemic that endangers women. However, more recent systematic review/meta-analysis evidence points to inconclusive association between IPV and alcohol use. Furthermore, much of the evidence is often non-population-based that focuses on the co-occurrence rather than synergistic SAVA interaction. In this study, using the latest data from the South Africa Demographic and Health Survey (SA-DHS), we identified geographic synergistic clustering of IPV associated with HIV and substance abuse in South Africa as a measure of population-level interactions among these factors. The SA-DHS is a nationally representative sample that includes wide-ranging data on health, social challenges and household geo-locations of 5,874 women who participated in the domestic violence module. First, geographical IPV, harmful alcohol use (as the substance abuse measure available in SA-DHS) and HIV clusters were identified using the Kulldorff spatial scan statistic in SaTScan. Second, synergistic interactions related to recent IPV (i.e. recent physical, sexual, emotional violence during the last 12 months) with harmful alcohol use and HIV challenge were measured using RERI [Relative excess risk due to interaction], AP [attributable proportion] and S [Synergy index]. In our results, we spatially identified geographical physical IPV syndemic interactions in parts of the Eastern Cape/Free State Provinces (RERI = 4.42 [95% CI: 2.34–6.51], AP = 0.56 [95% CI: 0.44–0.68], S = 2.77 [95% CI: 2.01–3.84], but not in other forms of IPV. Although IPV, based on decade old concept of SAVA syndemic, was less common/widespread than expected from the national scale population-based data, we identified population-level physical violence syndemic ...
Keywords	Medicine ; R ; Science ; Q
Subject code	310
Language	English
Publishing date	2022-10-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Narrative minireview of the spatial epidemiology of substance use disorder in the United States: Who is at risk and where?

Cuadros, Diego F / Branscum, Adam J / Moreno, Claudia M / MacKinnon, Neil J

World journal of clinical cases

2023 Volume 11, Issue 11, Page(s) 2374–2385

Abstract: Drug overdose is the leading cause of death by injury in the United States. The incidence of substance use disorder (SUD) in the United States has increased steadily over the past two decades, becoming a major public health problem for the country. The ... ...

Abstract	Drug overdose is the leading cause of death by injury in the United States. The incidence of substance use disorder (SUD) in the United States has increased steadily over the past two decades, becoming a major public health problem for the country. The drivers of the SUD epidemic in the United States have changed over time, characterized by an initial heroin outbreak between 1970 and 1999, followed by a painkiller outbreak, and finally by an ongoing synthetic opioid outbreak. The nature and sources of these abused substances reveal striking differences in the socioeconomic and behavioral factors that shape the drug epidemic. Moreover, the geospatial distribution of the SUD epidemic is not homogeneous. The United States has specific locations where vulnerable communities at high risk of SUD are concentrated, reaffirming the multifactorial socioeconomic nature of this epidemic. A better understanding of the SUD epidemic under a spatial epidemiology framework is necessary to determine the factors that have shaped its spread and how these patterns can be used to predict new outbreaks and create effective mitigation policies. This narrative minireview summarizes the current records of the spatial distribution of the SUD epidemic in the United States across different periods, revealing some spatiotemporal patterns that have preceded the occurrence of outbreaks. By analyzing the epidemic of SUD-related deaths, we also describe the epidemic behavior in areas with high incidence of cases. Finally, we describe public health interventions that can be effective for demographic groups, and we discuss future challenges in the study and control of the SUD epidemic in the country.
Language	English
Publishing date	2023-04-14
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2307-8960
ISSN	2307-8960
DOI	10.12998/wjcc.v11.i11.2374
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Article ; Online: Analysis of Vaccination Rates and New COVID-19 Infections by US County, July-August 2021.

Cuadros, Diego F / Miller, F DeWolfe / Awad, Susanne / Coule, Philip / MacKinnon, Neil J

JAMA network open

2022 Volume 5, Issue 2, Page(s) e2147915

MeSH term(s)	COVID-19/epidemiology ; COVID-19 Vaccines/administration & dosage ; Cross-Sectional Studies ; Demography ; Female ; Humans ; Male ; Pandemics ; SARS-CoV-2 ; United States ; Vaccination Coverage/statistics & numerical data
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-02-01
Publishing country	United States
Document type	Journal Article ; Observational Study
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2021.47915
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Article: Spatial epidemiology of diabetes: Methods and insights.

