Objective: To describe the spatial distribution characteristics of the HIV prevalence among pregnant women in mainland China in 2016, providing scientific evidence for the prevention of mother-to-child transmission of HIV. Methods: Data on pregnant women and those living with HIV in 2016 for all counties in mainland China is from the National Maternal & Child Health Statistics dataset. To obtain robust estimates, 2 964 counties were merged into 344 cities. Spatial autocorrelation analysis and trend analysis were performed based on the city-level dataset to detailedly describe the characteristics of the spatial distribution. Results: A total of 14 879 082 pregnant women were included in the analysis, among whom 5 051 were diagnosed to be infected with HIV, giving an overall prevalence of 34.0 per 100 000 pregnant women. The prevalence was higher in the south than in the north, and decreased from the west (93.5/100 000) to the east(8.6/100 000 ), more specifically, the prevalence in the West region was 11 times as high as that in the East region(χ(trend)(2)=68.61, P<0.01). Stratified analysis by provinces showed that there were 6 provinces whose prevalence was >50.0 per 100 000, and they (Yunnan, Xinjiang, Sichuan, Guangxi, Guizhou and Chongqing) were all located in the West Region; pregnant women in these provinces accounted for 21% of all pregnant women, but the HIV cases accounted for 76% of all cases diagnosed in mainland China. Stratified analysis by cities showed that there were 30 cities whose prevalence was >100.0 per 100 000, and 28 of these cities were also located in the western provinces above. Furthermore, the global Moran's I (0.5, P<0.01) indeed indicated a strong clustered distribution across mainland China; 2 hot spots were observed in the Midwest of Xinjiang, and Yunnan and its bordering areas (Sichuan, Guizhou, Guangxi and Chongqing), while 1 cold spot in the central and east China. The HIV prevalence in the hot spots (183.6/100 000) was 23 times as much as that in the cold spot (8.1/100 000). Conclusion: The overall HIV prevalence for pregnant women who lived in mainland China in 2016 (34.0/100 000) ranked at low-level worldwide, but varied markedly across the whole country with 2 high-prevalence-clustered areas: the Midwest of Xinjiang Uygur Autonomous Region, and Yunnan province along with its bordering areas, indicating comprehensive intervention strategies especially targeted to the areas with high HIV prevalence should be developed.
目的： 描述2016年中国孕产妇艾滋病病毒(HIV)感染的空间分布特征，为预防艾滋病母婴传播工作提供科学依据。 方法： 产妇数和孕产妇HIV感染资料来自全国妇幼卫生年报；纳入县(区)2 964个，形成包括344个地市的数据集。计算地市别孕产妇HIV感染率，采用空间自相关和趋势分析揭示空间分布特征。 结果： 2016年研究地区分娩产妇14 879 082人，HIV感染者5 051人，HIV感染率34.0/10万。HIV感染率呈南高北低，由西(93.5/10万)向东(8.6/10万)递减，西部是东部的11倍(χ(趋势)(2)＝68.61，P<0.01)。从省份来看，云南、新疆、四川、广西、贵州和重庆6个西部省份的感染率>50.0/10万，其产妇占比为21%，感染人数占比却高达76%。从地市来看，感染率>100.0/10万的地市有30个，其中28个分布在上述西部省份。HIV感染率的全局莫兰指数(Moran′s I)为0.5(P<0.01)，提示存在较强的空间聚集性；热点分析进一步揭示，新疆中西部地区、云南及其毗邻省份(四川、贵州、广西和重庆)的部分区域是高发聚集的"热点区域"(183.6/10万)，东部省份以及中部偏东的部分区域属于低发的"冷点区域"(8.1/10万)，热点区域的感染率是冷点区域的23倍。 结论： 2016年中国孕产妇HIV感染率处于国际较低水平，但地区差异显著、有明显的空间聚集性，新疆中西部、云南和毗邻的川黔桂渝的部分区域是预防艾滋病母婴传播工作的重点地区，宜分析成因制定有针对性的综合防控措施。.
Keywords: HIV; Pregnant women; Spatial analysis.