The Role of Viral Introductions in Sustaining Community-Based HIV Epidemics in Rural Uganda: Evidence from Spatial Clustering, Phylogenetics, and Egocentric Transmission Models: e1001610
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 s...
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| Veröffentlicht in: | PLoS medicine 2014-03, Vol.11 (3) |
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| creator | Grabowski, Mary K Lessler, Justin Redd, Andrew D Kagaayi, Joseph Laeyendecker, Oliver Ndyanabo, Anthony Nelson, Martha I Cummings, Derek AT Bwanika, John Baptiste Mueller, Amy C Reynolds, Steven J Munshaw, Supriya Ray, Stuart C Lutalo, Tom Manucci, Jordyn Tobian, Aaron AR Chang, Larry W Beyrer, Chris Jennings, Jacky M Nalugoda, Fred Serwadda, David Wawer, Maria J Quinn, Thomas C Gray, Ronald H Program, Rakai HealthSciences |
| 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 |
| doi_str_mv | 10.1371/journal.pmed.1001610 |
| format | Article |
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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</description><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1001610</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>HIV ; Households ; Human immunodeficiency virus ; Phylogenetics ; Sexual behavior ; Sexually transmitted diseases ; STD</subject><ispartof>PLoS medicine, 2014-03, Vol.11 (3)</ispartof><rights>2014 Garbowski et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Grabowski MK, Lessler J, Redd AD, Kagaayi J, Laeyendecker O, et al. (2014) The Role of Viral Introductions in Sustaining Community-Based HIV Epidemics in Rural Uganda: Evidence from Spatial Clustering, Phylogenetics, and Egocentric Transmission Models. PLoS Med 11(3): e1001610. doi:10.1371/journal.pmed.1001610</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,860,27903,27904</link.rule.ids></links><search><creatorcontrib>Grabowski, Mary K</creatorcontrib><creatorcontrib>Lessler, Justin</creatorcontrib><creatorcontrib>Redd, Andrew D</creatorcontrib><creatorcontrib>Kagaayi, Joseph</creatorcontrib><creatorcontrib>Laeyendecker, Oliver</creatorcontrib><creatorcontrib>Ndyanabo, Anthony</creatorcontrib><creatorcontrib>Nelson, Martha I</creatorcontrib><creatorcontrib>Cummings, Derek AT</creatorcontrib><creatorcontrib>Bwanika, John Baptiste</creatorcontrib><creatorcontrib>Mueller, Amy C</creatorcontrib><creatorcontrib>Reynolds, Steven J</creatorcontrib><creatorcontrib>Munshaw, Supriya</creatorcontrib><creatorcontrib>Ray, Stuart C</creatorcontrib><creatorcontrib>Lutalo, Tom</creatorcontrib><creatorcontrib>Manucci, Jordyn</creatorcontrib><creatorcontrib>Tobian, Aaron AR</creatorcontrib><creatorcontrib>Chang, Larry W</creatorcontrib><creatorcontrib>Beyrer, Chris</creatorcontrib><creatorcontrib>Jennings, Jacky M</creatorcontrib><creatorcontrib>Nalugoda, Fred</creatorcontrib><creatorcontrib>Serwadda, David</creatorcontrib><creatorcontrib>Wawer, Maria J</creatorcontrib><creatorcontrib>Quinn, Thomas C</creatorcontrib><creatorcontrib>Gray, Ronald H</creatorcontrib><creatorcontrib>Program, Rakai HealthSciences</creatorcontrib><title>The Role of Viral Introductions in Sustaining Community-Based HIV Epidemics in Rural Uganda: Evidence from Spatial Clustering, Phylogenetics, and Egocentric Transmission Models: e1001610</title><title>PLoS medicine</title><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</description><subject>HIV</subject><subject>Households</subject><subject>Human immunodeficiency virus</subject><subject>Phylogenetics</subject><subject>Sexual behavior</subject><subject>Sexually transmitted diseases</subject><subject>STD</subject><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNqNkEtLw0AUhQdRsD7-gYsLbts405jEuDSktAtB2thtGZKbdMo84jyE_it_oqPUvat74Zz7cc4l5I7RhKUFeziYYDWXyaiwSxilLGf0jExY9ljOWF7k53_7vCguyZVzB0rnJS3phHw1e4S1kQimh62wXMJKe2u60HphtAOhYROc50ILPUBllApa-OPshTvsYLnaQj2KDpVof73r8IN4H7ju-DPUn1HSLUJvjYLNyL2IaiUjEG3kTeFtf5RmQI0-AqYQz6AeTIsxg2ihsVw7JZyLUeDVdCjdDbnouXR4e5rX5H5RN9VyNlrzEdD53ekbbseyWJ49pUWW_s_1DUICa0A</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Grabowski, Mary K</creator><creator>Lessler, Justin</creator><creator>Redd, Andrew D</creator><creator>Kagaayi, Joseph</creator><creator>Laeyendecker, Oliver</creator><creator>Ndyanabo, Anthony</creator><creator>Nelson, Martha I</creator><creator>Cummings, Derek AT</creator><creator>Bwanika, John Baptiste</creator><creator>Mueller, Amy C</creator><creator>Reynolds, Steven J</creator><creator>Munshaw, Supriya</creator><creator>Ray, Stuart