Cuadros, Diego F / Li, Jingjing / Musuka, Godfrey / Awad, Susanne F

World journal of diabetes

2021 Volume 12, Issue 7, Page(s) 1042–1056

Abstract: Diabetes mellitus (DM) is a growing epidemic with global proportions. It is estimated that in 2019, 463 million adults aged 20-79 years were living with DM. The latest evidence shows that DM continues to be a significant global health challenge and is ... ...

Abstract	Diabetes mellitus (DM) is a growing epidemic with global proportions. It is estimated that in 2019, 463 million adults aged 20-79 years were living with DM. The latest evidence shows that DM continues to be a significant global health challenge and is likely to continue to grow substantially in the next decades, which would have major implications for healthcare expenditures, particularly in developing countries. Hence, new conceptual and methodological approaches to tackle the epidemic are long overdue. Spatial epidemiology has been a successful approach to control infectious disease epidemics like malaria and human immunodeficiency virus. The implementation of this approach has been expanded to include the study of non-communicable diseases like cancer and cardiovascular diseases. In this review, we discussed the implementation and use of spatial epidemiology and Geographic Information Systems to the study of DM. We reviewed several spatial methods used to understand the spatial structure of the disease and identify the potential geographical drivers of the spatial distribution of DM. Finally, we discussed the use of spatial epidemiology on the design and implementation of geographically targeted prevention and treatment interventions against DM.
Language	English
Publishing date	2021-07-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2583471-X
ISSN	1948-9358
ISSN	1948-9358
DOI	10.4239/wjd.v12.i7.1042
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Article: Progress Towards UNAIDS's 95-95-95 Targets in Zimbabwe: Sociodemographic Constraints and Geospatial Heterogeneity.

Chowdhury, Md Tuhin / Bershteyn, Anna / Milali, Masabho / Citron, Daniel / Nyimbili, Sulani / Musuka, Godfrey / Cuadros, Diego F

medRxiv : the preprint server for health sciences

2023

Abstract: The HIV/AIDS epidemic remains critical in sub-Saharan Africa, with UNAIDS establishing "95-95-95" targets to optimize HIV care. Using the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) geospatial data, this study aimed to identify patterns in ... ...

Abstract	The HIV/AIDS epidemic remains critical in sub-Saharan Africa, with UNAIDS establishing "95-95-95" targets to optimize HIV care. Using the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) geospatial data, this study aimed to identify patterns in these targets and determinants impacting the HIV care continuum in underserved Zimbabwean communities. Analysis techniques, including Gaussian kernel interpolation, optimized hotspot, and multivariate geospatial k-means clustering, were utilized to establish spatial patterns and cluster regional HIV care continuum needs. Further, we investigated healthcare availability, access, and social determinants and scrutinized the association between socio-demographic and behavioral covariates with HIV care outcomes. Disparities in progress toward the "95-95-95" targets were noted across different regions, with each target demonstrating unique geographic patterns, resulting in four distinct clusters with specific HIV care needs. Key factors associated with gaps in achieving targets included younger age, male sex, employment, and minority or no religious affiliation. Our study uncovers significant spatial heterogeneity in the HIV care continuum in Zimbabwe, with unique regional patterns in "95-95-95" targets. The spatial analysis of the UNAIDS targets presented here could prove instrumental in designing effective control strategies by identifying vulnerable communities that are falling short of these targets and require intensified efforts. Our result provides insights for designing region-specific interventions and enhancing community-level factors, emphasizing the need to address regional gaps and improve HIV care outcomes in vulnerable communities lagging behind.
Language	English
Publishing date	2023-07-28
Publishing country	United States
Document type	Preprint
DOI	10.1101/2023.07.26.23293207
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Article: Convergence of HIV and non-communicable disease epidemics: geospatial mapping of the unmet health needs in an HIV hyperendemic community in South Africa.

Cuadros, Diego F / Devi, Chayanika / Singh, Urisha / Olivier, Stephen / Castle, Alison C / Moosa, Yumna / Edwards, Johnathan A / Kim, Hae-Young / Siedner, Mark J / Wong, Emily B / Tanser, Frank

BMJ global health

2024 Volume 9, Issue 1

Abstract: Introduction: As people living with HIV (PLHIV) are experiencing longer survival, the co-occurrence of HIV and non-communicable diseases has become a public health priority. In response to this emerging challenge, we aimed to characterise the spatial ... ...

