Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda

Oliver Ratmann; Joseph Kagaayi; Matthew Hall; Tanya Golubchick; Godfrey Kigozi; Xiaoyue Xi; Chris Wymant; Gertrude Nakigozi; Lucie Abeler-Dörner; David Bonsall; Astrid Gall; Anne Hoppe; Paul Kellam; Jeremiah Bazaale; Sarah Kalibbala; Oliver Laeyendecker; Justin Lessler; Fred Nalugoda; Larry W Chang; Tulio de Oliveira; Deenan Pillay; Thomas C Quinn; Steven J Reynolds; Simon E F Spencer; Robert Ssekubugu; David Serwadda; Maria J Wawer; Ronald H Gray; Christophe Fraser; M Kate Grabowski; Helen Ayles; Rory Bowden; Vincent Calvez; Myron Cohen; Anne Dennis; Max Essex; Sarah Fidler; Dan Frampton; Richard Hayes; Josh Herbeck; Pontiano Kaleebu; Cissy Kityo; Jairam Lingappa; Vladimir Novitsky; Nick Paton; Andrew Rambaut; Janet Seeley; Deogratius Ssemwanga; Frank Tanser; Tom Lutalo; Ronald Galiwango; Fred Makumbi; Nelson Sewankambo; Dorean Nabukalu; Anthony Ndyanabo; Joseph Ssekasanvu; Hadijja Nakawooya; Jessica Nakukumba; Grace Kigozi; Betty Nantume; Nampijja Resty; Jedidah Kambasu; Margaret Nalugemwa; Regina Nakabuye; Lawrence Ssebanobe; Justine Nankinga; Adrian Kayiira; Gorreth Nanfuka; Ruth Ahimbisibwe; Stephen Tomusange; Ronald Galiwango; Margaret Nakalanzi; Joseph Otobi; Denis Ankunda; Joseph Ssembatya; John Ssemanda; Emmanuel Kato; Robert Kairania; Alice Kisakye; James Batte; James Ludigo; Abisagi Nampijja; Steven Watya; Kighoma Nehemia; Sr. Margaret Anyokot; Joshua Mwinike; George Kibumba; Paschal Ssebowa; George Mondo; Francis Wasswa; Agnes Nantongo; Rebecca Kakembo; Josephine Galiwango; Geoffrey Ssemango; Andrew Redd; John Santelli; Caitlin Kennedy; Jennifer Wagman; Aaron Tobian

doi:10.1016/S2352-3018(19)30378-9

Journal Articles The Lancet HIV Year : 2020

Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda

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Oliver Ratmann

Function : Author

Department of Mathematics [Imperial College London]

Joseph Kagaayi

Function : Author

Rakai Health Sciences Program

Matthew Hall

Function : Author

Nuffield Department of Medicine [Oxford, UK]

Tanya Golubchick

Function : Author

Nuffield Department of Medicine [Oxford, UK]

Godfrey Kigozi

Function : Author

Rakai Health Sciences Program

Xiaoyue Xi

Function : Author

Department of Mathematics [Imperial College London]

Chris Wymant

Function : Author

Nuffield Department of Medicine [Oxford, UK]

Gertrude Nakigozi

Function : Author

Rakai Health Sciences Program

Lucie Abeler-Dörner

Function : Author

Nuffield Department of Medicine [Oxford, UK]

David Bonsall

Function : Author

Nuffield Department of Medicine [Oxford, UK]

Astrid Gall

Function : Author

European Molecular Biology Laboratory [Hinxton]

European Bioinformatics Institute [Hinxton]

Anne Hoppe

Function : Author

University College of London [London]

Paul Kellam

Function : Author

Imperial College London

Jeremiah Bazaale

Function : Author

Rakai Health Sciences Program

Sarah Kalibbala

Function : Author

Rakai Health Sciences Program

Oliver Laeyendecker

Function : Author

Johns Hopkins University School of Medicine [Baltimore]

National Institute of Allergy and Infectious Diseases [Bethesda]

Justin Lessler

Function : Author

Johns Hopkins Bloomberg School of Public Health [Baltimore]

Fred Nalugoda

Function : Author

Rakai Health Sciences Program

Larry W Chang

Function : Author

Johns Hopkins University School of Medicine [Baltimore]

Rakai Health Sciences Program

Johns Hopkins Bloomberg School of Public Health [Baltimore]

Tulio de Oliveira

Function : Author

University of KwaZulu-Natal [Durban, Afrique du Sud]

Deenan Pillay

Function : Author

University College of London [London]

Thomas C Quinn

Function : Author

Johns Hopkins University School of Medicine [Baltimore]

National Institute of Allergy and Infectious Diseases [Bethesda]

Steven J Reynolds

Function : Author

Rakai Health Sciences Program

Johns Hopkins University School of Medicine [Baltimore]

National Institute of Allergy and Infectious Diseases [Bethesda]

