Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda
| Autor: | Abisagi Nampijja, Regina Nakabuye, Ronald H. Gray, Justine Nankinga, Myron S. Cohen, Vladimir Novitsky, James Batte, Joseph Lister Ssembatya, Joshua Mwinike, Sarah Kalibbala, Adrian Kayiira, Fred Makumbi, Steven J. Reynolds, Nampijja Resty, George Kibumba, David Bonsall, Robert Kairania, Agnes Nantongo, Dan Frampton, Francis Wasswa, Jennifer A. Wagman, Astrid Gall, Oliver Ratmann, Grace Kigozi, Larry W. Chang, Steven Watya, Jeremiah Bazaale, Frank Tanser, Helen Ayles, Sr. Margaret Anyokot, George Mondo, Lawrence Ssebanobe, Denis Ankunda, Janet Seeley, Matthew Hall, Anthony Ndyanabo, Joseph Ouma Otobi, Thomas C. Quinn, Aaron A.R. Tobian, Paschal Ssebowa, James Ludigo, Tanya Golubchick, Nelson K. Sewankambo, Ronald Galiwango, Dorean Nabukalu, Maria J. Wawer, Caitlin E. Kennedy, Josephine Galiwango, Jedidah Kambasu, Godfrey Kigozi, Emmanuel Kato, Tulio de Oliveira, Margaret Nalugemwa, John Baptist Ssemanda, Tom Lutalo, Anne Hoppe, Cissy Kityo, Rory Bowden, Gertrude Nakigozi, Max Essex, Joseph Kagaayi, Rebecca Kakembo, Joseph Ssekasanvu, Ronald M. Galiwango, Anne Dennis, David Serwadda, Geoffrey Ssemango, Stephen Tomusange, Hadijja Nakawooya, Betty Nantume, Jessica Nakukumba, Andrew Rambaut, Andrew D. Redd, Lucie Abeler-Dörner, Deogratius Ssemwanga, Nicholas I. Paton, Josh Herbeck, M. Kate Grabowski, Simon E. F. Spencer, Justin Lessler, John S. Santelli, Ruth Ahimbisibwe, Richard J. Hayes, Fred Nalugoda, Xiaoyue Xi, Alice Kisakye, Robert Ssekubugu, Gorreth Nanfuka, Christophe Fraser, Chris Wymant, Kighoma Nehemia, Sarah Fidler, Margaret Nakalanzi, Jairam R. Lingappa, Oliver Laeyendecker, Pontiano Kaleebu, Vincent Calvez, Deenan Pillay, Paul Kellam |
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| Přispěvatelé: | Graduate School, AII - Infectious diseases, APH - Personalized Medicine, APH - Quality of Care, Bill & Melinda Gates Foundation, National Institutes of Health, Department of Mathematics [Imperial College London], Imperial College London, Rakai Health Sciences Program, Nuffield Department of Medicine [Oxford, UK] (Big Data Institute), University of Oxford, European Molecular Biology Laboratory [Hinxton], European Bioinformatics Institute [Hinxton] (EMBL-EBI), EMBL Heidelberg, University College of London [London] (UCL), Johns Hopkins University School of Medicine [Baltimore], National Institute of Allergy and Infectious Diseases [Bethesda] (NIAID-NIH), National Institutes of Health [Bethesda] (NIH), Johns Hopkins Bloomberg School of Public Health [Baltimore], Johns Hopkins University (JHU), University of KwaZulu-Natal [Durban, Afrique du Sud] (UKZN), Department of Statistics [Warwick], University of Warwick [Coventry], Makerere University [Kampala, Ouganda] (MAK), London School of Hygiene and Tropical Medicine (LSHTM), École normale supérieure de Lyon (ENS de Lyon), Stratégies thérapeutiques contre l'infection VIH et les maladies virales associées [iPLesp] (THERAVIR), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), Harvard University |
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Male Epidemiology [SDV]Life Sciences [q-bio] Psychological intervention HIV Infections Corrections law.invention MESH: HIV-1 0302 clinical medicine law Residence Characteristics Prevalence Medicine HETEROGENEITY Uganda 030212 general & internal medicine MESH: Residence Characteristics MESH: Phylogeny 11 Medical and Health Sciences Phylogeny RISK education.field_of_study High prevalence MESH: Middle Aged MESH: HIV Infections Middle Aged Transmission (mechanics) Infectious Diseases MESH: Young Adult Female B990 Subjects Allied to Medicine not elsewhere classified Life Sciences & Biomedicine Cohort study AFRICA Adult Adolescent Fishing Population Immunology Article 03 medical and health sciences Young Adult Acquired immunodeficiency syndrome (AIDS) Virology parasitic diseases Humans education MESH: Uganda MESH: Prevalence MESH: Adolescent MESH: Humans Science & Technology business.industry MESH: Adult medicine.disease 030112 virology Mental health FISHING COMMUNITIES PREVENTION MESH: Male QR Rakai Health Sciences Program and the Pangea HIV Consortium HIV-1 business RA MESH: Female Demography RC |
| Zdroj: | The Lancet. HIV Lancet HIV, 7(3), e173-e183. Elsevier Limited e183 e173 The Lancet HIV The Lancet HIV, 2020, 7 (3), pp.e173-e183. ⟨10.1016/S2352-3018(19)30378-9⟩ |
| ISSN: | 2352-3018 2405-4704 |
| Popis: | International audience; 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.Funding: The Bill & Melinda Gates Foundation, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the National Institute of Child Health and Development, the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases, the World Bank, the Doris Duke Charitable Foundation, the Johns Hopkins University Center for AIDS Research, and the President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention. |
| Databáze: | OpenAIRE |
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