Geographic heterogeneity and temporal trends in HIV prevalence, positivity, and burden in India using national...

Human immunodeficiency virus (HIV) remains a major public health challenge in India. Given substantial heterogeneity across states and union territories (UTs) in India, understanding temporal and spatial patterns in the HIV epidemic is essential for monitoring the ongoing programs. However, recent scientific evidence on spatio-temporal dynamics in HIV epidemiological indicators remains limited. Therefore, this study aims to analyse spatio-temporal trends in HIV prevalence, positivity, and burden across Indian states and UTs. This study utilized data from the National AIDS Control Organization (NACO), India. Temporal and spatial variations in testing growth rate, positivity rate, prevalence, and burden were assessed, and Pearson correlation analysis was performed to examine the relationship between testing and positivity rate. The growth rate of HIV testing increased (+ 137.3%) in Jammu and Kashmir during 2017-2018, but declined to a negative growth rate (- 26%) during 2019-2020. During the same period, a negative growth rate was also observed in Chandigarh (- 53.7%) and Delhi (- 50.7%). Except for Tripura, the positivity rate declined across states and UTs over time. HIV prevalence declined from 0.24% to 0.21% during 2017-2021. High prevalence was observed in the north-eastern region, while the burden was predominantly concentrated in the Gangetic plain region. The correlation between testing and positivity rate was statistically weak (r = 0.149). The annual growth rate of HIV testing remained positive across most states, except during the COVID-19 period, reflecting pandemic-related service disruptions.