Browsing by Author "Lessler, Justin"

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    Heterogeneity of the HIV epidemic in agrarian, trading, and fi shing communities in Rakai, Uganda: an observational epidemiological study
    (The lancet HIV, 2016) Chang, Larry W.; Grabowsk, Mary K.; Ssekubugu, Robert; Nalugoda, Fred; Kigozi, Godfrey; Nantume, Betty; Lessler, Justin; Moore, Sean M.; Quinn, Thomas C.; Reynolds, Steven J.; Gray, Ronald H.; Serwadda, David; Wawer, Maria J.
    Understanding the extent to which HIV burden diff ers across communities and the drivers of lo cal disparities is crucial for an eff ective and targeted HIV response. We assessed community-level variations in HIV prevalence, risk factors, and treatment and prevention service uptake in Rakai, Uganda. Methods The Rakai Community Cohort Study (RCCS) is an open, population-based cohort of people aged 15–49 years in 40 communities. Participants are HIV tested and interviewed to obtain sociodemographic, behavioural, and health information. RCCS data from Aug 10, 2011, to May 30, 2013, were used to classify communities as agrarian (n=27), trading (n=9), or lakeside fi shing sites (n=4). We mapped HIV prevalence with Bayesian methods, and characterised variability across and within community classifi cations. We also assessed diff erences in HIV risk factors and uptake of antiretroviral therapy and male circumcision between community types. Findings 17 119 individuals were included, 9215 (54%) of whom were female. 9931 participants resided in agrarian, 3318 in trading, and 3870 in fi shing communities. Median HIV prevalence was higher in fi shing communities (42%, range 38–43) than in trading (17%, 11–21) and agrarian communities (14%, 9–26). Antiretroviral therapy use was signifi cantly lower in both men and women in fi shing communities than in trading (age-adjusted prevalence risk ratio in men 0·64, 95% CI 0·44–0·97; women 0·53, 0·42–0·66) and agrarian communities (men 0·55, 0·42–0·72; women 0·65, 0·54–0·79), as was circumcision coverage among men (vs trading 0·48, 0·42–0·55; vs agrarian 0·64, 0·56–0·72). Self-reported risk behaviours were signifi cantly higher in men than in women and in fi shing communities than in other community types. Interpretation Substantial heterogeneity in HIV prevalence, risk factors, and service uptake in Rakai, Uganda, emphasises the need for local surveillance and the design of targeted HIV responses. High HIV burden, risk behaviours, and low use of combination HIV prevention in fi shing communities make these populations a priority for intervention. Funding National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Development, and the National Institute for Allergy and Infectious Diseases Division of Intramural Research, National Institutes of Health; the Bill & Melinda Gates Foundation; and the Johns Hopkins University Center for AIDS Research.
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    HIV epidemiologic trends among occupational groups in Rakai, Uganda: A population-based longitudinal study, 1999–2016
    (Public Library of Science, 2024-02-20) Popoola, Victor O; Kagaayi, Joseph; Ssekasanvu, Joseph; Ssekubugu, Robert; Kigozi, Grace; Ndyanabo, Anthony; Nalugoda, Fred; Chang, Larry W; Lutalo, Tom; Tobian, Aaron A. R; Kabatesi, Donna; Alamo, Stella; Mills, Lisa A; Kigozi, Godfrey; Wawer, Maria J; Santelli, John; Gray, Ronald H; Reynolds, Steven J; Serwadda, David; Lessler, Justin; Grabowski, M. Kate
    Certain occupations have been associated with heightened risk of HIV acquisition and spread in sub-Saharan Africa, including female bar and restaurant work and male transportation work. However, data on changes in population prevalence of HIV infection and HIV incidence within occupations following mass scale-up of African HIV treatment and prevention programs is very limited. We evaluated prospective data collected between 1999 and 2016 from the Rakai Community Cohort Study, a longitudinal population-based study of 15- to 49-year-old persons in Uganda. Adjusted prevalence risk ratios for overall, treated, and untreated, prevalent HIV infection, and incidence rate ratios for HIV incidence with 95% confidence intervals were estimated using Poisson regression to assess changes in HIV outcomes by occupation. Analyses were stratified by gender. There were 33,866 participants, including 19,113 (56%) women. Overall, HIV seroprevalence declined in most occupational subgroups among men, but increased or remained mostly stable among women. In contrast, prevalence of untreated HIV substantially declined between 1999 and 2016 in most occupations, irrespective of gender, including by 70% among men (12.3 to 4.2%; adjPRR = 0.30; 95%CI:0.23–0.41) and by 78% among women (14.7 to 4.0%; adjPRR = 0.22; 95%CI:0.18–0.27) working in agriculture, the most common self-reported primary occupation. Exceptions included men working in transportation. HIV incidence similarly declined in most occupations, but there were no reductions in incidence among female bar and restaurant workers, women working in local crafts, or men working in transportation. In summary, untreated HIV infection and HIV incidence have declined within most occupational groups in Uganda. However, women working in bars/restaurants and local crafts and men working in transportation continue to have a relatively high burden of untreated HIV and HIV incidence, and as such, should be considered priority populations for HIV programming.
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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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    Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 2020
    (Emerging infectious diseases, 2021) Wiens, Kirsten E.; Mawien, Pinyi Nyimol; Rumunu, John; Slater, Damien; Jones, Forrest K.; Moheed, Serina; isch, Andrea Cafl; Bior, Bior K.; Jacob, Iboyi Amanya; Lako, Richard Lino; Guyo, Argata Guracha; Olu, Olushayo Oluseun; Maleghemi, Sylvester; Baguma, Andrew; Hassen, Juma John; Baya, Sheila K.; Deng, Lul; Lessler, Justin; Demby, Maya N.; Sanchez, Vanessa; Mills, Rachel; Fraser, Clare; Charles, Richelle C.; Harris, Jason B.; Azman, Andrew S.; Wamala, Joseph F.
    Relatively few coronavirus disease cases and deaths have been reported from sub-Saharan Africa, although the extent of its spread remains unclear. During August 10–September 11, 2020, we recruited 2,214 participants for a representative household-based cross-sectional serosurvey in Juba, South Sudan. We found 22.3% of participants had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor binding domain IgG titers above prepandemic levels. After accounting for waning antibody levels, age, and sex, we estimated that 38.3% (95% credible interval 31.8%–46.5%) of the population had been infected with SARS-CoV-2. At this rate, for each PCR–confirmed SARS-CoV-2 infection reported by the Ministry of Health, 103 (95% credible interval 86–126) infections would have been unreported, meaning SARS-CoV-2 has likely spread extensively within Juba. We also found differences in background reactivity in Juba compared with Boston, Massachusetts, USA, where the immunoassay was validated. Our findings underscore the need to validate serologic tests in sub-Saharan Africa populations.