Browsing by Author "Bazaale, Jeremiah"

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    HIV viral suppression and geospatial patterns of HIV antiretroviral therapy treatment facility use in Rakai, Uganda
    (AIDS (London, England), 2018) Billioux, Veena G.; Grabowski, Mary K.; Ssekasanvu, Joseph; Reynolds, Steven J.; Berman, Amanda; Bazaale, Jeremiah; Patel, Eshan U.; Bugos, Eva; Ndyanabo, Anthony; Kisakye, Alice; Kagaayi, Joseph; Gray, Ronald H.; Nakigozi, Gertrude; Ssekubugu, Robert; Nalugoda, Fred; Serwadda, David; Wawer, Maria J.; Chang, Larry W.
    To assess geospatial patterns of HIV antiretroviral therapy (ART) treatment facility use and whether they were impacted by viral load (VL) suppression. Methods—We extracted data on the location and type of care services utilized by HIV-positive persons accessing ART between February 2015 and September 2016 from the Rakai Community Cohort Study (RCCS) in Uganda. The distance from RCCS households to facilities offering ART was calculated using the open street map road network. Modified Poisson regression was used to identify predictors of distance traveled and, for those traveling beyond their nearest facility, the probability of accessing services from a tertiary care facility. Results—1554 HIV-positive participants were identified, of whom 68% had initiated ART. The median distance from households to the nearest ART facility was 3.10 km (Interquartile range, IQR, 1.65–5.05), but the median distance traveled was 5.26 km (IQR, 3.00–10.03, p<0.001) and 57% of individuals travelled further than their nearest facility for ART. Those with higher education and wealth were more likely to travel further. 93% of persons on ART were virally suppressed, and there was no difference in the distance traveled to an ART facility between those with suppressed and unsuppressed VLs (5.26 km vs. 5.27 km, p=0.650). Conclusions—Distance traveled to HIV clinics was increased with higher socioeconomic status, suggesting that wealthier individuals exercise greater choice. However, distance traveled did not vary by those who were or were not virally suppressed.
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    Migration, hotspots, and dispersal of HIV infection in Rakai, Uganda
    (Nature Communications, 2020) Grabowski, Mary Kate; Lessler, Justin; Bazaale, Jeremiah; Nabukalu, Dorean; Nankinga, Justine; Nantume, Betty; Ssekasanvu, Joseph; Reynolds, Steven J.; Ssekubugu, Robert; Nalugoda, Fred; Kigozi, Godfrey; Kagaayi, Joseph; Santelli, John S.; Kennedy, Caitlin; Wawer, Maria J.; Serwadda, David; Chang, Larry W.; Gray, Ronald H.
    HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas.
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    Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda
    (The Lancet HIV, 2020) Ratmann, Oliver; Kagaayi, Joseph; Hall, Matthew; Golubchick, Tanya; Kigozi, Godfrey; Nakigozi, Gertrude; Bazaale, Jeremiah; Kalibbala, Sarah; Nalugoda, Fred; Ssekubugu, Robert; Serwadda, David
    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.