C</creator><creator>Lutalo, Tom</creator><creator>Manucci, Jordyn</creator><creator>Tobian, Aaron AR</creator><creator>Chang, Larry W</creator><creator>Beyrer, Chris</creator><creator>Jennings, Jacky M</creator><creator>Nalugoda, Fred</creator><creator>Serwadda, David</creator><creator>Wawer, Maria J</creator><creator>Quinn, Thomas C</creator><creator>Gray, Ronald H</creator><creator>Program, Rakai HealthSciences</creator><general>Public Library of Science</general><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20140301</creationdate><title>The Role of Viral Introductions in Sustaining Community-Based HIV Epidemics in Rural Uganda: Evidence from Spatial Clustering, Phylogenetics, and Egocentric Transmission Models</title><author>Grabowski, Mary K ; Lessler, Justin ; Redd, Andrew D ; Kagaayi, Joseph ; Laeyendecker, Oliver ; Ndyanabo, Anthony ; Nelson, Martha I ; Cummings, Derek AT ; Bwanika, John Baptiste ; Mueller, Amy C ; Reynolds, Steven J ; Munshaw, Supriya ; Ray, Stuart C ; Lutalo, Tom ; Manucci, Jordyn ; Tobian, Aaron AR ; Chang, Larry W ; Beyrer, Chris ; Jennings, Jacky M ; Nalugoda, Fred ; Serwadda, David ; Wawer, Maria J ; Quinn, Thomas C ; Gray, Ronald H ; Program, Rakai HealthSciences</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-proquest_journals_15167183753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>HIV</topic><topic>Households</topic><topic>Human immunodeficiency virus</topic><topic>Phylogenetics</topic><topic>Sexual behavior</topic><topic>Sexually transmitted diseases</topic><topic>STD</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grabowski, Mary K</creatorcontrib><creatorcontrib>Lessler, Justin</creatorcontrib><creatorcontrib>Redd, Andrew D</creatorcontrib><creatorcontrib>Kagaayi, Joseph</creatorcontrib><creatorcontrib>Laeyendecker, Oliver</creatorcontrib><creatorcontrib>Ndyanabo, Anthony</creatorcontrib><creatorcontrib>Nelson, Martha I</creatorcontrib><creatorcontrib>Cummings, Derek AT</creatorcontrib><creatorcontrib>Bwanika, John Baptiste</creatorcontrib><creatorcontrib>Mueller, Amy C</creatorcontrib><creatorcontrib>Reynolds, Steven J</creatorcontrib><creatorcontrib>Munshaw, Supriya</creatorcontrib><creatorcontrib>Ray, Stuart C</creatorcontrib><creatorcontrib>Lutalo, Tom</creatorcontrib><creatorcontrib>Manucci, Jordyn</creatorcontrib><creatorcontrib>Tobian, Aaron AR</creatorcontrib><creatorcontrib>Chang, Larry W</creatorcontrib><creatorcontrib>Beyrer, Chris</creatorcontrib><creatorcontrib>Jennings, Jacky M</creatorcontrib><creatorcontrib>Nalugoda, Fred</creatorcontrib><creatorcontrib>Serwadda, David</creatorcontrib><creatorcontrib>Wawer, Maria J</creatorcontrib><creatorcontrib>Quinn, Thomas C</creatorcontrib><creatorcontrib>Gray, Ronald H</creatorcontrib><creatorcontrib>Program, Rakai HealthSciences</creatorcontrib><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grabowski, Mary K</au><au>Lessler, Justin</au><au>Redd, Andrew D</au><au>Kagaayi, Joseph</au><au>Laeyendecker, Oliver</au><au>Ndyanabo, Anthony</au><au>Nelson, Martha I</au><au>Cummings, Derek AT</au><au>Bwanika, John Baptiste</au><au>Mueller, Amy C</au><au>Reynolds, Steven J</au><au>Munshaw, Supriya</au><au>Ray, Stuart C</au><au>Lutalo, Tom</au><au>Manucci, Jordyn</au><au>Tobian, Aaron AR</au><au>Chang, Larry W</au><au>Beyrer, Chris</au><au>Jennings, Jacky M</au><au>Nalugoda, Fred</au><au>Serwadda, David</au><au>Wawer, Maria J</au><au>Quinn, Thomas C</au><au>Gray, Ronald H</au><au>Program, Rakai HealthSciences</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Role of Viral Introductions in Sustaining Community-Based HIV Epidemics in Rural Uganda: Evidence from Spatial Clustering, Phylogenetics, and Egocentric Transmission Models: e1001610</atitle><jtitle>PLoS medicine</jtitle><date>2014-03-01</date><risdate>2014</risdate><volume>11</volume><issue>3</issue><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>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</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><doi>10.1371/journal.pmed.1001610</doi><oa>free_for_read</oa></addata></record> |
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| subjects | HIV Households Human immunodeficiency virus Phylogenetics Sexual behavior Sexually transmitted diseases STD |
| title | The Role of Viral Introductions in Sustaining Community-Based HIV Epidemics in Rural Uganda: Evidence from Spatial Clustering, Phylogenetics, and Egocentric Transmission Models: e1001610 |
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