Spatio-temporal trends and forecasting of HIV Positivity rates at district level in the Amhara Region, Ethiopia

Abstract Background: Human Immunodeficiency Virus remains a significant global public health challenge, despite decades of hard work and remarkable scientific advances in prevention, diagnosis and antiretroviral therapy, the declines in numbers at the end of 2024 were not sufficient to end AIDS as a public health threat by 2030. Health systems disruptions, political and economic instability, and loss of social networks are common aspects of humanitarian crises that can contribute to a person’s vulnerability to HIV infection. The current study aims to generate evidence by analysing district level spatio-temporal trends and forecast HIV positivity rate through 2030in the Amhara region, Ethiopia. Methods: A retrospective ecological study was conducted to investigate the spatio-temporal distribution of HIV positivity rate in the Amhara region from 2016 to 2024 using data from DHIS2, PHEM and SGBV. Spatial autocorrelation analysis, Hot spot analysis, Heat mapping, Neural network machine learning and exponential smoothing forecasting were performed. Results: Analysis from the complementary datasets revealed temporal differences and geographic heterogeneity in HIV positivity rate during relative stabile and conflict conditions. Analysis of a regional nine years DHIS2 data base revealed a clear pattern of initial rise, sustained decline, and subsequent resurgence of HIV positivity rates per 1,000 population in the Amhara region. In addition, analysis from SGBV program database and PHEM surveillance data further supports the presence of high HIV positivity rate within particularly vulnerable populations and a rapidly increasing number of newly identified HIV-positive cases respectively. Testing volume, conflict and year are predictors influencing HIV positivity rate and forecast analysis predicted HIV positivity rate in the Amhara region is expected to remain relatively at around 5% through 2030. Conclusion: The Amhara region demonstrates substantial spatio-temporal heterogeneity in HIV positivity rate. Strengthening conflict-sensitive HIV programming including intensive support for high-burden District and reinforcing surveillance in low-burden areas are essential. Targeted, resilient interventions are urgently needed to help the region realign with national and global HIV elimination targets.