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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The Role of Viral Introductions in Sustaining Community-Based HIV Epidemics in Rural Uganda: Evidence from Spatial Clustering, Phylogenetics, and Egocentric Transmission Models
PLoS Medicine, Volume 11, No. 3, Article e1001610, Year 2014
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Description
Background:It is often assumed that local sexual networks play a dominant role in HIV spread in sub-Saharan Africa. The aim of this study was to determine the extent to which continued HIV transmission in rural communities-home to two-thirds of the African population-is driven by intra-community sexual networks versus viral introductions from outside of communities.Methods and Findings:We analyzed the spatial dynamics of HIV transmission in rural Rakai District, Uganda, using data from a cohort of 14,594 individuals within 46 communities. We applied spatial clustering statistics, viral phylogenetics, and probabilistic transmission models to quantify the relative contribution of viral introductions into communities versus community- and household-based transmission to HIV incidence. Individuals living in households with HIV-incident (n = 189) or HIV-prevalent (n = 1,597) persons were 3.2 (95% CI: 2.7-3.7) times more likely to be HIV infected themselves compared to the population in general, but spatial clustering outside of households was relatively weak and was confined to distances <500 m. Phylogenetic analyses of gag and env genes suggest that chains of transmission frequently cross community boundaries. A total of 95 phylogenetic clusters were identified, of which 44% (42/95) were two individuals sharing a household. Among the remaining clusters, 72% (38/53) crossed community boundaries. Using the locations of self-reported sexual partners, we estimate that 39% (95% CI: 34%-42%) of new viral transmissions occur within stable household partnerships, and that among those infected by extra-household sexual partners, 62% (95% CI: 55%-70%) are infected by sexual partners from outside their community. These results rely on the representativeness of the sample and the quality of self-reported partnership data and may not reflect HIV transmission patterns outside of Rakai.Conclusions:Our findings suggest that HIV introductions into communities are common and account for a significant proportion of new HIV infections acquired outside of households in rural Uganda, though the extent to which this is true elsewhere in Africa remains unknown. Our results also suggest that HIV prevention efforts should be implemented at spatial scales broader than the community and should target key populations likely responsible for introductions into communities.Please see later in the article for the Editors' Summary. © 2014 Garbowski et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s001.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s002.tif
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https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s005.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s006.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s007.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s008.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s009.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s010.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s011.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s012.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s013.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s014.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s015.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s016.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s017.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s018.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s019.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s020.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s021.docx
https://efashare.b-cdn.net/share/pmc/articles/PMC3942316/bin/pmed.1001610.s022.docx
Authors & Co-Authors
Grabowski, Mary Kate
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Lessler, Justin T.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Redd, Andrew D.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Kagaayi, Joseph
Uganda, Kalisizo
Rakai Health Sciences Program
Laeyendecker, Oliver B.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
United States, Baltimore
Johns Hopkins University
Ndyanabo, Anthony
Uganda, Kalisizo
Rakai Health Sciences Program
Nelson, Martha Irene
United States, Bethesda
National Institutes of Health Nih
Cummings, Derek A.T.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Bwanika, John Baptist
Uganda, Kalisizo
Rakai Health Sciences Program
Mueller, Amy C.
United States, Baltimore
Johns Hopkins University
Reynolds, Steven James
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Uganda, Kalisizo
Rakai Health Sciences Program
United States, Baltimore
Johns Hopkins University
Munshaw, Supriya
United States, Baltimore
Johns Hopkins University
Ray, Stuart C.
United States, Baltimore
Johns Hopkins University
Lutalo, Tom
Uganda, Kalisizo
Rakai Health Sciences Program
Manucci, Jordyn L.
United States, Baltimore
Johns Hopkins University
Tobian, Aaron A.R.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Uganda, Kalisizo
Rakai Health Sciences Program
United States, Baltimore
Johns Hopkins University
Chang, Larry William
Uganda, Kalisizo
Rakai Health Sciences Program
United States, Baltimore
Johns Hopkins University
Beyrer, Chris C.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Jennings, Jacky M.
United States, Baltimore
Johns Hopkins University
Nalugoda, Fred Kakaire
Uganda, Kalisizo
Rakai Health Sciences Program
Serwadda, David Musoke
Uganda, Kalisizo
Rakai Health Sciences Program
Uganda, Kampala
Makerere University
Wawer, Maria J.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Uganda, Kalisizo
Rakai Health Sciences Program
Quinn, Thomas Charles
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
United States, Baltimore
Johns Hopkins University
Gray, Ronald H.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Uganda, Kalisizo
Rakai Health Sciences Program
Statistics
Citations: 128
Authors: 24
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pmed.1001610
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Uganda