A Machine Learning Approach to Predict HIV Viral Load Hotspots in Kenya Using Real-World Data.

Background: Machine learning models are not in routine use for predicting HIV status. Our objective is to describe the development of a machine learning model to predict HIV viral load (VL) hotspots as an early warning system in Kenya, based on routinely collected data by affiliate entities of the Ministry of Health. Based on World Health Organization's recommendations, hotspots are health facilities with ≥20% people living with HIV whose VL is not suppressed. Prediction of VL hotspots provides an early warning system to health administrators to optimize treatment and resources distribution. Methods: A random forest model was built to predict the hotspot status of a health facility in the upcoming month, starting from 2016. Prior to model building, the datasets were cleaned and checked for outliers and multicollinearity at the patient level. The patient-level data were aggregated up to the facility level before model building. We analyzed data from 4 million tests and 4,265 facilities. The dataset at the health facility level was divided into train (75%) and test (25%) datasets. Results: The model discriminates hotspots from non-hotspots with an accuracy of 78%. The F1 score of the model is 69% and the Brier score is 0.139. In December 2019, our model correctly predicted 434 VL hotspots in addition to the observed 446 VL hotspots. Conclusion: The hotspot mapping model can be essential to antiretroviral therapy programs. This model can provide support to decision-makers to identify VL hotspots ahead in time using cost-efficient routinely collected data.