Abstract	Introduction: As people living with HIV (PLHIV) are experiencing longer survival, the co-occurrence of HIV and non-communicable diseases has become a public health priority. In response to this emerging challenge, we aimed to characterise the spatial structure of convergence of chronic health conditions in an HIV hyperendemic community in KwaZulu-Natal, South Africa. Methods: In this cross-sectional study, we used data from a comprehensive population-based disease survey conducted in KwaZulu-Natal, South Africa, which collected data on HIV, diabetes and hypertension. We implemented a novel health needs scale to categorise participants as: diagnosed and well-controlled (Needs Score 1), diagnosed and suboptimally controlled (Score 2), diagnosed but not engaged in care (Score 3) or undiagnosed and uncontrolled (Score 4). Scores 2-4 were indicative of unmet health needs. We explored the geospatial structure of unmet health needs using different spatial clustering methods. Results: The analytical sample comprised 18 041 individuals. We observed a similar spatial structure for HIV among those with combined needs Score 2-3 (diagnosed but uncontrolled) and Score 4 (undiagnosed and uncontrolled), with most PLHIV with unmet needs clustered in the southern urban and peri-urban areas. Conversely, a high prevalence of need Scores 2 and 3 for diabetes and hypertension was mostly distributed in the more rural central and northern part of the surveillance area. A high prevalence of need Score 4 for diabetes and hypertension was mostly distributed in the rural southern part of the surveillance area. Multivariate clustering analysis revealed a significant overlap of all three diseases in individuals with undiagnosed and uncontrolled diseases (unmet needs Score 4) in the southern part of the catchment area. Conclusions: In an HIV hyperendemic community in South Africa, areas with the highest needs for PLHIV with undiagnosed and uncontrolled disease are also areas with the highest burden of unmet needs for other chronic health conditions, such as diabetes and hypertension. Our study has revealed remarkable differences in the distribution of health needs across the rural to urban continuum even within this relatively small study site. The identification and prioritisation of geographically clustered vulnerable communities with unmet health needs for both HIV and non-communicable diseases provide a basis for policy and implementation strategies to target communities with the highest health needs.
MeSH term(s)	Humans ; South Africa/epidemiology ; HIV Infections/epidemiology ; Noncommunicable Diseases/epidemiology ; Cross-Sectional Studies ; Diabetes Mellitus/epidemiology ; Hypertension/epidemiology
Language	English
Publishing date	2024-01-04
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2023-012730
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Article ; Online: Dynamics of the COVID-19 epidemic in urban and rural areas in the United States.

Cuadros, Diego F / Branscum, Adam J / Mukandavire, Zindoga / Miller, F DeWolfe / MacKinnon, Neil

Annals of epidemiology

2021 Volume 59, Page(s) 16–20

Abstract: Purpose: There is a growing concern about the COVID-19 epidemic intensifying in rural areas in the United States (U.S.). In this study, we described the dynamics of COVID-19 cases and deaths in rural and urban counties in the U.S.: Methods: Using ... ...

Abstract	Purpose: There is a growing concern about the COVID-19 epidemic intensifying in rural areas in the United States (U.S.). In this study, we described the dynamics of COVID-19 cases and deaths in rural and urban counties in the U.S. Methods: Using data from April 1 to November 12, 2020, from Johns Hopkins University, we estimated COVID-19 incidence and mortality rates and conducted comparisons between urban and rural areas in three time periods at the national level, and in states with higher and lower COVID-19 incidence rates. Results: Results at the national level showed greater COVID-19 incidence rates in urban compared to rural counties in the Northeast and Mid-Atlantic regions of the U.S. at the beginning of the epidemic. However, the intensity of the epidemic has shifted to a rapid surge in rural areas. In particular, high incidence states located in the Mid-west of the country had more than 3,400 COVID-19 cases per 100,000 people compared to 1,284 cases per 100,000 people in urban counties nationwide during the third period (August 30 to November 12). Conclusions: Overall, the current epicenter of the epidemic is located in states with higher infection rates and mortality in rural areas. Infection prevention and control efforts including healthcare capacity should be scaled up in these vulnerable rural areas.
MeSH term(s)	COVID-19 ; Epidemics ; Humans ; Rural Population ; SARS-CoV-2 ; United States/epidemiology ; Urban Population
Language	English
Publishing date	2021-04-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	1074355-8
ISSN	1873-2585 ; 1047-2797
ISSN (online)	1873-2585
ISSN	1047-2797
DOI	10.1016/j.annepidem.2021.04.007
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