br Discussion The LISA analysis indicated that HIV was
Discussion The LISA analysis indicated that HIV was geographically clustered in the north-west districts of Amhara Region. A high rate of HIV infection was found in Metema and Mirab Armacho districts, which share borders with Eretria and Sudan. Various studies have linked risk of infectious disease to agricultural activities and border areas in Ethiopia (Alemayehu et al., 2017, Alene et al., 2017, Deribew, 2009). Indeed the districts identified in this study as being important spatiotemporal HIV hotspots are known for being highly agricultural areas as well as transport corridors for truck drivers, with large numbers of other HIV MARPs such as day labourers during the harvesting season, commercial sex workers, and truckers. Furthermore, these districts are also known to constitute gateways for migrants, female returnees, and sex workers (Gezie et al., 2015). The detection of high HIV infection rates in these districts implies that HIV-related knowledge and condom promotion and distribution services are likely to be sub-optimal in these districts. Therefore, this study could inform and strengthen current HIV control policy in areas where MARPs are concentrated. The results of this study showed temporal patterns in HIV infection with a decline of infection from 2015 to 2017. The Ethiopian health data analytics platform also shows that HIV notification decreased in the region (Ethiopian Ministry of Health, 2016/7). Scale up of ART, expansion of HCT, and integrated HIV care and support in the country likely contributed to this Dipraglurant (Assefa et al., 2014, WHO, 2015). It was found that HIV infection is higher in districts with a higher proportion of individuals who have never attended school. Prior findings have also shown educational status to be associated with HIV prevalence, in that the risk of HIV infection was found to be higher in the less educated groups (Bradley et al., 2007, Fontanet et al., 2000, Glynn et al., 2004). Educated populations may be more likely to use condoms compared to those less educated, which may help lower HIV transmission. Less educated populations often live in rural areas and commonly travel to engage in income-generating activities such as sex work (Bradley et al., 2007). In contrast, a study done using individual EDHS data demonstrated that HIV prevalence was higher among educated groups compared to less educated groups (Lakew et al., 2015). The present study used data aggregated at the district level, which might not be generalizable for individuals. It would be valuable to examine the association of education and HIV using individual-level data. Districts with a higher proportion of migrants were statistically at greater risk for HIV infection. This finding could be explained in part by risky sexual behaviours, such as multiple sexual partners or low and inconsistent condom use, likely to increase vulnerability to HIV infection (Federal and Prevention, 2007, Tiruneh et al., 2015). Seasonal migration of labour in the study area, largely undertaken by younger individuals (mean age 28.4 years), also contributes to HIV transmission.
Conflict of interest
Significant progress has been achieved regarding the treatment and prevention of HIV infection in the past two decades. Combinatory antiretroviral treatment (cART) has transformed a deadly disease into a manageable chronic infection. cART drastically reduces viremia to undetectable titers in the blood through inhibition of new rounds of cellular infections, although it is not capable of eliminating already infected cells. HIV persists in so-called viral reservoirs from where it rebounds as soon as cART is stopped. A therapeutic strategy to target the eradication of HIV has been steadfastly sought but has encountered multiple hurdles. The virus most likely possesses several nonexclusive mechanisms to persist once the infection is established. These mechanisms include escape from immune surveillance, clonal proliferation of infected cells, and residual viral replication in immunoprivileged sites of the body such as B cell follicles . Although HIV persists predominantly in intestinal mucosae and lymph nodes, it can be detected in nearly every tissue of the body during cART.