Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
The Lancet HIV
Abstract
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.
Description
Keywords
HIV transmission flow, Hotspots, Communities, Uganda
Citation
Ratmann, O., Kagaayi, J., Hall, M., Golubchick, T., Kigozi, G., Xi, X., ... & Tobian, A. (2020). Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda. The Lancet HIV. https://doi.org/10.1016/ S2352-3018(19)30378-9