Simon E F Spencer

Function : Author

Department of Statistics [Warwick]

Robert Ssekubugu

Function : Author

Rakai Health Sciences Program

David Serwadda

Function : Author

Rakai Health Sciences Program

Makerere University [Kampala, Ouganda]

Maria J Wawer

Function : Author

Rakai Health Sciences Program

Johns Hopkins Bloomberg School of Public Health [Baltimore]

Ronald H Gray

Function : Author

Rakai Health Sciences Program

Johns Hopkins Bloomberg School of Public Health [Baltimore]

Christophe Fraser

Function : Author

Nuffield Department of Medicine [Oxford, UK]

M Kate Grabowski

Function : Author

Rakai Health Sciences Program

Johns Hopkins University School of Medicine [Baltimore]

University of KwaZulu-Natal [Durban, Afrique du Sud]

Helen Ayles

Function : Author

London School of Hygiene and Tropical Medicine

Rory Bowden

Function : Author

University of Oxford

Vincent Calvez

Function : Author
PersonId : 11087
IdHAL : vincent-calvez
ORCID : 0000-0002-3674-1965
IdRef : 122596943

École normale supérieure de Lyon

Stratégies thérapeutiques contre l'infection VIH et les maladies virales associées [iPLesp]

Myron Cohen

Function : Author

University of North Carolina [Chapel Hill]

Anne Dennis

Function : Author

University of North Carolina [Chapel Hill]

Max Essex

Function : Author

Harvard University

Sarah Fidler

Function : Author

Dan Frampton

Function : Author

Richard Hayes

Function : Author

Josh Herbeck

Function : Author

Pontiano Kaleebu

Function : Author

Cissy Kityo

Function : Author

Jairam Lingappa

Function : Author

Vladimir Novitsky

Function : Author

Nick Paton

Function : Author

Andrew Rambaut

Function : Author

Janet Seeley

Function : Author

Deogratius Ssemwanga

Function : Author

Frank Tanser

Function : Author

Tom Lutalo

Function : Author

Ronald Galiwango

Function : Author

Fred Makumbi

Function : Author

Nelson Sewankambo

Function : Author

Dorean Nabukalu

Function : Author

Anthony Ndyanabo

Function : Author

Joseph Ssekasanvu

Function : Author

Hadijja Nakawooya

Function : Author

Jessica Nakukumba

Function : Author

Grace Kigozi

Function : Author

Betty Nantume

Function : Author

Nampijja Resty

Function : Author

Jedidah Kambasu

Function : Author

Margaret Nalugemwa

Function : Author

Regina Nakabuye

Function : Author

Lawrence Ssebanobe

Function : Author

Justine Nankinga

Function : Author

Adrian Kayiira

Function : Author

Gorreth Nanfuka

Function : Author

Ruth Ahimbisibwe

Function : Author

Stephen Tomusange

Function : Author

Ronald Galiwango

Function : Author

Margaret Nakalanzi

Function : Author

Joseph Otobi

Function : Author

Denis Ankunda

Function : Author

Joseph Ssembatya

Function : Author

John Ssemanda

Function : Author

Emmanuel Kato

Function : Author

Robert Kairania

Function : Author

Alice Kisakye

Function : Author

James Batte

Function : Author

James Ludigo

Function : Author

Abisagi Nampijja

Function : Author

Steven Watya

Function : Author

Kighoma Nehemia

Function : Author

Sr. Margaret Anyokot

Function : Author

Joshua Mwinike

Function : Author

George Kibumba

Function : Author

Paschal Ssebowa

Function : Author

George Mondo

Function : Author

Francis Wasswa

Function : Author

Agnes Nantongo

Function : Author

Rebecca Kakembo

Function : Author

Josephine Galiwango

Function : Author

Geoffrey Ssemango

Function : Author

Andrew Redd

Function : Author

John Santelli

Function : Author

Caitlin Kennedy

Function : Author

Jennifer Wagman

Function : Author

Aaron Tobian

Function : Author

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. 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.

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Life Sciences [q-bio]

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https://hal.sorbonne-universite.fr/hal-03728140

Submitted on : Wednesday, July 20, 2022-9:58:58 AM

Last modification on : Monday, November 25, 2024-2:50:03 PM

Long-term archiving on : Friday, October 21, 2022-6:26:21 PM

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hal-03728140 , version 1 (20-07-2022)

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HAL Id : hal-03728140 , version 1
DOI : 10.1016/S2352-3018(19)30378-9
PUBMED : 31953184
PUBMEDCENTRAL : PMC7167508

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Oliver Ratmann, Joseph Kagaayi, Matthew Hall, Tanya Golubchick, Godfrey Kigozi, et al.. Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda. The Lancet HIV, 2020, 7 (3), pp.e173-e183. ⟨10.1016/S2352-3018(19)30378-9⟩. ⟨hal-03728140⟩

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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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