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Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities : a population-based study in Rakai, Uganda
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Rakai Health Sciences Program, Pangea HIV Consortium (Including:
). (2020) Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities : a population-based study in Rakai, Uganda. The Lancet HIV, 7 (3). e173-e183. doi:10.1016/S2352-3018(19)30378-9 ISSN 2352-3018.
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Official URL: https://doi.org/10.1016/S2352-3018(19)30378-9
Abstract
Background
International and global organisations advocate targeting interventions to areas of high HIV prevalence (ie, hotspots). To better understand the potential benefits of geo-targeted control, we assessed the extent to which HIV hotspots along Lake Victoria sustain transmission in neighbouring populations in south-central Uganda.
Methods
We did a population-based survey in Rakai, Uganda, using data from the Rakai Community Cohort Study. The study surveyed all individuals aged 15–49 years in four high-prevalence Lake Victoria fishing communities and 36 neighbouring inland communities. Viral RNA was deep sequenced from participants infected with HIV who were antiretroviral therapy-naive during the observation period. Phylogenetic analysis was used to infer partial HIV transmission networks, including direction of transmission. Reconstructed networks were interpreted through data for current residence and migration history. HIV transmission flows within and between high-prevalence and low-prevalence areas were quantified adjusting for incomplete sampling of the population.
Findings
Between Aug 10, 2011, and Jan 30, 2015, data were collected for the Rakai Community Cohort Study. 25 882 individuals participated, including an estimated 75·7% of the lakeside population and 16·2% of the inland population in the Rakai region of Uganda. 5142 participants were HIV-positive (2703 [13·7%] in inland and 2439 [40·1%] in fishing communities). 3878 (75·4%) people who were HIV-positive did not report antiretroviral therapy use, of whom 2652 (68·4%) had virus deep-sequenced at sufficient quality for phylogenetic analysis. 446 transmission networks were reconstructed, including 293 linked pairs with inferred direction of transmission. Adjusting for incomplete sampling, an estimated 5·7% (95% credibility interval 4·4–7·3) of transmissions occurred within lakeside areas, 89·2% (86·0–91·8) within inland areas, 1·3% (0·6–2·6) from lakeside to inland areas, and 3·7% (2·3–5·8) from inland to lakeside areas.
Interpretation
Cross-community HIV transmissions between Lake Victoria hotspots and surrounding inland populations are infrequent and when they occur, virus more commonly flows into rather than out of hotspots. This result suggests that targeted interventions to these hotspots will not alone control the epidemic in inland populations, where most transmissions occur. Thus, geographical targeting of high prevalence areas might not be effective for broader epidemic control depending on underlying epidemic dynamics.
Item Type: | Journal Article | ||||||||||||||||||||||||||||||||||||||||||||||||
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Alternative Title: | |||||||||||||||||||||||||||||||||||||||||||||||||
Subjects: | Q Science > QR Microbiology R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Science > Statistics | ||||||||||||||||||||||||||||||||||||||||||||||||
Library of Congress Subject Headings (LCSH): | HIV infections, HIV infections -- Uganda -- Rakai, HIV infections -- Transmission -- Uganda -- Rakai, HIV-positive persons , HIV-positive persons -- Uganda -- Rakai | ||||||||||||||||||||||||||||||||||||||||||||||||
Journal or Publication Title: | The Lancet HIV | ||||||||||||||||||||||||||||||||||||||||||||||||
Publisher: | Lancet | ||||||||||||||||||||||||||||||||||||||||||||||||
ISSN: | 2352-3018 | ||||||||||||||||||||||||||||||||||||||||||||||||
Official Date: | March 2020 | ||||||||||||||||||||||||||||||||||||||||||||||||
Dates: |
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Volume: | 7 | ||||||||||||||||||||||||||||||||||||||||||||||||
Number: | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||
Page Range: | e173-e183 | ||||||||||||||||||||||||||||||||||||||||||||||||
DOI: | 10.1016/S2352-3018(19)30378-9 | ||||||||||||||||||||||||||||||||||||||||||||||||
Status: | Peer Reviewed | ||||||||||||||||||||||||||||||||||||||||||||||||
Publication Status: | Published | ||||||||||||||||||||||||||||||||||||||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||||||||||||||||||||||||||||||||||||||
Date of first compliant deposit: | 25 November 2019 | ||||||||||||||||||||||||||||||||||||||||||||||||
Date of first compliant Open Access: | 24 January 2020 | ||||||||||||||||||||||||||||||||||||||||||||||||
RIOXX Funder/Project Grant: |
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